How Did Veterans’ Reliance on Veterans Health Administration Outpatient Care Change After Expansion of the Veterans Community Care Program?

Abstract

Background: The Veterans Community Care Program (VCCP) aims to address access constraints in the Veterans Health Administration (VA) by reimbursing care from non-VA community providers. Little existing research explores how veterans’ choice of VA versus VCCP providers has evolved as a significant VCCP expansion in 2014 as part of the Veterans Access, Choice, and Accountability Act. Objectives: We examined changes in reliance on VA for primary care (PC), mental health (MH), and specialty care (SC) among VCCP-eligible veterans. Research Design: We linked VA administrative data with VCCP claims to retrospectively examine utilization during calendar years 2016–2018. Subjects: 1.78 million veterans enrolled in VA before 2013 and VCCP-eligible in 2016 due to limited VA capacity or travel hardship. Measures: We measured reliance as the proportion of total annual outpatient (VA+VCCP) visits occurring in VA for PC, MH, and SC. Results: Of the 26.1 million total outpatient visits identified, 45.6% were for MH, 29.9% for PC, and 24.4% for SC. Over the 3 years, 83.2% of veterans used any VA services, 23.8% used any VCCP services, and 20.0% were dual VA-VCCP users. Modest but statistically significant declines in reliance were observed from 2016–2018 for PC (94.5%–92.2%), and MH (97.8%–96.9%), and a more significant decline was observed for SC (88.5%–79.8%). Conclusions: Veterans who have the option of selecting between VA or VCCP providers continued using VA for most of their outpatient care in the initial years after the 2014 VCCP expansion.

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

“…We find smaller changes in VHA-share of screening colonoscopies compared with studies that examine broad categories of care, such as primary care, outpatient care, or gastroenterology. 7,10,11,26 Our findings suggest that changes in broad categories of care may be obscuring significant procedure-level heterogeneity-enrollees may be more or less responsive to policy changes for particular procedures.…”

“…This study followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guidelines. 25 3 | RESULTS care, 8 primary care, 7,10 and specialty care 9,11,12,28 following implementation of the Choice Act. Another study has documented small declines in wait times for specialty care services.…”

“…This work adds to the growing literature studying the use of care purchased by the VHA from non‐VHA providers following the Choice and MISSION Act. Prior work has generally found an increase in the utilization or share of VHA‐purchased care services in outpatient care, 8 primary care, 7,10 and specialty care 9,11,12,28 following implementation of the Choice Act. Another study has documented small declines in wait times for specialty care services 29 .…”

“…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.…”

Prevalence and Correlates of VA-Purchased Community Care Use Among Post-9/11-Era Veterans With Traumatic Brain Injury

“…First, approximately one-third of veterans with TBI used VA-purchased care in a given study year, a somewhat larger proportion than that observed among VA-purchased care-eligible veterans during a similar period (2016-2018). 36 In addition, the total number of veterans with TBI and the number with TBI who used VA-purchased care increased during the study period. This is consistent with existing evidence documenting that as VA-purchased care eligibility has expanded, use of VA-purchased care among veterans has grown markedly.…”