With the enactment of the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) (?Veterans Choice Act? or ?Choice?), aimed to improve access to timely, high-quality health care for Veterans, implementation of the new community care networks was rapid with limited time for transitions and development of best care coordination practices. With the further expansion of Choice to include all VA community care, that is Choice plus the traditional ?fee-basis care?, and in 98 community care markets in 2018, the Office of Community Care (OCC) has a daunting responsibility. With an expanded implementation comes increased need for enhanced care coordination with community networks and providers to improve the Veteran experience, access, and timeliness of care. Attention to local and national organizational level needs during the expansion are important for successful deployment and management of practice variation. Identifying specific needs to inform resource planning and to evaluate implementation of the program is vital to know if the goals of the expanded Community Care program are being met. Building on our planning grant partnership with OCC, we will continue our partnership to support program evaluation. Focused on the RFA Care Coordination track, we will address the following Aims: 1. Assess and summarize approaches used for regional and local VA facility implementation of quality, safety and value governance and monitoring under the Community Care program, including patient and provider perspectives. 2. Identify and evaluate organizational and health information exchange needs to support clinical care coordination and quality monitoring in the expanded Community Care program. 3. Develop and apply methods to evaluate and compare process and outcomes-based quality measures for primary care and specialty care among select high volume and high cost procedures under the Community Care program with those veterans receiving care exclusively in the VA. 4. Develop and apply methods to evaluate and compare the extent of overuse and/or duplication of services for veterans authorized for Community Care for primary care and specialty care among select high volume and high cost procedures with those veterans receiving care exclusively in the VA. We will use a mixed methods approach, with emphasis on primary care and specialty care across domains of care (e.g., inpatient, outpatient, and pharmacy). Assessing the new processes being put in place for quality governance, integrated care management, and health information exchange will enable greater understanding of areas that work well and that could be employed at other facilities (Aims 1&2). Planning a quasi-experimental design with a concurrent control group will enable examination of the effects of the expanded Community Care program on access to care, quality of care, and duplication of services provided compared to services provided at VA facilities (Aims 3&4). With a three-year project timeline, our evaluation plans are well specified, yet can be flexible as the Community Care program implementation plans evolve. Our experienced research team, including Center of Innovation and VA Information Resource Center based investigators and staff, will leverage current measurement efforts and explore new outcomes-based quality measures and standardized episodes with consultation from the VA Reporting, Analytics, Performance, Improvement & Deployment Program and the National Committee for Quality Assurance. An Advisory Committee of experts in clinical guidelines, quality measurement and health information exchange will advise on additional data sources and measurement strategies. We will collaborate with the other research teams and the Partnered Evidenced Based Policy Evaluation Resource Center. These partnerships and our research experience will support our efforts to inform implementation and evaluation of expanded VA Community Care.
With the rapid expansion of the VA Community Care program, aimed to improve access to timely, high- quality health care for Veterans, support for implementation and evaluation of the new Community Care program is needed. Building on our planning grant partnership with the Office of Community Care, our experienced research team will continue to support implementation and program evaluation with a three-year project plan. We will use a mixed methods approach, with emphasis on care coordination for primary care and specialty care across inpatient and outpatient care. We will assess new processes being put in place for quality governance, integrated care management, and health information exchange. We will examine the impact of the expanded Community Care program on access to care, quality of care, and duplication of services provided compared to services provided at VA facilities. Established partnerships with internal and external stakeholders, and with clinical, care coordination, and quality experts, will support our efforts. 1
