Community Care Program Lacks Essential Data for Health Care Decisions

Recommendations to Assure the Quality of VCCP Care

With review and revision of VCCP quality standards now underway, the following remedial actions are recommended:

1. VCCP metrics must be compiled using data on veterans’ care, not the general population, and be published on the Access to Care website. This indispensable information is published on the website for VA care but not for VCCP. Unless VCCP is required to track their veterans, apples-to-apples comparisons of quality of care will remain difficult to attain. Supplemental research that directly contrasts quality of VA to VCCP care should be posted. For example, a 2021 study of enrolled veterans brought by ambulance to VA or community emergency rooms found that all 170 VA medical centers had lower comparative death rates.
2. VCCP providers should be held to the same quality standards as those applied to VA clinicians. In a 2020 critical issue update on implementation of the MISSION Act, major veterans service organizations (VSOs) recommended that competency, training, and quality standards for non-VA community clinicians must be equivalent to benchmarks expected of VA clinicians. That includes credentials, initial and follow-up training, diagnostic screening, care-delivery, and documentation standards. Enacting the Veterans’ Culturally Competent Care Act and the Lethal Means Safety Training Act would begin to meet the MISSION Act’s clear statutory language.
3. The VA and VCCP should add quality information about major diagnostic categories. This will allow veterans to make informed decisions about their personal condition. For most health diagnoses, there is no searchable listing by disorder. 
4. Quality assessments should be realigned to focus on outcome measures. For prospective patients, outcome results provide the most meaningful basis for comparing and selecting clinicians. Proxy measures may have little bearing on whether veterans receive effective care. (As Albert Einstein’s famously observed, “Not everything that can be counted counts.”). Also, the specific measures used for a clinician’s HPP designation should be delineated.
5. The VA must enforce the MISSION Act’s instruction to renew or cancel contracts based on demonstrated quality of care. As VSOs emphasized, “if the private sector is unwilling or unable to match the VA’s access and quality standards, the VA must consider whether it needs to find new community partners.”  

Seventeen billion dollars is spent yearly on purchased health care whose quality remains indeterminate. Ironclad commitments are needed from Congress and the VA to ensure that the effectiveness of, and standards for, veterans care options in the private sector match that in the VA.