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Health Services Research & Development

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HSR&D In Progress

May 2020

In This Issue: Advancements in VA Primary Care
» Table of Contents


Measuring the Value of Improving Access to Community Care

Feature Article


Takeaway: This study will identify key determinants of Veterans’ choice of VA community care providers to guide operational partners with assessing the adequacy of Community Care provider networks. Through the development of a simulation tool, partners will be able to adapt to changing conditions by establishing the business case of “what-if” scenarios. This includes simulating the hypothetical addition and subtraction of providers within a Community Care network. This simulation feature will facilitate future analyses to ensure Community Care networks include high-quality providers that best match Veterans’ preferences.

To improve access to care, VA implemented the Veterans Choice Program in August 2014, which provides eligible Veterans the option of receiving care from community providers paid for by VA. Currently, there is a substantial gap in scientific evidence on the effect of the Choice Program and other VA community care programs, particularly in regard to the degree the program has improved access to care from the perspective of Veterans. More generally, non-VA literature examining the effect of greater provider options has focused on changes in healthcare use, but it has not assessed the value of improved patient choice.

This HSR&D-funded study (June 2019 – May 2023) aims to:

  • Develop new econometric method applications to quantitatively measure the value of greater access to providers from the perspective of Veterans, and
  • Examine the relative importance of local area and provider characteristics in determining Veterans’ value of having improved access to providers.

The development of measures that capture the value of greater provider options is challenging because patients’ preferences are not directly observed and value encompasses many dimensions of access (e.g., travel distance, appointment wait times, provider quality). To address these evidence gaps, investigators are working to develop and examine new measures that will comprehensively capture the value of provider options to Veterans using state-of-the art econometric methods.

Methods

This observational study is assessing VA administrative data and existing public data characterizing outpatient providers. Investigators will use VA data to identify: 1) Veterans eligible for the VA Choice Program in 2016, 2) VA and Choice outpatient providers, and 3) the use of VA outpatient services through the Choice Program. Investigators will analyze Veterans’ revealed preference for providers using econometric random utility models. These models assume that Veterans select the provider that yields the greatest benefit, given all available options. Econometric models will then calculate Veterans’ willingness to pay, which represents the maximum dollar amount an individual would theoretically pay for greater provider options. Further, investigators will assess the influence of key provider and local area characteristics in determining value. Incorporating study results, investigators will develop a simulation tool designed for non-researchers to estimate the value to Veterans of a specified set of provider options (i.e., a community care network).

Findings

None at this time.

Anticipated Impact

Study findings will help improve implementation of VA Community Care programs moving forward by identifying key factors that influence Veterans’ choice of providers. Using model results, investigators will develop a simulation tool to provide the ability for operational partners to assess the adequacy of Community Care networks and to establish the business case of “what-if” scenarios. Stakeholders will be able to adapt to changing conditions through simulating the hypothetical addition and subtraction of providers within a Community Care network. This simulation feature will facilitate future analyses to ensure Community Care networks include high-quality providers that best match Veterans’ preferences.

Principal Investigator: Edwin Wong, PhD, MA, is part of HSR&D’s Seattle-Denver Center of Innovation.

Publications

None at this time.

View study abstract

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