Veteran Use of Health Care Systems in Rural States: Comparing VA and Non‐VA Health Care Use Among Privately Insured Veterans Under Age 65

Charlton, Mary E.; Mengeling, Michelle A.; Schlichting, Jennifer A.; Jiang, Lan; Turvey, Carolyn; Trivedi, Amal N.; Kizer, Kenneth W.; West, Alan N.

doi:10.1111/jrh.12206

Cited by 21 publications

(19 citation statements)

References 10 publications

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“…5,6 Studies characterizing Veterans' healthcare utilization indicate that as many as half of Veterans rely on both VA and non-VA sources of care, with older and more rural Veterans more likely to be dual users. [7][8][9] Patients make complex decisions regarding healthcare seeking based on their access to care, perceptions of care, prior utilization, satisfaction, quality, and outcomes [10][11][12] and there is growing recognition of the need to assess patient experiences of cross-system care as a means of evaluating its coordination and quality. 13 Both VA and non-VA providers have reported significant frustration with crosssystem care coordination, particularly related to barriers to information exchange and a lack of role clarity and care tracking.…”

Section: Current Evidence On Cross-system Care Coordinationmentioning

confidence: 99%

“…However, higher levels of care coordination may be warranted due to greater healthcare need (e.g., multiple comorbidities, advanced or more severe conditions), limited personal resources, and frequent cross-system use. 7,[21][22][23] In addition to PACT, VA Office of Community Care has developed a triage tool to differentiate Veterans with low, moderate, or high needs for coordination to facilitate coordination and navigation within and outside the VA. This tool also helps in documenting the intensity ("dosage") of coordination delivered.…”

Section: Identifying Veterans Who Benefit Most From Care Coordinationmentioning

confidence: 99%

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Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

et al. 2019

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Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination. KEY WORDS: Veterans; care coordination; health information interoperability; delivery of healthcare.

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Section: Current Evidence On Cross-system Care Coordinationmentioning

confidence: 99%

Section: Identifying Veterans Who Benefit Most From Care Coordinationmentioning

confidence: 99%

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

et al. 2019

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“…However, dual use is an ongoing coordination issue for VA facilities, where Veterans who are ‡65 years of age are eligible for VA services and may also use Medicare to access care and cover health expenses. Recent studies have also shown that dual use is common among working-age Veterans (those under age 65) to address both inpatient and outpatient care needs, [9][10][11] particularly in rural areas. One study found that 54% of rural dwelling Veterans used both VA and private insurances.…”

Section: Introductionmentioning

confidence: 99%

“…One study found that 54% of rural dwelling Veterans used both VA and private insurances. 9 Furthermore, higher risk Veteran patients (i.e., those with higher Hierarchical Condition Category [HCC] scores) are more likely to be dual users. 10…”

Section: Introductionmentioning

confidence: 99%

Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

Wakefield

Turvey

Hogan

et al. 2020

Telemedicine and e-Health

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Background: Patients seek care across multiple health care settings. One coordination issue is the unnecessary duplication of laboratory across different health care settings. This analysis examined the association between patient portal use and duplication of laboratory testing among Veterans who are dual users of Veterans Affairs (VA) and non-VA providers. Materials and Methods: A national sample of Veterans who were newly authenticated users of the portal during fiscal year (FY) 2013 who used Blue Button at least once were compared with a random sample of Veterans who were not registered to use the portal. From these two groups, Veterans who were also Medicare-eligible users in FY2014 were identified. Duplicate testing was defined as receipt of more than five HbA1c (hemoglobin A1c) in 1 year. Results: Use of the Blue Button decreased the odds of duplicate HbA1c testing in VA and Medicare-covered facilities across three comparisons: (1) overall between users and nonusers: portal users were less likely to have duplicate testing; (2) prepost comparison: there was a trend toward lower duplicate testing in both groups across time; and (3) pre-post comparisons accounting for use of the portal: the trend toward lower duplicate testing was greater in Blue Button users. Conclusion: Duplicate HbA1c testing was significantly lower in dual users of VA and Medicare services who used the Blue Button feature of their VA patient portal. Non-VA providers encounter barriers to access of complete information about Veterans who also use VA health care. Provider endorsement of consumer-mediated health information exchange could help further this model of sharing information.

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“…Veterans with complex health care needs increasingly utilize both the Veterans Health Administration (VA) and non-VA hospitals [1–3]. Roughly 50% of Veterans are dual-users [2–4], receiving care from both VA and non-VA hospitals. With the addition of the VA’s Mission Act (previously the Choice Act), access to community care will likely increase.…”

Section: Introductionmentioning

confidence: 99%

The advanced care coordination program: a protocol for improving transitions of care for dual-use veterans from community emergency departments back to the Veterans Health Administration (VA) primary care

Miller

Sjoberg

Mayberry

et al. 2019

BMC Health Serv Res

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BackgroundVeterans who access both the Veterans Health Administration (VA) and non-VA health care systems require effective care coordination to avoid adverse health care outcomes. These dual-use Veterans have diverse and complex needs. Gaps in transitions of care between VA and non-VA systems are common. The Advanced Care Coordination (ACC) quality improvement program aims to address these gaps by implementing a comprehensive longitudinal care coordination intervention with a focus on Veterans’ social determinants of health (SDOH) to facilitate Veterans’ transitions of care back to the Eastern Colorado Health Care System (ECHCS) for follow-up care.MethodsThe ACC program is an ongoing quality improvement study that will enroll dual-use Veterans after discharge from non-VA emergency department (EDs), and will provide Veterans with social worker-led longitudinal care coordination addressing SDOH and providing linkage to resources. The ACC social worker will complete biopsychosocial assessments to identify Veteran needs, conduct regular in-person and phone visits, and connect Veterans back to their VA care teams.We will identify non-VA EDs in the Denver, Colorado metro area that will provide the most effective partnership based on location and Veteran need. Veterans will be enrolled into the ACC program when they visit one of our selected non-VA EDs without being hospitalized. We will develop a program database to allow for continuous evaluation. Continuing education and outreach including the development of a resource guide, Veteran Care Cards, and program newsletters will generate program buy-in and bridge communication. We will evaluate our program using the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework, supported by the Practical, Robust Implementation and Sustainability Model, Theoretical Domains Framework, and process mapping.DiscussionThe ACC program will improve care coordination for dual-use Veterans by implementing social-work led longitudinal care coordination addressing Veterans’ SDOH. This intervention will provide an essential service for effective care coordination.

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Veteran Use of Health Care Systems in Rural States: Comparing VA and Non‐VA Health Care Use Among Privately Insured Veterans Under Age 65

Cited by 21 publications

References 10 publications

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

Recommendations for the Evaluation of Cross-System Care Coordination from the VA State-of-the-art Working Group on VA/Non-VA Care

Impact of Patient Portal Use on Duplicate Laboratory Tests in Diabetes Management

The advanced care coordination program: a protocol for improving transitions of care for dual-use veterans from community emergency departments back to the Veterans Health Administration (VA) primary care

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