New York State Example
The U.S. Department of Veterans Affairs (VA) is responsible for the government's obligation to provide health care to U.S. veterans. However, not all veterans are eligible for VA care. In addition, veterans who are eligible for veterans' care often rely on multiple sources, including veterans' care paid for by the VA but provided by non-VA providers and care that veterans purchase from private providers.
Thus, private providers are an increasingly important part of the care workforce for veterans, a clinically complex population with higher rates of certain mental and chronic illnesses and higher rates of suicide than the general population.
The evaluation examined three aspects of provider capacity:
- Timeliness of care-do providers accept new patients and do patients receive appointments within two weeks?
- Is the care culturally competent-are providers familiar with the military culture and how might this affect veterans' willingness to receive care?
- Quality of care – Do providers routinely screen for conditions such as suicidal ideation, which are more common among veterans than the general population, and do they follow evidence-based guidelines?
Providers' knowledge of military culture is uneven
Knowledge of military culture can help providers understand how a veteran's background has affected his or her current health status and help build a good provider-patient relationship. However, only 19% report regularly asking patients about their military history, and only one in three providers meet the minimum standard for knowledge of military culture.
Mental health providers were the most likely to be familiar with different aspects of military and veteran culture, while medical and nursing professionals were the least likely to report familiarity.
Quality of care differs
We asked how often municipal health care providers check for certain common health problems among veterans (e.g., sleep problems, pain problems, physical ailments).
We found that only 43% of providers reported routinely screening for certain health problems, and 1% of providers reported routinely performing such screenings. However, 70% of providers reported using clinical practice guidelines when making treatment decisions, suggesting the use of evidence-based care.
Access to timely care is not a major concern
- 92% – Nearly all New York providers reported accepting new patients.
- 61% – Most reported that new patients are seen within two weeks of making an appointment.
- 45% – Nearly half of respondents report that most patients get same-day appointments. If these reports are true, timely access to health care in the community DeepL should not be a major problem for New York veterans.
Seven dimensions of quality care were analyzed and graded thresholds were defined to assess the overall readiness of providers to deliver quality, culturally competent, and timely care. Although 92% of New York City healthcare providers accepted new patients, only 2.3% met all seven threshold criteria.
Improve the capacity of private providers to serve veterans
1. Awareness and preparedness for military culture and service-related health issues
Although many campaigns and programs have been organized to educate applicants about military culture, the participation rate has been low at around 12%. Furthermore, our study revealed that participation in a program does not guarantee that applicants are culturally competent.
This problem could be addressed by introducing a post-training test to demonstrate cultural competence. To this end, some organizations focused on improving competency have discussed how to include relevant questions on medical boards or state licensing and certification exams to encourage providers to learn the material.
2. Improve Screens
Fewer than half of providers reported routinely screening veterans for common conditions, exposures, or other clinical and functional problems. Screening should be expanded to include questions about current or past military affiliation and appropriate follow-up for any service-connected health problems requiring attention.
If new awareness campaigns are considered to improve screening, the range of questions could be expanded. It is not enough to ask about current or past military service: additional questions are needed to ensure that veterans' health problems are properly identified and treated.
3. Improve veterans' engagement with available resources
As the Veterans Administration and Congress continue to debate the potential expansion of community-based care for veterans, it is important to keep these findings in mind.
While the primary goal of community-based but VA-funded care is to facilitate VA referrals to the community, there are situations in which community providers must refer eligible patients to the VA. However, the majority (72%) of New York City health care providers did not know how to refer patients to the VA.
In addition, only one in five were aware of VA community care programs or had treated VA patients. To ensure consistency and coordination across sectors, efforts should be made to educate community health care providers and VA providers on how best to share information and refer patients.
Awareness strategies should include specific information about the type and quality of services provided by the IL. In particular, it is important to help community providers identify when it may be helpful to refer a patient to an IL or other provider with specialized expertise in the community.
As VA continues to work with third-party administrators to coordinate care with private providers (as in the Veterans Choice program), this information can be incorporated into provider referral toolkits and materials.
4. Establish quality control
A quality monitoring and management system for community providers serving veterans would allow for ongoing assessment of provider capacity and capability. The system would help identify strengths and opportunities for improvement and make decisions about including or excluding providers from the VA provider network. VA could establish its own internal control and management standards for the third parties that manage the care networks it acquires.
This study is the first to assess the ability of nonveteran health care providers to provide quality, culturally competent, and timely care to veterans. Most New York healthcare providers reported that they are able to provide timely care and follow clinical guidelines.
However, most reported that they know little about the military or veterans, that they do not routinely screen veterans for common illnesses, and that they are unaware of the VA or initiatives to expand access to community care for veterans who are members of the VA.
Training programs to increase providers' military cultural competency and knowledge of the VA, as well as efforts to encourage providers to screen veterans for common service-connected illnesses, could improve the preparedness of health care providers across the country.
As VA and Congress continue discussions on the potential expansion of care to veterans in the community, it will be critical to take these findings into account to determine whether veterans are receiving the same level of care they received at VA facilities.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.