The 40+ Mile Choice Cohort: Sociodemographics, VA Health Care Use and Safety Net Provider Access

Mengeling M, Franciscus CL, Sadler AG. The 40+ Mile Choice Cohort: Sociodemographics, VA Health Care Use and Safety Net Provider Access. Paper presented at: VA Rural Health State of the Science Conference; 2016 Sep 12; Washington, DC.

Objectives: The Veterans Choice Program (Choice) expanded VA-provided health care by allowing Veterans, who face barriers to VA care, access to non-VA health care providers. Choice eligibility addresses: 1) timeliness of appointment scheduling ('wait time') and 2) travel burdens ('mileage'). We sought to characterize the largely rural mileage-eligible cohort by examining their sociodemographic characteristics, prior VA health care use, and availability of local safety net providers. Methods: The VA's Chief Business Office, Systems Management Office identified the Choice population (April 2015). Veteran-level VA data sources were merged by social security numbers. Safety net provider information was obtained from the Health Resources and Services Administration Data Warehouse. ARCGIS software was used to compute distances from Veterans' residence to nearest safety net providers (i.e., Federally Qualified Health Centers (FQHCs), FQHC Look-Alikes, Critical Access Hospitals, Community Mental Health Centers, and Rural Health Clinics). Results: Over one million VA-enrolled Veterans are eligible for Choice; the majority (58%) are mileage-eligible. Women make-up 5% of the mileage-eligible cohort but 10% of VA health care users. The median age of mileage-eligible males is 67 years; 51 years for females. Approximately half live in rural and isolated rural areas. Half have a service connection (46% men; 55% women). Ten percent served during OEF/OIF. MyVA Region 3 (Midwest) has the most mileage-eligible male Veterans, whereas MyVA Region 5 (West) has the most female Veterans. In 2014, less than 4% had at least 1 VHA inpatient stay and approximately 1% received inpatient purchased care. Two-thirds had at least one outpatient visit days (median = 3) and a fifth received outpatient purchased care. The majority of mileage-eligible Veterans (85%) have access to a FQHC/FQHC Look-Alike healthcare facility within 40 miles of their residence, but this varies by state. Region 3 (Minnesota, Nebraska, Iowa, Kansas) and Region 4 (Texas) states have the greatest number of mileage-eligible Veterans without access to a FQHC within 40 miles. Access to Community Mental Health Centers ranges from 3% to 34% among MyVA Regions. Conclusions: The characteristics, health care use, and the extent of the safety net represent baseline information for this cohort. Next steps require examining how Veterans choose to participate and evaluating Choice implementation. Impacts: Choice leverages the national health care system in order to provide Veterans increased access through VA/non-VA partnering; however this data identifies a subpopulation of rural Veterans who may have limited access to both VA and non-VA providers.