title: Authorities and Mechanisms for Purchased Care at the Department of Veterans Affairs.
abstract: The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the authorities and mechanisms by which the Department of Veterans Affairs (VA) pays for health care services from non-VA providers. Purchased care accounted for 10 percent, or around $5.6 billion, of VA's health care budget in fiscal year 2014, and the amount of care purchased from outside VA is growing rapidly. VA purchases non-VA care through an array of programs, each with different payment processes and eligibility requirements for veterans and outside providers. A review and analysis of statutes, regulations, legislation, and literature on VA purchased care, along with interviews with expert stakeholders, a survey of VA medical facilities, and an evaluation of local-level policy documents revealed that VA's purchased care system is complex and decentralized. Inconsistencies in procedures, unclear goals, and a lack of cohesive strategy for purchased care could have ramifications for veterans' access to care. Adding to the complexity of VA's purchased care system is a lack of systematic data collection on access to and quality of care provided through VA's purchased care programs. The analysis also explored concepts of "episodes of care" and their implications for purchased care by VA.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Greenberg
authors.forename: Caroline
authors.initials: C
authors.lastname: Batka
authors.forename: Christine
authors.initials: C
authors.lastname: Buttorff
authors.forename: Molly
authors.initials: M
authors.lastname: Dunigan
authors.forename: Susan L
authors.initials: SL
authors.lastname: Lovejoy
authors.forename: Geoffrey
authors.initials: G
authors.lastname: McGovern
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Pace
authors.forename: Francesca
authors.initials: F
authors.lastname: Pillemer
authors.forename: Kayla M
authors.initials: KM
authors.lastname: Williams
authors.forename: Eric
authors.initials: E
authors.lastname: Apaydin
authors.forename: Clara
authors.initials: C
authors.lastname: Aranibar
authors.forename: Maya
authors.initials: M
authors.lastname: Buenaventura
authors.forename: Phillip
authors.initials: P
authors.lastname: Carter
authors.forename: Samantha
authors.initials: S
authors.lastname: Cherney
authors.forename: Lynn E
authors.initials: LE
authors.lastname: Davis
authors.forename: Amy Grace
authors.initials: AG
authors.lastname: Donohue
authors.forename: Lily
authors.initials: L
authors.lastname: Geyer
authors.forename: Joslyn
authors.initials: J
authors.lastname: Hemler
authors.forename: Parisa
authors.initials: P
authors.lastname: Roshan
authors.forename: Lauren
authors.initials: L
authors.lastname: Skrabala
authors.forename: Stephen
authors.initials: S
authors.lastname: Simmons
authors.forename: Joseph
authors.initials: J
authors.lastname: Thompson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Welch
authors.forename: Susan D
authors.initials: SD
authors.lastname: Hosek
authors.forename: Carrie M
authors.initials: CM
authors.lastname: Farmer