Improving VHA’s Approach to Community Care: Lessons Learned From an Imperfect Hepatitis C Choice Program

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To the Editor:
The July 2017 Medical Care Supplement on early Choice Act Veterans Choice Program (Choice) implementation highlighted the challenges of rapid policy implementation in a large health care system such as the Veterans Health Administration (VHA). The early implementation of Choice had many problems: inadequate staffing, miscommunication between VHA and third-party administrators, and Veteran confusion about the purpose of Choice, including frustration with the administrative requirements to receive community care. We asked whether VHA had acted as the learning health care organization that it strives to be as it responded to the shortcomings of Choice. In the search for an answer we considered the care of Veterans with hepatitis C virus (HCV). In the 2017 Medical Care Supplement, our results showed that Choice infrastructure in 3 states was not robust enough for the rapid influx of HCV patients needing community care, which led to long delays, frustration, and confusion among Veterans, Veterans Affairs health care providers, and community HCV providers.1
Since we published our results, VHA has made substantial progress in reforming its approach to community care. The Table 1 below illustrates the problems we uncovered in our interviews with HCV Choice stakeholders, and some of the ways that the VHA Office of Community Care has addressed those shortcomings by creating a new operating model for Veterans Affairs community care. The model’s principles are: clear roles and responsibilities, consistent processes and procedures, active partnerships, standardized care coordination, and responsive customer service.
Access to community care outside of VHA facilities, when properly implemented, has the potential to be of great benefit to Veterans in need of specialty services like treatment for HCV. As community care programs and contracts continue to improve, we look forward to evaluating progress so that VHA can further improve treatment experiences and outcomes for Veterans.

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