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QUERI Evaluates Effects of Veterans Choice Act

The Veterans Access, Choice and Accountability Act ("Choice Act") authorized the expanded availability of non-VA healthcare for Veterans who have difficulty accessing VA healthcare (e.g., Veterans living in rural settings). The Office of Management and Budget (OMB) then asked VA to evaluate the implementation of the Choice Act, which became a joint effort of VA's Office of Analytics and Business Intelligence and the Office of Research and Development (ORD). QUERI also plays a prominent role, with seven evaluation projects.

One of these projects is "A Mixed-Method, Multi-Site Evaluation of the Implementation of the Veterans Choice Act," in which we conducted an in-depth evaluation at three healthcare systems (Denver, Seattle, and Cleveland), which involved two Third Party Administrator (TPA) regions. [TPA is a person or organization that processes claims and performs other administrative services in accordance with a service contract.]

We used geo-spatial analysis to better understand the geographic location of VA facilities and their accessibility to Veterans, given that one of the Choice Act eligibility criteria was for Veterans living 40 miles or more from VA healthcare facilities. To complete this analysis, we needed to access and collect information about changes in geospatial access to care associated with Choice Act use based on the specific specialty in which the Veteran needed care, as well as their residence based on home zip codes. Additionally, we sought information on the location and specialty of non-VA providers seeing patients through the new Choice Program. This required collaboration with various VA offices in order to access data sets that would effectively define access barriers in the context of geographic distance from providers and clinics.

Evan Carey, our lead spatial analyst, established collaborative relationships with the VHA Chief Business Office (CBO) to identify patients that have used the Choice Program, and CBO's Purchased Care to identify non-Veteran care providers. The initial results of this work were shared with Health Care Management in VA Central Office. It demonstrated potential analytic techniques that can be used to optimize the placement of potential new non-VA providers that would improve geospatial access to care for Veterans. Mr. Carey also directly engaged with a group working to create a GIS (geographic information systems) software for widespread sharing of spatial analytical results that would allow decision makers to access the most up-to-date information regarding Veteran's geographic access to care.

These efforts will potentially allow us to improve Veterans' access to care by identifying access care gaps in under-served areas. In addition, these areas may be targets for VA specialty care outreach programs, and could also inform a priority list of where new external providers can be located to optimize access to care for Veterans. The following Figures (1-3) illustrate results from VISN 10, and demonstrate the type of work that was generated from these collaborations.

Evan Carey, MS, and Michael Ho, MD, Principal Investigator, A Mixed-Method, Multi-Site Evaluation of the Implementation of the Veterans Choice Act, and Triple Aim QUERI Program