Challenges in Accessing Community-Based Care for Veterans

The Veterans Health Administration (VHA), a crucial component of the US Department of Veterans Affairs (VA), plays a pivotal role in providing health care services to eligible veterans across the US. This integrated health care system comprises 171 medical centers and 1,113 outpatient sites, serving a substantial portion of the veteran population. In 2021, over 9.2 million veterans, approximately half of all living US veterans, were enrolled in VHA, with around 6.8 million receiving health care through VHA. However, access to community-based care in conjunction with non-VHA providers presents numerous challenges, according to an article published in Rand Health Quarterly.

Veterans who utilize VA health care (eg, VHA patients) are a complex group characterized by a higher prevalence of serious health conditions than nonveterans and veterans not using VA health care. Eligibility for VA health care benefits is determined by factors such as military service duration, service-related health conditions, and income, which get sorted into VHA enrollment priority groups based on these criteria. VHA patients frequently present with service-related injuries and chronic health issues, including traumatic brain injury, cancer, diabetes, hypertension, and posttraumatic stress disorder.

Even though there is a decline in the veteran population, the number of veterans relying on VHA has increased. And, despite expanding community care, such as the Veterans Choice and VA Mission Acts (enacted in 2014 and 2018), community care has become an increasingly significant component of veterans' health care, accounting for a substantial portion of VHA's health services, with costs rising from $7.9 billion in 2014 to $18.5 billion in 2021. Yet, questions remain about the cost and quality compared to VHA-delivered care. Some research suggests that community care may be more expensive than VHA care, primarily due to a lack of control over community care practices.

While community care intends to reduce wait times, studies indicate that veterans have yet to experience shorter wait times for appointments consistently, even though the health system relies on effective coordination with non-VHA providers to share information. This dynamic presents challenges, such as patient confusion, redundant tests, increased costs, and lower-quality care. The COVID-19 pandemic exacerbated some of these challenges. Limited data are available on whether access to community care is significantly better than access to VHA facilities. It is worth noting, according to coauthors, that community care providers may not always be equipped to meet the unique needs of veterans, who often present with specific health issues related to military service.

Training is available for community care providers to enhance their cultural competency and familiarity with veterans' health care issues, but uptake of this training still needs to be improved.

"As Secretary of Veterans Affairs Denis McDonough recently stated, the future of VHA depends on its ability to attract veterans to its facilities and—through high-quality, accessible services—keep those veterans returning to VHA for their needed medical care," said coauthors.

While community care has expanded access to care, questions remain about its cost, quality, and impact on veterans' access and outcomes. "Coordinating with community care providers and ensuring that eligible veterans can access the high-quality care they need in a timely fashion, whether at VHA facilities or in the community, will be integral to achieving those goals," said coauthors.

Reference

Rasmussen P, Farmer CM. The promise and challenges of VA community care: veterans’ issues in focus. Rand Health Quarterly. 2023;10(3):9. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10273892/