Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4022 — Examining Women Veterans' Perceptions, Experiences and Satisfaction with the Veterans Choice Program (VCP)

Lead/Presenter: Kristin Mattocks, COIN - West Haven
All Authors: Mattocks KM (VA Central Western Massachusetts Healthcare System) Brown AN (VA Central Western Massachusetts Healthcare System) Bastian LA (VA Connecticut Healthcare System)

Objectives:
Women Veterans must often rely on non-VA care for gender-specific health services. The aim of our study was to examine women Veterans' experiences with care coordination, perceived quality, and satisfaction with the Veterans Choice Program (VCP).

Methods:
We rank-ordered all VA facilities in the proportion of women Veterans who received non-VA (fee basis) care in FY14. We divided all VA facilities into tertiles according to the highest, medium, and lowest utilization of fee basis care in FY12, then randomly selected five facilities from each tertile and sent letters of invitation to all women Veterans who received non-VA care at that facility in FY14. Telephone interviews were conducted with women Veterans who expressed interest in the study. Given that VCP launched in September 2014, we modified the interview guide to include extensive questions on VCP in addition to traditional fee basis care.

Results:
One hundred and fifty women Veterans who received care from 15 VA Medical Centers (VAMCs) were interviewed. These VAMCs represented 11 VISNs and both urban and rural locations across the United States. The majority of participants were white (70%), married (48%), retired or disabled and not working (62%), had no service-connected disability rating (61%), and rated their health as good or better (65%). Overall, 42% of participants had used VCP care. Among those that received VCP care, four major themes emerged: (1) responsibility for non-VA care coordination fell on the shoulders of women Veterans; (2) communication between VA and VCP providers was poor, leaving VA providers with inadequate knowledge of the care women Veterans received from VCP; (3) women Veterans often bounced back and forth between VA and VCP, causing substantial delays in care, and (4) mounting unpaid bills for VCP care sent many women Veterans to collections, which were unable to be resolved for up to a year after receiving VCP care.

Implications:
Women Veterans experienced substantial challenges with VCP since its inception. Problems related to care coordination and billing were among the most important concerns for women Veterans.

Impacts:
While VHA has made progress providing women Veterans expanded access to timely health care through VCP, there is still opportunity to further improve the program. Developing systems to improve care coordination so all coordination doesn't fall squarely on the shoulders of women Veterans would substantially improve overall perceptions and satisfaction with VCP.