Access to Safety Net Providers among Choice-eligible Rural Veterans

Mengeling M, Franciscus CL, Sadler AG. Access to Safety Net Providers among Choice-eligible Rural Veterans. Paper presented at: VA HSR&D National Meeting; 2016 Aug 9; Washington, DC.

Objectives: The Veterans Access, Choice, and Accountability Act (Choice) expands rural Veterans' healthcare access through purchased care from non-VHA providers within Veterans' communities ("community providers"). Choice is evolving to become the sole means through which Veterans seek care from non-VHA providers. The success of this new program in part hinges on assumptions that rural veterans' community providers are within 40 miles of their residence and closer than VHA providers. Community providers include federally-funded partners, such as Federally Qualified Health Centers (FQHCs) that serve many rural populations, and community partners who meet minimum credentialing criteria such as critical access hospitals (CAHs) and rural health clinics (RHCs). We examined the largely rural mileage-eligible Choice cohort's access to local safety net providers (FQHCs, CAHs, community mental health centers, and RHCs). Methods: The VA's Chief Business Office, Systems Management Office identified the Choice population (April 2015). Safety net provider information was obtained from the Health Resources and Services Administration Data Warehouse. ARCGIS software was used to compute distances from Veterans' residence to nearest safety net providers. Results: Over one million VA-enrolled Veterans are eligible for Choice; the majority (58%) is mileage-eligible. Over half live in rural and isolated rural areas. The majority of mileage-eligible Veterans (85%) have access to a FQHC/FQHC Look-Alike healthcare facility within 40 miles of their residence, but this varies by state. Region 3 (Minnesota, Nebraska, Iowa, Kansas) and Region 4 (Texas) states have the greatest number of mileage-eligible Veterans without access to a FQHC within 40 miles. Access to CAHs range from 56% to 92% among MyVA Regions and 39% to 98% for rural health clinics. Access to Community Mental Health Centers ranges from 3% to 34% among MyVA Regions. Conclusions: This analysis represents foundational information regarding the extent of the safety net for Choice-eligible Veterans. Next steps require examining rural Veterans' use of Choice and estimates of community providers' capacity to accept new Veteran patients. Impacts: Choice leverages the national health care system in order to provide Veterans increased access through VA/non-VA partnering; however this data identifies a subpopulation of rural Veterans who may have limited access to both VA and non-VA providers.