Optimizing Veteran Decision-Making About Use of VA and Non-VA Health Care

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Background: Major health care transformations within and outside of VA are now providing Veterans with unprecedented health care choices. Within VA, under recent federal legislation integrated networks of community providers and public reporting of access and quality at VA facilities are aiming to expand health care choices for Veterans and improve the timeliness of services. Outside of VA, many lower-income Veterans in states that expanded Medicaid now have a public insurance option, while privately-insured Veterans are increasingly facing high deductibles in their health plans. Significance/Impact: Major shifts in health care financing and delivery present Veterans with opportunities to make decisions about their use of VA and non-VA health care that optimize the timeliness, affordability, quality, and patient-centeredness of their care. However, these decisions also carry great potential for unintended consequences if they are not well-informed. Despite such high stakes, little is known about how Veterans are making decisions about using VA and non-VA care, what information they want to use in this decision-making, and how provision of information to Veterans about their health care options could be improved. Understanding these issues is critical to the success of national efforts to expand health care choices for Veterans under the VA MISSION Act and to achieve a VA health care system that is maximally responsive to Veterans’ needs. Innovation: This study is the first to assess the views, experiences, and information needs of Veterans who are users and non-users of VA health care. Specific Aims: Aim 1: Examine how Veterans are making decisions about VA and non-VA care and what information they want to use when making these decisions. Aim 2: Identify correlates of Veterans’ decisions to use and experiences with using VA and non-VA health care. Aim 3: Engage Veterans and VA leaders to identify opportunities to optimize Veterans’ decisions about use of VA and non-VA care and VA’s responsiveness to Veterans’ health care preferences. Methodology: We will partner with Veterans organizations to conduct focus groups and semi-structured interviews that will examine decision-making experiences of Veterans who use VA care, non-VA care, or both; the sources of information Veterans have used and would want to use in this decision-making; and Veterans’ experiences with the timeliness, affordability, quality, and patient-centeredness of VA and non-VA care. We will use these findings to develop and field a national survey of Veterans’ use of and decision-making about VA and non-VA care; factors related to their decision-making and health needs; and perceptions of the timeliness, affordability, quality, and patient-centeredness of their health care. The nationally representative sample of 3,000 Veterans will include both users and non-users of VA health care. We will identify Veteran characteristics associated with use of VA and non-VA health care services and with their health care experiences in VA and community health care settings. Finally, we will conduct deliberative forums with Veterans and VA operational leaders to develop actionable strategies that can be used to support Veterans’ decisions about VA and non-VA health care. Using a combination of deliberation and design methods, we will share key findings from the first 2 Aims and then guide participants through a collaborative process in which they will identify and prioritize programs and policies that could support Veteran decision-making about use of VA and non-VA care. Next Steps/Implementation: Products will include a compendium of the types of information Veterans use and need for decision-making about VA and non-VA care, new survey measures to assess Veterans’ decisions about VA and non-VA care, and a prioritized list of programs and policies that could be implemented to help Veterans make decisions about VA and non-VA care. We will use these products to work with our VA and non- VA partners to develop new strategies to optimize Veteran decision-making about VA and non-VA care.