Responding to VHA’s Urgent Need to Address Community Care Spending and Access Strategies

Responding to VHA’s Urgent Need to Address Community Care Spending and Access Strategies



published June 2024

The cost of the Veterans Community Care Program (VCCP) skyrocketed nearly 200% over the past five years. Aptive developed five strategies to increase Veteran use of health care from the Veterans Health Administration (VHA) and lower community care spending.

The large increase is due to the growing number of Veteran referrals to community care. VHA can decrease VCCP spending by ensuring that Veterans receive referrals only when community care truly proves to be sooner, better, and more accessible.

Most studies have found VA care to be as good as, or better than, care in the community when it comes to quality and safety. For access and cost/efficiency, studies were more evenly split among the categories of “VA care is better, VA and community care are about the same, and community care is better.” By addressing access issues, creating an integrated marketing/ communications strategy, standardizing and broadening demographic data collection, diversifying care locations, and strengthening care coordination, VHA can attract more Veterans to its direct system of care.

Aptive developed five overarching strategies to increase Veteran use of direct VHA health care and lower VCCP spending.

1. Improve Access and Care Standards

VHA should adopt a utilization management model for community care to support the creation of regulatory guardrails and validation of procedures as medically necessary. The agency should also enable the Center for Care and Payment Innovation to test, analyze, and launch innovative payment models to ensure value among community providers. In addition, VHA could assess the community emergency care notification and authorization process and identify best practices among VA Medical Centers (VAMCs). The agency could then standardize and scale these best practices across its health system to improve the continuity of Veteran care following the delivery of community emergency department (ED) services.

2. Build an Attraction Strategy

An integrated communications and marketing strategy could bring new Veterans into the VHA health system and other Veterans back for their care by highlighting its benefits and positive outcomes. VHA also needs to proactively hire, train, and retain a qualified workforce to meet the Veteran population’s emerging and evolving health care needs over the long term.

3. Evolve as a Data-Driven, Learning Health Care Organization

Standardizing and broadening Veteran demographic data collection can ensure a more personalized care experience for Veterans at VHA. The agency can also use advanced analytics, responsible artificial intelligence, and machine learning to stratify high-risk Veterans to better target health interventions and improve health equity.

4. Rethink Where VHA Provides Care

VHA can increase Veteran use of telehealth services by ensuring Veterans are aware of significantly growing capabilities, especially in mental health. Increasing home-based care services using remote monitoring technologies and optimizing VHA community-based outpatient clinics (CBOCs) can also expand how Veterans receive care outside the traditional VAMC setting.

5. Leverage and Create Care Coordination Opportunities

Continuing to standardize and scale strong health care coordination practices offers significant opportunities to minimize community care costs and improve the patient experience for the most vulnerable Veterans. VHA can create incentives to encourage the effective use of referral coordination teams (RCTs) and a whole-health approach to coordinating Veteran care. The agency can also continue to implement integrated care models that combine mental health services with primary care (e.g., PCMHI) and other medical specialties to provide comprehensive and coordinated care for Veterans with complex health needs. By addressing mental health issues alongside physical health conditions, integrated care models can improve health outcomes and reduce the overall burden on the health system, including the use of community care and emergency visits to manage chronic mental health needs.

Building on existing and already completed efforts to improve access and quality of care, and addressing related issues within the VHA health system, can decrease use of community care and increase use of direct VHA services. VHA’s health network has already demonstrated its capacity to absorb more patients across specialties. With VHA leadership, innovation, and collaboration across program offices agency wide, more Veterans can get the care they need within the VA health care system.

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