Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation

Vanneman, Megan E.; Harris, Alex H. S.; Asch, Steven M.; Scott, Winifred; Murrell, Samantha S.

doi:10.1097/mlr.0000000000000678

Cited by 22 publications

(19 citation statements)

References 27 publications

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“…Previous research involving semi-structured interviews with VA key stakeholders (i.e., administrators, Veterans, pharmacists) and surveys with community providers during initial implementation of the Choice Program found similar problems regarding care fragmentation, 6,8 inadequate sharing of medical records, 8,17 administrative burdens for VA staff when dealing with community specialists' prescriptions, 7 prescription delays, 10 community specialist participation barriers, 17,18 and lack of provider role clarity associated with the Choice Program. 8 Our study shows, first, that these problems persist and, second, how they affect VA PCPs' experiences with referring patients to community specialty care.…”

Section: Discussionmentioning

confidence: 95%

“…However, since its rollout, the Choice Program has faced challenges due to the rapid 90-day implementation period, ongoing refinements to the eligibility criteria, and delays with paying claims. 2 Previous literature summarizes the rollout of the Choice Program 5 and research findings on early implementation challenges with Veteran utilization, 6 pharmacy use, 7 women's health care coordination, 8 community specialist interest, 9 and hepatitis C care. 10 Yet none of these studies assessed the viewpoints of referring VA primary care providers (PCPs), who play a central role coordinating care 11 between the VA and community providers and were on the frontline during the implementation of the Choice Program.…”

Section: Introductionmentioning

confidence: 99%

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A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program

et al. 2019

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BACKGROUND: The Veterans Access, Choice and Accountability Act (hereafter, Choice Program) seeks to improve access to care by enabling eligible Veterans to receive care from community providers. Veterans Affairs (VA) primary care providers (PCPs) play a key role in making referrals to community specialists, but their frontline experiences with referrals are not well understood. OBJECTIVE: To understand VA PCPs' experiences referring patients to community specialists while VA works to expand and refine the implementation of the Choice Program. DESIGN: Qualitative study using interview methods. PARTICIPANTS: Semi-structured telephone interviews were conducted with VA primary care providers (N = 72 out of 599 contacted) recruited nationally. APPROACH: Open-ended interview questions elicited PCP perceptions and experiences with referrals to community specialists via the Choice Program. Keywords were identified using automated coding features in ATLAS.ti and evaluated using conventional content analysis to inductively describe the qualitative data. KEY RESULTS: VA PCPs emphasized problems with care coordination and continuity between the VA and community specialists (e.g., BIt is extremely difficult for us to obtain and continue continuity of care because there's not much communication with the community specialist^). They described difficulties with tracking the initial referral, coordinating care after receiving community specialty care, accessing community medical records, and aligning community specialists' prescriptions with the VA formulary. CONCLUSIONS: The VA Choice Program provides access to community specialists for VA patients; however, VA primary care providers face challenges tracking referrals to community specialists and in coordinating care. Strategies to improve care coordination between the VA and community providers should focus on providing PCPs with information to follow Veterans throughout the Choice referral process and follow-up.

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Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program

et al. 2019

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“…With increasing prevalence of ESRD among veterans and VA priorities to improve veterans' access to care, assessing the consequences of the VA Health Care System's "make versus buy" decision-making process for dialysis care is critically important. 30 The tradeoffs of "making" more VA dialysis care must be balanced against the tradeoffs of "buying" outpatient dialysis care from providers in the private sector as well as potential savings in VA dollars related to other medical care. Our findings suggest considerations of both the clinical consequences and operational realties of effective and efficient provision of dialysis services to veterans.…”

Section: Discussionmentioning

confidence: 99%

Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings

Wang

Stechuchak

Berkowitz

et al. 2018

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Background Outcomes of veterans with ESRD may differ depending on where they receive dialysis and who finances this care, but little is known about variation in outcomes across different dialysis settings and financial arrangements. MethodsWe examined survival among 27,241 Veterans Affairs (VA)-enrolled veterans who initiated chronic dialysis in 2008-2011 at (1) VA-based units, (2) community-based clinics through the Veterans Affairs Purchased Care program (VA-PC), (3) community-based clinics under Medicare, or (4) more than one of these settings ("dual" care). Using a Cox proportional hazards model, we compared all-cause mortality across dialysis settings during the 2-year period after dialysis initiation, adjusting for demographic and clinical characteristics. ResultsOverall, 4% of patients received dialysis in VA, 11% under VA-PC, 67% under Medicare, and 18% in dual settings (nearly half receiving dual VA and VA-PC dialysis). Crude 2-year mortality was 25% for veterans receiving dialysis in the VA, 30% under VA-PC, 42% under Medicare, and 23% in dual settings. After adjustment, dialysis patients in VA or in dual settings had significantly lower 2-year mortality than those under Medicare; mortality did not differ in VA-PC and Medicare dialysis settings.Conclusions Mortality rates were highest for veterans receiving dialysis in Medicare or VA-PC settings and lowest for veterans receiving dialysis in the VA or dual settings. These findings inform institutional decisions about provision of dialysis for veterans. Further research identifying processes associated with improved survival for patients receiving VA-based dialysis may be useful in establishing best practices for outsourced veteran care.

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“…Preliminary evaluations of Choice showed that only 2-13% of eligible Veterans received health care through Choice in its first year of implementation. 3,4 Those Veterans who did use Choice still reported barriers related to pre-authorization and scheduling, inadequate provider networks, and liability for treatment costs. 3,5 Veteran experiences with Choice and VA health care during the initial rollout of this new program are largely unknown.…”

Section: Introductionmentioning

confidence: 99%

Veteran Satisfaction with Early Experiences of Health Care Through the Veterans Choice Program: a Concurrent Mixed Methods Study

et al. 2019

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Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation

Abstract: There was low uptake of VCP services in the first year of the program. Data from additional years are needed to better understand the impact of this policy.

Cited by 22 publications

References 27 publications

A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program

A Qualitative Study of Primary Care Providers’ Experiences with the Veterans Choice Program

Survival among Veterans Obtaining Dialysis in VA and Non-VA Settings

Veteran Satisfaction with Early Experiences of Health Care Through the Veterans Choice Program: a Concurrent Mixed Methods Study

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