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Publication Briefs

Study Shows Differences between VA- and Community-Provided Behavioral Healthcare

Since implementation of the Choice Act of 2014 and MISSION Act of 2018, more than 31% of nearly 9 million VA enrollees have received community care referrals. Implications of this transition are unclear for patients with behavioral health needs, who represent over 25% of Veterans receiving VA primary care. Historically these Veterans have relied on VA for behavioral healthcare, including treatment for psychiatric and substance use disorders. VA providers are trained in evidence-based therapies for behavioral health, as well as military cultural competence. This retrospective cross-sectional study examined differences in the amount and type of behavioral healthcare delivered in VA and purchased in the community, as well as patient characteristics and area supply/demand factors. Using VA data, investigators identified 204,094 Veterans enrolled in VA healthcare with 448,648 inpatient behavioral health stays and 3,467,010 VA enrollees with 55,043,607 outpatient behavioral health visits from FY2016 through 2019. Patient and provider characteristics for VA and community care were examined.


  • More than 25% of Veterans receiving inpatient behavioral healthcare used VA-purchased community care, but severe behavioral conditions were treated more frequently in VA.
  • Only 4% of Veterans received outpatient behavioral healthcare in the community, but they saw less highly-trained providers. There were more highly-trained specialists, namely psychiatrists/behavioral neurologists (22% vs. 10%) and psychologists (25% vs. 18%) treating Veterans in VA compared to those treating Veterans in the community. There also was a greater presence of social workers in VA than in community care (36% vs 15%).
  • The top two services provided during VA outpatient visits were group psychotherapy (14%) and individual psychotherapy (9%). The top two services provided in community care were individual psychotherapy (47%) and methadone administration (15%).


  • Coordination between VA and community care providers is needed to ensure continuity and quality of outpatient behavioral healthcare, as well as follow-up care after inpatient behavioral health stays.


  • It is possible that VA providers code care differently than community providers; however, whether coding practices would affect findings is unknown.

This study was funded by HSR&D (SDR 18-318); Dr. Vanneman is supported by an HSR&D Career Development Award, Dr. Rosen by an HSR&D Senior Research Career Scientist award, and Dr. Wagner by a Research Career Scientist award. Dr. Vanneman is part of HSR&D’s Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0). Dr. Rosen is with HSR&D’s Center for Healthcare Organization and Implementation Research (CHOIR), and Dr. Wagner leads HSR&D’s Health Economics Resource Center (HERC).

Vanneman M, Rosen A, Wagner T, et al. Differences between VHA-Delivered and VHA-Purchased Behavioral Health Care in Service and Patient Characteristics. Psychiatric Services. August 30, 2022; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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