The Veterans Choice Act

Abstract

Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.

Access to specialty healthcare in urban versus rural US populations: a systematic literature review

“…In terms of legislation as a barrier, interviews with VHA staff ( n = 43; rural West, South, and Midwest US) about the effects of the Veterans Choice Act to allow veterans to seek care outside the VHA suggested three reasons it resulted in even longer access delays: 1) the policy was implemented too quickly without adequate preparation; 2) external care relied upon already overburdened community providers; and 3) communication and scheduling barriers existed outside the VHA [88]. Mexican immigrants ( n = 81) in an urban North Carolina study suggested that by providing proof of insurance one would not have to provide a Social Security number, a common barrier to seeking healthcare [66].…”

“…Third, several new themes that impact access were identified that may be important to integrate into conceptual frameworks for improving our understanding of care access. Government and insurance policies may facilitate or restrict access through training resource allocation [86], financial incentives [87], insurance policy [61, 64], reimbursement [64, 72], legislation [66, 72, 87, 88], malpractice [64, 89], and increased government oversight [89]. Health organization and operations influence may include organizational culture or leadership [72], process and performance initiatives [90, 91], specialist recruitment strategies [91, 92], strategic geographic location [33], insurance acceptance [33], and decisions regarding offered specialty services [93].…”

Patient-Rated Access to Needed Care: Patient-Centered Medical Home Principles Intertwined

“…However, of the changes within the VA intended to improve access, the most substantial change may be the Veterans Choice Act, which increases reliance on providers outside the VA (Gellad, 2016). Research on this program to date has identified profound challenges in the coordination of care with providers outside VA (Mattocks, Mengeling, Sadler, Baldor, & Bastian, 2017). Our results suggest that approaches to improving access that compromise the care team’s ability to coordinate care, or that diminish the care team’s role as a primary point of contact for patients, may prove ineffective or counterproductive – particularly for women Veterans, who already face disproportionate challenges to coordinated care (Mattocks et al, 2010).…”

Impact of Deployment on Reproductive Health in U.S. Active-Duty Servicewomen and Veterans

“…A study exploring quality and coordination of non-VA/Choice care found the VACAA was enacted too rapidly without adequate preparation, community networks were poorly established, and care was increasingly delayed due to scheduling or communication challenges. 21 Additionally, referring out reproductive health services meant women Veterans were cared for by civilian providers who may be less familiar with Veteran, and especially deployment-related experiences and needs. 22 The newly passed VA Mission Act of 2018 will attempt to address some of these issues, including providing continuing education for community providers who serve Veterans.…”