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Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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4024 — Implementation through Intermediaries: The Use of Third Party Contractors to Implement the Veterans Choice Program

Lead/Presenter: Andrea Nevedal, COIN - Palo Alto
All Authors: Koenig CJ (Palo Alto Veterans Health Care System) Nevedal AN (Palo Alto Veterans Health Care System) Ellerbe LE (Palo Alto Veterans Health Care System) Asch SM (Palo Alto Veterans Health Care System) Wagner T (Palo Alto Veterans Health Care System)

The Veterans Choice Program (Choice) gives eligible military Veterans the option to receive care from approved non-VA community providers. Choice program implementation requires complex coordination of administrative processes among three medical systems: Veterans Health Affairs (VA); third party administrators or Choice contractors, e.g., TriWest Healthcare Alliance or Health Net Federal Services; and community providers. Our objective was to explore VA primary care providers' experiences referring Veterans to specialty care Choice providers.

As part of an ongoing mixed methods study, we conduct qualitative, semi-structured telephone interviews with a purposive sample of VA primary care providers (n = 56). Participants work in diverse clinical settings, and all but three VA regions are currently represented. Interviews were professionally transcribed verbatim and uploaded into ATLAS.ti for analysis. We used the autocoding function to identify Choice program mentions in interview transcripts. Three experienced qualitative analysts manually reviewed transcripts for additional context and inductively categorized all segments by topic for a descriptive qualitative content analysis.

VA primary care providers described some positive and many negative features of the Choice program specialty care referral process. VA providers observed that Choice contractors provided support for specialty care referrals for services not typically covered by VA, such as Chiropractic, acupuncture, and non-claustrophobic (open) MRIs. However, VA providers experienced challenges with Choice contractors' management of specialty care referrals, including 1) inconsistent Veteran referral case management by Choice contractors; 2) inappropriate referrals to specialists closest to Veterans; 3) delays in processing Choice referrals; 4) inadequate identification of primary consultation questions to Choice specialist providers; 5) inadequate communication among VA, Veterans, and Choice providers; and 6) unfamiliarity with administrative and medical documentation and VA procedures for submitting payment to Choice providers.

The Choice program is an innovative program that facilitates Veteran access to non-VA healthcare. However, implementation of the Choice program faces continued challenges that negatively affect Veteran access to high quality specialty care.

While Choice has the potential to improve access to health care for Veterans, third party intermediaries must improve communication and coordination between VA, Veterans, and non-VA providers to enhance successful Choice program implementation.