A Qualitative Study of VA Stakeholders’ Experiences Discussing Community Care with Veterans

Abstract Background: Veterans have access to community care, which is covered through Veterans Health Administration (VHA) benefits. However, in 2018, the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act (Government bill S.2372) was passed, which allows for more Veterans to be eligible for the VHA-purchased health care provided by community clinicians (i.e., “community care). The current study aims to describe the process of community care coordination, assess experiences of Veterans Affairs stakeholders around patient decision-making for where to receive care, and identify opportunities for improvement. Methods: Primary interview data were collected from VA clinicians and staff across the United States between February and October 2020. We conducted qualitative interviews with 20 clinicians and staff involved in Veterans’ decisions about where to receive their health care. We focused on experiences with the MISSION Act; communication with Veterans about care options; and suggestions to support decision-making related to community care. We professionally transcribed and de-identified the interviews. We utilized a rapid analysis process of the transcripts.Results: First, participants reported having insufficient time or knowledge to help Veterans make decisions about receiving community care. Second, participants were concerned about the quality of care outside of VA. Third, the referral process is complicated, and it would be helpful for clinicians and patients to have more access to information about the process. Lastly, coordination and continuity of care are highly important aspects of care but were hard to manage when patients use community health care. Participants worried that patients may not realize the implications of using community health care.Conclusions: Veterans need to be able to make informed choices about where to receive their health care and may require decision support that integrates their informational needs with their values and preferences surrounding health care quality, coordination, and Veteran-centeredness. VA may be able to leverage existing decision support tools that incorporate patient preferences and values, modify them to include data on the quality of VA and community care and implications of choosing community health care.