The Veterans Choice Act: A Qualitative Examination of Rapid Policy Implementation in the Department of Veterans Affairs.
Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 [Veterans Choice Act (VCA)] to improve access to timely, high-quality health care for Veterans. Although Congress mandated that VCA must begin within 90 days of passage of the legislation, no guidelines were provided in the legislation to ensure that Veterans had access to an adequate number of community providers across different specialties of care or distinct geographic areas, including rural areas of the country.



To examine VCA policy implementation across a sampling of Veterans Health Administration (VHA) Medical Centers.



We conducted a qualitative study of 43 VHA staff and providers by conducting in-person interviews at 5 VA medical centers in the West, South, and Midwest United States. Interview questions focused on perceptions and experiences with VCA and challenges related to implementation for VHA staff and providers.



We identified 3 major themes to guide description of choice implementation: (1) VCA implemented too rapidly with inadequate preparation; (2) community provider networks insufficiently developed; and (3) communication and scheduling problems with subcontractors may lead to further delays in care.



Our evaluation suggests that VCA was implemented far too rapidly, with little consideration given to the adequacy of community provider networks available to provide care to Veterans. Given the challenges we have highlighted in VCA implementation, it is imperative that the VHA continue to develop care coordination systems that will allow the Veterans to receive seamless care in the community.
*VA Central Western Massachusetts Healthcare System, Leeds †Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA ‡Center for Comprehensive Access & Delivery Research and Evaluation (CADRE) §VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Central Region (VRHRC-CR), Iowa City VA Medical Center Departments of ∥Internal Medicine ¶Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA #VA Connecticut Healthcare System, West Haven **Department of General Internal Medicine, Yale University School of Medicine, New Haven, CT.
Kristin M
KM
Mattocks
Michelle
M
Mengeling
Anne
A
Sadler
Rebecca
R
Baldor
Lori
L
Bastian
D004608:Eligibility Determination; D006078:Government Programs; D019983:Guideline Adherence; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D007407:Interviews as Topic; D011050:Policy Making; D036301:Qualitative Research; D014481:United States; D014493:United States Department of Veterans Affairs / Q000331:legislation & jurisprudence*; D058014:Veterans Health