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Publication Briefs

Medical Care Supplement Highlights VA Efforts to Increase Healthcare Options for Veterans through Community Care

Since the implementation of the VA MISSION Act on June 6, 2019, more than 2.7 million Veterans have been referred to community care, representing 31% of the 8.92 million enrolled Veterans in VA care. Over the course of that time, 1.2 million providers have enrolled in VA’s Community Care Network (CCN) – VA’s direct link with community providers to ensure that Veterans receive timely, high-quality care. Care provided in the community includes services that VA does not offer, such as obstetrics care, as well as services that VA provides. In this Medical Care Supplement, 12 articles highlight research focusing on Veterans’ use of community care and how VA facilities interact with community care providers. The Supplement offers a broad examination of VA’s expanded Community Care program, from the Choice Act through the first two years of MISSION Act implementation, and highlights areas where additional research is needed to understand Veterans’ perceptions, satisfaction, and use of VA Community Care. Below are several of the studies included in this Supplement.

Articles include, but are not limited to: 

  • Garvin and colleagues examined the inter-organizational care coordination initiatives that VA and community care (CC) partners have pursued in support of rural Veterans over the past decade – and found that VA and community efforts to align their care coordination domains directly impacts healthcare outcomes, while rurality serves as a critical contextual factor.
  • Gurewich and colleagues conducted a study of wait times for specialty outpatient services in CC and VA between FY15 and FY18, and found that mean wait times for both VA and community care decreased for all services for both rural and urban Veterans, though declines were greatest for VA.
  • Hynes and colleagues compared Veterans’ use of primary care services at VA facilities versus CC from FY15-FY18. Among the 6.3 million Veterans included, Veterans who were female, lived in rural areas, had a driving distance greater than 40 miles, and/or who had health insurance or had a psychiatric/depression condition were more likely to receive CC primary care. While most Veterans continued use of VA primary care, use of CC primary care increased over time.
  • Mattocks and colleagues examined the challenges VA medical centers face in their relationships with engaging community providers in care (e.g., timely reimbursement of community providers).
  • Mengeling and colleagues discuss the value of partnered research between VA researchers and VA’s Office of Community Care (OCC), including OCC-identified areas where research is most needed.
  • Vashi and colleagues examined predictors of Veterans’ use of the MISSION Act urgent care (UC) benefits during the program’s first nine months (June 2019-February 2020) and found that a Veteran’s driving time to a VA emergency department and/or urgent care center was the strongest predictor of UC benefit use.

Summary: The enduring challenge for VA is to determine what balance of in-person VA care, virtual VA care, and care in the community offers the optimal balance of timely high-quality care. More work is needed to understand how Veterans make choices regarding VA versus community care, what factors are most important in these decisions, and what factors drive optimal patient experiences for Veterans in choosing among their care options. Additional work will be needed to understand and improve care coordination between VA and community providers, and determine what additional systems are needed to ensure that accurate and important information is exchanged between healthcare systems.

VA Community Care: Understanding Veterans’ Access, Utilization, and Satisfaction. Medical Care. May 13, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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