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Innovation Update

Development of a New Measure to Assess the Adequacy of VA Outpatient Provider Options

Delivering timely, accessible, high-quality healthcare to Veterans is a top VA priority, reiterated in VA’s Fiscal Year 2022-2028 Strategic Plan. Consistent with this goal, Veterans have the choice of receiving care from outpatient provider options at over 900 VA facilities nation-wide. Eligible Veterans also have the choice of care options available through the Veterans Community Care Program (VCCP).

To date, the adequacy of provider options available to Veterans has been captured using objective measures such as appointment wait times and driving distance. However, these measures, when used to inform decision- making, are frequently considered in isolation and ignore other factors that infuence Veterans’ desired choice of provider. For example, Fortney et al. (2011) demonstrate that provider access is determined by a wider set of considerations, including fnancial, cultural, and digital.¹ This prior research also points to the importance of how dimensions of access are perceived in Veterans’ choice of provider. Additionally, theory indicates that the attributes of providers such as gender concordance and clinical quality infuence provider selection.

Research currently being conducted as part of a VA HSR&D merit award study titled “Measuring the Value of Improving Access to Community Care” seeks to address existing limitations in the measurement of access to VA provider options. Within this project, our study team at the Seattle-Denver Center of Innovation is developing econometric methods that measure the value of access to outpatient provider options within VA and through VCCP from the perspective of Veterans. These econometric methods measure Veterans’ revealed preferences for provider attributes (e.g., travel time, wait time, gender concordance, clinical quality) and use VA administrative data to observe the tradeoffs that Veterans make when choosing providers. By understanding tradeoffs between indirect costs (e.g., travel costs, opportunity costs of time) and other provider attributes, our econometric models estimate an overall monetary value that Veterans derive from the provider options available in their local market area. The advantage of the proposed methods is the ability to measure Veterans’ perceived value simultaneously across multiple provider attributes into a single, easily interpretable, composite access measure. Early results from this study were  presented at the 2022 AcademyHealth Annual Research Meeting in Washington, DC.

The new approach to measuring access to provider options in this study will yield insights in at least two areas. First, model estimates will identify how much weight is placed on different provider attributes nherent in Veterans’ choice of provider and will describe differences in these preference weights by geographical region. Second, products from this study represent a potential approach for VA and non-VA stakeholders to compare the desirability of provider options to an enrollee population, which can inform areas where provider networks are potentially inadequate and require more options. For VA, this may include greater use of community providers through VCCP. To enable this, simulation models are currently being developed to allow stakeholders the ability to examine access under “what-if” scenarios, such as the addition of providers with specifc attributes in user specifed locations.

Reference

1. Fortney JC, Burgess JF, Jr., Bosworth HB, Booth BM,. “A Re-conceptualization of Access for 21st Century Healthcare,” Journal of General Internal Medicine 2011; 26 Suppl 2:639-64.