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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1152 — Characteristics and Trends in Veterans Affairs Community Care Utilization

Lead/Presenter: Liam Rose,  Resource Center - HERC
All Authors: Rose LF (Health Economics Resource Center), Schoemaker L (Health Economics Resource Center) Wagner T (Health Economics Resource Center)

Objectives:
VA has greatly expanded access to community care (VACC) since the implementation of the MISSION Act in June 2019. However, there remains little information on who uses community care and how that has changed over time.

Methods:
This cross-sectional study examines the characteristics of patients in VA and community care encounters from 2013-2021. Demographic characteristics over time are presented for four types of encounters: VA inpatient, VA outpatient, VACC inpatient, and VACC outpatient. We then examine four distinct eras: before the Choice Act (2013-14), Choice Act era (2015-June 2019), MISSION Act era (June 2019-March 2020), post-MISSION COVID-19 era (March 2020-December 2021). We calculate unadjusted odds ratios of patient characteristics for VA and VACC in each of these eras.

Results:
The volume of both inpatient and outpatient community care has increased drastically, with the number of VACC inpatient visits nearly equal to VA inpatient visits. VACC has a higher proportion of visits with older, male, rural, and white patients in both inpatient and outpatient visits. Despite changing access standards related to travel time, the average travel time for VACC encounters did not vary during the study period (16.3 miles to nearest VA facility). The COVID-19 pandemic has had only marginal impact on demographic characteristic differences between patients in VA and VACC encounters.

Implications:
These data point out important changes in community care use among Veterans, including the rising volume of community care use and change in demographics among users.

Impacts:
VHA has invested significantly in the expansion of community care in order to improve access. To find the right balance between being a provider and payer while providing equitable access to care, it will need to pay close attention to the changing demographics of Veterans that choose to access care outside VA facilities.