VA-Delivered or VA-Purchased Care: Important Factors for Veterans Navigating Care Decisions

Lafferty, Megan; Govier, Diana J; Golden, Sara E.; Disher, Natalie; Hynes, Denise M.; Slatore, Christopher G.

doi:10.1007/s11606-023-08128-0

Cited by 5 publications

(12 citation statements)

References 35 publications

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“…On the other hand, VHA enrollees receiving a VHA‐purchased screening colonoscopy were more likely to live further from VHA specialty care or have some VHA‐purchased in the prior FY. The increased likelihood of VHA enrollees with more attachment to community providers, either by having prior VHA‐purchased care or living farther away from VHA specialty care, is consistent with VHA enrollees valuing continuity in their relationships with providers 27 …”

Section: Discussionmentioning

confidence: 69%

“…Care coordination mitigates fragmentation of care 33 . Finally, when choosing their source of care, VHA enrollees consider both continuity in the provider relationship and the broader ecosystem of care 27 . As VHA‐share declines, the VHA may need to adopt strategies for cross‐system care coordination to ensure effective and efficient care for VHA enrollees.…”

Section: Discussionmentioning

confidence: 99%

“…33 Finally, when choosing their source of care, VHA enrollees consider both continuity in the provider relationship and the broader ecosystem of care. 27 As VHA-share declines, the VHA may need to adopt strategies for cross-system care coordination to ensure effective and efficient care for VHA enrollees. The demand for effective care coordination for high-risk enrollees is likely to be particularly high for specialty services.…”

Section: Trends In Screening Colonoscopy Volume By Care Source and Timementioning

confidence: 99%

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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

Eck,

Jiang,

Petersen

2023

Health Services Research

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ObjectiveTo estimate whether those enrolled in the Veterans Health Administration (VHA) were less likely to use VHA‐delivered colorectal cancer screening colonoscopies after the MISSION Act.Data Sources and Study SettingSecondary data were collected on VHA‐enrolled Veterans from FY2017–FY2021.Study DesignThis retrospective cross‐sectional study measured the volume and share of screening colonoscopies that were VHA‐delivered over time and by drive time eligibility—defined as living more than 60 min away from the nearest VHA specialty‐care clinic. We used a multivariable logistic regression to adjust for patient and facility factors.Data ExtractionData were extracted for VHA enrollees (n = 773,766) who underwent a screening colonoscopy either performed or purchased by the VHA from FY2017–FY2021.Principal FindingsIn the 9 months after the implementation of the MISSION Act, and before the onset of the Covid‐19 pandemic, the average monthly VHA‐share of screening colonoscopies decreased by 3 percentage points (pp; 95% confidence interval [CI] = [−4 to −2 pp]) for the non‐drive time eligible group and it decreased by 16 pp (95% CI = [−22 to −9 pp]) for the drive time eligible group. The total number of screening colonoscopies did not significantly change in either group during this time period. After adjusting for patient characteristics, a linear time trend, and parent facility fixed effects, implementation of the MISSION Act was associated with a reduction in the probability of a VHA‐delivered screening colonoscopy (average marginal effect [AME]: −2.5 pp; 95% CI = [−5.1 to 0.0 pp]) for the non‐drive time eligible group. The drive time eligible group (AME: −9.4 pp; 95% CI = [−13.2 to −5.5 pp]) experienced a larger change.ConclusionsThe VHA‐share of screening colonoscopies among VHA enrollees fell in the 9 months immediately after the passage of the MISSION Act. This decline was larger for VHA enrollees who were targeted for eligibility due to a longer drive time. These results suggest that the MISSION Act led to more VHA‐purchased care among targeted VHA enrollees, though it is unclear whether total utilization increased.

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Section: Discussionmentioning

confidence: 69%

Section: Discussionmentioning

confidence: 99%

Section: Trends In Screening Colonoscopy Volume By Care Source and Timementioning

confidence: 99%

See 1 more Smart Citation

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

Eck,

Jiang,

Petersen

2023

Health Services Research

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“…Patients, including Veterans, in this and previous studies have expressed frustration at lack of communication between health care institutions leading to poor continuity of care (Mattocks et al, 2018;Miller et al, 2021;Noe¨l et al, 2020;Lafferty et al, 2023). Needs assessments among all parties involved in the care chain could be helpful in making improvements, as well as ensuring goals are agreed upon, collaboration is encouraged, and awareness of the care chain (Minkman, 2012).…”

Section: Discussionmentioning

confidence: 87%

“…Further, participants in our study felt that currently available quality metrics would not help most patients since they are difficult to measure and interpret, and may not be available for all non-VA or VA clinicians. Patients have preferences that go beyond quality metrics, including valuing relationships with clinicians (Lafferty et al, 2023). That being said, policy makers may be interested in vetting the quality of care of community providers and/or developing a sort of ''preferred provider'' network to provide more guidance for patients, fitting with the DMIC recommendations to create a multidisciplinary care pathway where all parties are in agreement about the goal, while always incorporating the patients' needs and preferences.…”

Section: Discussionmentioning

confidence: 99%

A Qualitative Study of VA Entrants’ Experiences Discussing Community Care With Veterans

Golden,

Lafferty,

Tyzik

et al. 2023

SAGE Open

Self Cite

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We conducted interviews with clinicians and staff involved in Veterans’ decisions about where to receive their health care to assess experiences with community care coordination and identify areas for improvement. Insufficient time and knowledge were cited as barriers to assisting Veterans in making decisions about whether to use community care resources. Concerns regarding quality of community care and lack of patient understanding on the implications of accessing community care also arose. Clinicians need to be able to help Veterans make informed choices about where to receive their health care and may require decision support that integrates their informational needs with their values and preferences, clarity on the referral process, and improved ways to measure and describe quality of care to Veterans. VA has recognized issues with community care and established new initiatives but the rollout is complex and ongoing.

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Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-term Institutional Care

Bouldin,

Brintz,

Hansen

et al. 2024

Medical Care

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Background: We aimed to identify combinations of long-term services and supports (LTSS) Veterans use, describe transitions between groups, and identify factors influencing transition. Methods: We explored LTSS across a continuum from home to institutional care. Analyses included 104,837 Veterans Health Administration (VHA) patients 66 years and older at high-risk of long-term institutional care (LTIC). We conduct latent class and latent transition analyses using VHA and Medicare data from fiscal years 2014 to 2017. We used logistic regression to identify variables associated with transition. Results: We identified 5 latent classes: (1) No Services (11% of sample in 2015); (2) Medicare Services (31%), characterized by using LTSS only in Medicare; (3) VHA-Medicare Care Continuum (19%), including LTSS use in various settings across VHA and Medicare; (4) Personal Care Services (21%), characterized by high probabilities of using VHA homemaker/home health aide or self-directed care; and (5) Home-Centered Interdisciplinary Care (18%), characterized by a high probability of using home-based primary care. Veterans frequently stayed in the same class over the three years (30% to 46% in each class). Having a hip fracture, self-care impairment, or severe ambulatory limitation increased the odds of leaving No Services, and incontinence and dementia increased the odds of entering VHA-Medicare Care Continuum. Results were similar when restricted to Veterans who survived during all 3 years of the study period. Conclusions: Veterans at high risk of LTIC use a combination of services from across the care continuum and a mix of VHA and Medicare services. Service patterns are relatively stable for 3 years.

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VA-Delivered or VA-Purchased Care: Important Factors for Veterans Navigating Care Decisions

Cited by 5 publications

References 35 publications

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

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

A Qualitative Study of VA Entrants’ Experiences Discussing Community Care With Veterans

Trajectories and Transitions in Service Use Among Older Veterans at High Risk of Long-term Institutional Care

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