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. 2019 Oct;34(10):2141-2149.
doi: 10.1007/s11606-019-05224-y. Epub 2019 Aug 6.

Experiences with the Veterans' Choice Program

Kevin T Stroupe  1   2 , Rachael Martinez  3 , Timothy P Hogan  4   5 , Elisa J Gordon  6 , Beverly Gonzalez  3 , Ibuola Kale  3 , Chad Osteen  3 , Elizabeth Tarlov  3   7 , Frances M Weaver  3   8 , Denise M Hynes  9   10   11   12 , Bridget M Smith  3   13
Affiliations

Experiences with the Veterans' Choice Program

Kevin T Stroupe et al. J Gen Intern Med. 2019 Oct.

Abstract

Background: To address concerns about Veterans' access to care at US Department of Veterans Affairs (VA) healthcare facilities, the Veterans Access, Choice, and Accountability Act was enacted to facilitate Veterans' access to care in non-VA settings, resulting in the "Veterans Choice Program" (VCP).

Objectives: To assess the characteristics of Veterans who used or planned to use the VCP, reasons for using or planning to use the VCP, and experiences with the VCP.

Design: Mixed-methods.

Subjects: After sampling Veterans in the Midwest census region receiving care at VA healthcare facilities, we included 4521 Veterans in the analyses. Of these, 60 Veterans participated in semi-structured qualitative interviews.

Approach: Quantitative data were derived from VA's administrative and clinical data and a survey of Veterans including Veteran characteristics and self-reported use of VCP. Associations between Veterans' characteristics and use or planned use of the VCP were assessed using logistic regression analysis. Interview data were analyzed using thematic analysis.

Key results: Veterans with a higher odds of reporting use or intended use of the VCP were women, lived further distances from VA facilities, or had worse health status than other Veterans (P ≤ 0.01). Key themes included positive experiences with the VCP (timeliness of care, location of care, access to services, scheduling improvements, and coverage of services), and negative experiences with the VCP (complicated scheduling processes, inconveniently located appointments, delays securing appointments, billing confusion, and communication breakdowns).

Discussion: Our findings suggest that Veterans value access to care close to their home and care that addresses the needs of women and Veterans with poor health status. The Mission Act was passed in June 2018 to restructure the VCP and consolidate community care into a single program, continuing VA's commitment to support access to community care into the future.

Keywords: Veterans; access to care; evaluation; qualitative research.

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Conflict of interest statement

Drs. Stroupe, Gonzalez, Smith, and Weaver received grant funding from Medtronic Neurologic for work unrelated to this manuscript.

All remaining authors declare that they do not have a conflict of interest

Figures

Figure 1
Figure 1
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References

    1. Veterans Access, Choice and Accountability Act of 2014 (“Choice Act” US Public Law 113–146). 2014. Available at: https://www.congress.gov/113/plaws/publ146/PLAW-113publ146.pdf. Accessed May 17, 2019.
    1. Finley EP, Noël PH, Mader M, et al. Clinicians and the Veterans Choice Program for PTSD care: understanding provider interest during early implementation. Med Care. 2017;55:S61–S70. doi: 10.1097/MLR.0000000000000668. - DOI - PubMed
    1. Mattocks KM, Mengeling M, Sadler A, Baldor R, Bastian L. The Veterans Choice Act: a qualitative examination of rapid policy implementation in the Department of Veterans Affairs. Med Care. 2017;55:S71–S75. doi: 10.1097/MLR.0000000000000667. - DOI - PubMed
    1. Department of Veterans Affairs. 38 CFR Part 17. Expanded access to non-VA care through the Veterans Choice Program. Federal Register, Vol. 80, No. 209. Thursday, October 29, 2015: 66420–66429. Available at https://www.govinfo.gov/content/pkg/FR-2015-10-29/pdf/2015-27481.pdf. Accessed May 17, 2019. - PubMed
    1. Department of Veterans Affairs. 38 CFR Part 17. Expanded access to non-VA care through the Veterans Choice Program. Federal Register, Vol. 83, No. 92: 21893–21897. Available at: https://www.govinfo.gov/content/pkg/FR-2018-05-11/pdf/2018-10054.pdf. Accessed May 17, 2019. - PubMed

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