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Publication Briefs

Timeliness of VA Purchased Community Primary Care Did Not Improve Following Early Expansion Under MISSION Act

Congress passed the MISSION Act in 2018, expanding VA’s role as a purchaser of care. It provided for new Community Care Networks (CCNs), which expanded networks of community providers and resulted in an increase of 300,000+ VA-contracted community providers, and instituted CCN network adequacy standards. This study examined whether early CCN implementation impacted community primary care (PC) appointment wait times. Investigators compared wait times before and after CCN implementation for appointments scheduled by VA facilities that did (CCN appointments) and did not (comparison appointments) implement CCNs. Using VA data and other regional area data, investigators identified Veterans (N=32,002) who had community PC appointments (N=54,358:13,720 CCN appointments and 40,638 comparison appointments) from February 2019 through February 2020. The main outcome was wait time for the first community PC appointment, measured as the number of days from a Veteran’s authorization to use community PC to their first appointment. Investigators also examined adjusted estimates that accounted for appointment-level sociodemographic, geographic, and health characteristics, and VA facility-level care coordination scores.


  • Expanded contracting with community providers and new provider network adequacy standards implemented through Community Care Networks did not, in early stages, improve the timeliness of community primary care for Veterans.
  • Wait times increased sharply for both CCN and comparison appointments after CCN implementation, ranging from approximately 30 to 40 days, which is beyond VA’s new urban and rural network adequacy wait-time standard for community care.


  • Re-evaluation of whether current network adequacy standards reflect actual access to purchased community care in rural and urban areas is needed.
  • Research is needed to disentangle the potential impacts of internal staff and process issues from community provider network issues and network adequacy standards on appointment wait times.


  • Investigators did not have information on appointment desired dates and, as such, were unable to determine whether wait times were planned.
  • There were five months of post-CCN data before the COVID pandemic began disrupting care. It will be important to monitor community care wait times after the pandemic subsides and as VA gains more experience managing growing community care volume.

This study was funded by HSR&D (SDR 18-321). Drs. Govier, Edwards, Niederhausen, and Hynes, and Mr. Hickok are part of HSR&D’s Center to Improve Veteran Involvement in Care (CIVIC); Drs. Weaver and Gordon are part of HSR&D’s Center of Innovation for Complex Chronic Healthcare (CINCCH). Drs. Hynes and Weaver are each supported by an HSR&D Research Career Scientist Award. Dr. Edwards is supported by a VA Career Development Award.

Govier D, Hickok A, Edwards S, Weaver F, Gordon H, Niederhausen M, and Hynes D. Early Impact of VA MISSION Act Implementation on Primary Care Appointment Wait Time. Journal of General Internal Medicine. October 28, 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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