Differences Between VHA-Delivered and VHA-Purchased Behavioral Health Care in Service and Patient Characteristics

Vanneman, Megan E.; Rosen, Amy K.; Shwartz, Michael; Gordon, Sarah H.; Greenberg, Greg A.; Zheng, Tianyu; Cook, James; Beilstein‐Wedel, Erin; Greene, Tom; Kelley, A. Taylor

doi:10.1176/appi.ps.202100730

Cited by 10 publications

(13 citation statements)

References 15 publications

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“…Similar approaches have been used to identify counties that have experienced more growth in CC primary care and patients that are more likely to use VHA-purchased behavioral health care. 17,18 The significance level was set beforehand as p < 0.05, and 95% confidence intervals (CIs) are presented alongside point estimates. All analyses were conducted with the statistical software package R, release 4.1.2.…”

Section: Discussionmentioning

confidence: 99%

“…Research on VHA-purchased care has documented the program's association with changes in access and healthcare utilization and compared VHA-delivered and VHA-purchased care quality and cost. [15][16][17][18][19][20][21] However, these studies have also documented significant differences in these associations across facilities and geographic regions. 15,[17][18][19][20][21][22][23][24] One potential reason for the observed variation in access and quality may be differences in the implementation or structure of the underlying physician network as well as the availability of non-VHA physicians.…”

Section: Discussionmentioning

confidence: 99%

“…13,14 Prior work on CC has typically taken the networks as given and studied the program's association with access to care and compared quality and cost outcomes between VHA and non-VHA physicians. [15][16][17][18][19][20][21] These studies have found that VHA care is typically as good as care from non-VHA physicians, but it is less clear whether policies such as the MISSION Act have improved access. 21 Additionally, some studies have found significant differences in quality and access across facilities and geographic regions.…”

Section: Introductionmentioning

confidence: 99%

“…21 Additionally, some studies have found significant differences in quality and access across facilities and geographic regions. 15,[17][18][19][20][21][22][23][24] Differences in the implementation or structure of the underlying physician network and availability of non-VHA physicians may help explain this variability and identify ways to improve access and quality.…”

Section: Introductionmentioning

confidence: 99%

“…These studies have found that VHA care is typically as good as care from non‐VHA physicians, but it is less clear whether policies such as the MISSION Act have improved access 21 . Additionally, some studies have found significant differences in quality and access across facilities and geographic regions 15,17–24 . Differences in the implementation or structure of the underlying physician network and availability of non‐VHA physicians may help explain this variability and identify ways to improve access and quality.…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act

Eck,

Ho,

Jiang

et al. 2023

Health Services Research

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ObjectiveTo measure key characteristics of the Veterans Health Administration's (VHA) Community Care (CC) referral network for screening colonoscopy and identify market and institutional factors associated with network size.Data SourcesVHA electronic health records, CC claim data, and National Plan and Provider Enumeration System.Study DesignIn this retrospective cross‐sectional study, we measure the size of the VHA's CC referral networks over time and by VHA parent facility (n = 137). We used a multivariable linear regression to identify factors associated with network size at the market‐year level. Network size was measured as the number of physicians who performed at least one VHA‐purchased screening colonoscopy per 1000 enrollees at baseline.Data ExtractionData were extracted for all Veterans (n = 102,119) who underwent a screening colonoscopy purchased by the VHA from a non‐VHA physician from 2018 to 2021.Principal FindingsFrom 2018 to 2021, median network volume of screening colonoscopies per 1000 enrollees grew from 1.6 (IQR: 0.6, 4.6) to 3.6 (IQR: 1.6, 6.6). The median network size grew from 0.63 (IQR: 0.30, 1.26) to 0.92 (IQR: 0.57, 1.63). Finally, the median procedures per physician increased from 2.5 (IQR: 1.6, 4.2) to 3.2 (IQR: 2.4, 4.7). After adjusting for baseline market characteristics, volume of screening colonoscopies was positively related to network size (β = 0.15, 95% CI: [0.10, 0.20]), negatively related to procedures per physician (β = −0.12, 95% CI: [−0.18, −0.05]), and positively associated with the percent of rural enrollees (β = 0.01, 95% CI: [0.00, 0.01]).ConclusionsVHA facilities with a higher volume of VHA‐purchased screening colonoscopies and more rural enrollees had more non‐VHA physicians providing care. Geographic variation in referral networks may also explain differences in the effects of the MISSION Act on access to care and patient outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act

Eck,

Ho,

Jiang

et al. 2023

Health Services Research

View full text Add to dashboard Cite

show abstract

Trends in Bundled Outpatient Behavioral Health Services in VA-Direct Versus VA-Purchased Care

Kelley,

Torre,

Wagner

et al. 2024

Adm Policy Ment Health

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Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act

Yoon,

Gujral,

Dismuke-Greer

et al. 2024

J GEN INTERN MED

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Background The Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 authorized a major expansion of purchased care in the community for Veterans experiencing access barriers in the Veterans Affairs (VA) health care system. Objective To estimate changes in primary care, mental health, and emergency/urgent care visits in the VA and community fiscal years (FY) 2018–2021 and differences between rural and urban clinics. Design A national, longitudinal study of VA clinics and outpatient utilization. Clinic-level analysis was conducted to estimate changes in number and proportion of clinic visits provided in the community associated with the MISSION Act adjusting for clinic characteristics and underlying time trends. Participants In total, 1050 VA clinics and 6.6 million Veterans assigned to primary care. Main Measures Number of primary care, mental health, and emergency/urgent care visits provided in the VA and community and the proportion provided in the community. Key Results Nationally, community primary care visits increased by 107% (50,611 to 104,923), community mental health visits increased by 167% (100,701 to 268,976), and community emergency/urgent care visits increased by 129% (142,262 to 325,407) from the first quarter of 2018 to last quarter of 2021. In adjusted analysis, after MISSION Act implementation, there was an increase in community visits as a proportion of total clinic visits for emergency/urgent care and mental health but not primary care. Rural clinics had larger increases in the proportion of community visits for primary care and emergency/urgent care than urban clinics. Conclusions After the MISSION Act, more outpatient care shifted to the community for emergency/urgent care and mental health care but not primary care. Community care utilization increased more in rural compared to urban clinics for primary care and emergency/urgent care. These findings highlight the challenges and importance of maintaining provider networks in rural areas to ensure access to care.

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Differences Between VHA-Delivered and VHA-Purchased Behavioral Health Care in Service and Patient Characteristics

Cited by 10 publications

References 15 publications

Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act

Determinants of referral network size for screening colonoscopies in the Veterans Health Administration after the implementation of the MISSION Act

Trends in Bundled Outpatient Behavioral Health Services in VA-Direct Versus VA-Purchased Care

Growth of Community Outpatient Care in the Veterans Affairs System After the MISSION Act

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