VA Hepatitis C Care and Experiences with the Choice Program
BACKGROUND:
VA has become the nation's largest provider of care for hepatitis C virus (HCV). The implementation of the Choice Program (2014-2015) allows eligible Veterans to receive care, including condition management, laboratory services, and drug prescriptions from non-VA facilities and community providers that are reimbursed by VA. This study examined perspectives and experiences with the VA Choice Program among Veterans with HCV (n=38) and their providers (n=10) at three VAMCs in the New England region. Interviews with patients and providers were conducted from October 2015 to May 2016. Patients were asked open-ended questions about their experience with past and current HCV treatment – and the Choice Program, as well as barriers and facilitators to treatment and completion. VA providers were asked about their experiences working with the Choice Program, the HCV medication funding shortage during the Choice First initiative, and the HCV treatment process.
FINDINGS:
- The Choice Program has the potential to increase Veterans' access to HCV treatment, but Veterans and VA providers have described substantial problems in the initial years of the program. Four main themes emerged:
1. Difficulties in enrollment, ongoing support, and billing with third-party administrators (i.e., many Veterans described confusion about eligibility and enrollment for the Program).
2. Veterans experienced a lack of choice in location of treatment (i.e., most Veterans at the study sites did not have the option to receive VA HCV treatment, but many wanted to).
3. Fragmented care led to coordination challenges between VA and community providers (i.e., various challenges arose around sharing medical records, prescription delays, and working with designated VA staff trained on the Choice Program).
4. VA providers expressed reservations about sending Veterans to community providers (i.e., VA providers were cautious about sending patients to the Choice Program because some community providers lacked specific experience in treating advanced cases of HCV).
IMPLICATIONS:
- Enhancing care coordination, incorporating shared decision-making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy Veterans.
LIMITATIONS:
- These findings are based on only three VAMCs. Given differences in funding, patient inflow, treatment protocols, and geography, VAMCs likely differ in how they use the Choice Program.
- VA administrators and non-VA providers were not interviewed, and their perspectives may have yielded additional valuable information.
- This study was conducted during the initial years of the Choice Program, so there are history effects to consider, and the Program may continue to evolve.
AUTHOR/FUNDING INFORMATION:
Dr. Tsai was supported by an HSR&D Career Development Award. Dr. Tsai and Ms. Jones are part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education Center (PRIME). Ms. Yakovchenko is part of Bridging the Care Continuum QUERI.
Tsai J, Yakovchenko V, Jones N, et al. “Where’s My Choice?” An Examination of Veteran and Provider Experiences with Hepatitis C Treatment through the Veteran Affairs Choice Program. Medical Care. March 3, 2017; Epub ahead of print. This article is part of a special Supplement of Medical Care focused on the Veterans Access, Choice and Accountability Act of 2014 (“Choice Act”).
