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2019 HSR&D/QUERI National Conference Abstract

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2001 — VA Community Care: Ongoing Evaluation Efforts, Preliminary Analyses, Data Systems, and Emerging Issues in the Implementation of The MISSION Act

Lead/Presenter: Michelle Mengeling,  COIN - Iowa City
All Authors: Mengeling MA, COIN - Iowa City; Hynes DM, COIN - Portland; Vanneman ME, COIN - Salt Lake City; Matthews K, Office of Community Care; Akinyele M, VA Innovation Center;

With enactment of major legislation including the Veterans Choice Act in 2014 and the MISSION Act in 2018, the US Department of Veterans Affairs (VA) is dramatically reorganizing how it delivers healthcare services within VA facilities and across community provider networks. As the Veterans Health Administration (VHA) begins to evolve into a payer, in addition to providing healthcare for millions of Veterans nationwide, the potential implications for patients, providers and healthcare organizational leaders are unprecedented. This forum will highlight ongoing evaluation efforts, preliminary analyses (including existing data systems), and emerging issues in VA Community Care implementation.

Activities: Our session will be divided into two segments: the first segment will be a brief overview of existing research focused on VA Community Care, while the second segment will feature a "Town Hall" regarding the current state of VA Community Care, including legislative updates and ongoing evaluation needs. Existing Community Care Research: The research segment will be comprised of presentations from three teams who have HSRandD Service-Directed Research Projects (SDR) focusing on VA Community Care (15 minutes per team followed by 5 minutes for questions). These presentations will include a focus on access to care, service utilization, and the adequacy of community provider networks. Access to Care: The expansion of VA's Community Care program through the Veterans Choice Act of 2014 was largely brought about due to issues related to Veterans' access to care, specifically long VA wait times. Methods for calculating wait times for Community Care are complex but should improve with implementation of new information systems. Our group will review how we have used patient perceptions from the VA Survey of Healthcare Experiences of Patients (SHEP) to compare access to care between VA and Community Care for primary care, mental health care, and specialty care. We will also review options for new access comparisons in the era of the MISSION Act, including development of some access measures for Community Care. Service Utilization/Care Coordination: As the care options for Veterans have expanded with the implementation of the Veterans Choice Act, and more recently with the MISSION Act, attention to how Veterans use both VA health care services offered at VA facilities and in the community is important. With this expansion of service options Veterans may use a mix of VA-facility-based and community-based care. With this change in the service mix, there is greater demand for care coordination across provider sites. We will discuss how Veterans' service use may impact their care coordination needs. We will present work underway comparing VA and community care use for select procedures and primary care and highlight insights that may inform prospective evaluation. Network Adequacy: We will present a brief overview of network adequacy, how it has been measured by non-VA entities (e.g., Affordable Care Act, Centers for Medicare and Medicaid Services, state-based insurance marketplaces, National Committee for Quality Assurance and Utilization Review Accreditation Commission requirements, private sector managed care plans) and within VA's contracts with network providers. We will share our Expert Panel's feedback on what is important for VA to consider when evaluating its networks and why non-VA evaluation measures may not be appropriate for VA's healthcare system. In addition, we will present our research efforts examining network adequacy and highlight additional avenues of inquiry. Town Hall: For the "Town Hall" segment, we have invited Dr. Kameron Matthews, Director of Community Care, and Mr. Michael Akinyele, VA Chief Innovation Officer, for an active conversation regarding the current state of VA Community Care, including the MISSION Act and evaluation needs therein. Dr. Kameron Matthews, Deputy Under Secretary for Health for Community Care, is a board-certified family physician and in addition to her administrative duties, continues to provide primary care to Veterans. She recently participated in a Town Hall event at the VA Patient Experience Symposium where over 400 VHA employees attended. Her participation in this Partnership Forum allows VHA researchers to gain knowledge of Community Care business processes, IT solutions, and priorities as VHA continues to evolve its Community Care programs. Michael Akinyele, VA Chief Innovation Officer and Executive Director of the VA Innovation Center is responsible for the MISSION Act's Section 152. Authority for Department of Veterans Affairs Center for Innovation for Care and Payment, which includes testing payment and service delivery models aimed at improving access, quality, timeliness, and patient satisfaction of care and services, as well as creating cost savings for the VA. The Town Hall will begin with an overview provided by Dr. Matthews and Mr. Akinyele (~20-30 minutes) followed by an hour opened to the audience. Discussion topics that would be of interest to VA health services researchers might include the provision for care at community-based urgent care centers (such as CVS or MinuteClinic) or Section 152 of the MISSION Act, which gives VA the authority to pilot innovative payment and service delivery models. The Town Hall discussions will be initiated by audience interests and questions, guided by our Partners' priorities, and kept on track by our Moderator. The issues will be examined in depth and engage researchers in finding ways to evaluate community care and particularly those aspects specific to the MISSION Act. The Town Hall format will allow active engagement by VA researchers in the audience and will be moderated by Dr. Kristin Mattocks.


VA researchers and policymakers

This partnership forum brings together VA leaders in Community Care with VA researchers to understand the most pressing needs regarding future Community Care research. Given the rapidly evolving nature of community care, especially considering the MISSION Act, it is critical that VA researchers learn what efforts are currently underway, what the priorities are for the Office of Community Care and VA's Innovation Center, and what data is available that can support their own research efforts. We anticipate that there will be many areas of interest from audience members, such as evaluating network adequacy, care coordination, quality, Veteran engagement and preferences, women-specific health care, and VA core services, to name a few. This session will serve the dual purpose of highlighting the capabilities of HSRandD researchers for senior leaders in VA Community Care, and enable VA researchers to understand timely issues from the perspective of leaders in Community Care. It is our hope that this session expands the number of VA researchers who focus on the most pressing VA Community Care issues. The discussions generated during the Town Hall session will be developed into a White Paper identifying and prioritizing the research questions, proposing ways to address those questions, and anticipating research's impact on national policies and VA processes.