Association of Expanded Health Care Networks With Utilization Among Veterans Affairs Enrollees

Abstract

IMPORTANCEHealth insurers alter the size of their networks, offering lower premiums in exchange for a more limited set of care choices. However, little is known about the association of network size with health care utilization and outcomes, particularly outside of the context of private insurance plans. OBJECTIVE To evaluate changes in health care utilization after an expansion in the Veterans Affairs Health Care System (VA) health care network. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included individuals enrolled in the VA from 2015 to 2018. Considering that the health care network expansion only affected a portion of enrollees, only those who lived between 20 and 60 miles from a VA facility were included. Data analysis was conducted from September 2020 to February 2021.EXPOSURES Individuals who lived 40 or more miles away from a VA facility were automatically eligible for an expanded health care network through non-VA practitioners (VA community care); those living less than 40 miles away from a VA facility were not automatically eligible. MAIN OUTCOMES AND MEASURES A regression discontinuity analysis of individuals who becameeligible for an expanded network based on geographic residence was performed. Inpatient and outpatient utilization rates per VA enrollee during the study period, with utilization differentiated by whether services were provided by a VA or non-VA practitioner, were calculated. RESULTSThe study included more than 2.7 million unique individuals whose characteristics largely reflected the demographic characteristics of the VA system (mean [SD] age, 62 [17] years; 2 589 252 [90%] men; 282 168 [10%] Black; 2 203 352 [77%] White). Patient characteristics (age, race, and comorbidities) did not vary significantly by eligibility status. Outpatient utilization was 3.2% higher (95% CI, 1.0% to 5.3%) among those with access to an expanded network. Increased utilization was most pronounced among those with a higher VA disability rating (3.1%; 95% CI, 0.5% to 5.7%) and among younger individuals without service-connected disabilities (7.0%, 95% CI, 1.7% to 12.3%).There was no evidence of changes to inpatient utilization (1.2%; 95% CI. -2.5% to 4.9%; P = .37) for those with access to the expanded network. CONCLUSIONS AND RELEVANCEIn this study, expanded network access was associated with increased total health care utilization among affected enrollees in the VA. Understanding how network size affects utilization is immediately informative for the VA, but it can also help to guide policies for insurance markets.

Sex differences in the relation between military sexual trauma and risk for alcohol misuse among U.S. Army Reserve and National Guard soldiers

“…Additionally, more than half of eligible veterans do not utilize VHA benefits (U.S. Department of Veterans Affairs, National Center for Veterans Analysis and Statistics, 2020). Even among eligible veterans who do utilize VHA benefits, the VA Choice Act (2014) led to an increase in veterans' access to and utilization of civilian healthcare providers (Rose et al, 2021). This use is expected to continue to grow with the passing of the VA MISSION Act (2018), which further expands veterans' ability to seek care outside the VHA system.…”

“…However, these findings cannot speak to the nature of problematic use outside clinical diagnoses and treatment-seeking VHA populations. Given the eligibility limitations for VHA care for many reserve soldiers, and increasing rates of seeking care through civilian providers (Rose et al, 2021), further examination of these potential connections is warranted.…”

Costs of Endoscopic vs Open Vein Harvesting for Coronary Artery Bypass Grafting

“…Subtotals were based on the inpatient treating specialties and outpatient clinic. 11,12 We then examined VA-purchased care, which has expanded since the passage of the Veterans Access, Choice, and Accountability Act (commonly referred to as the Choice Act) 13,14 and the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. 13,15 For follow-up care, we also examined VA health care utilization; this measure can sometimes provide insights into mechanisms that may underlie any cost differences.…”

Veterans Health Administration enrollees' choice of care setting relates to the expansion of care options: Evidence from screening colonoscopies before and after the MISSION Act

“…6 Prior work has documented increases in both purchased and overall utilization in the period following the Choice Act as well as improvements in access measures. [7][8][9][10][11][12] By making care more accessible, the Choice Act and subsequent reforms to increase non-VHA options may also influence where eligible enrollees choose to receive care.…”