The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (Mission) Act and Community Care: Progress, Opportunities, and the Path Forward
Introduction/Background: The VA Health Care System was established in 1930 and Community Care (CC) for veterans has been available since 1924. Prior to 2014 CC was only utilized for veterans’ Care in exceptional cases. The passage of the VA Choice Act in 2014 and the VA Mission Act of 2018 rapidly increased the availability of CC to veterans. This study is the first that utilizes a macro historical perspective combined with an empirical examination of the impact of the increased use of CC under the VA Mission Act post-program implementation and offers recommendations for a path forward. Methods: An analysis examining the use of community care in the VA with a focus on the VA Mission Act that encompasses both the macro level of policy development and the micro level of program implementation. Results: The initial results following the implementation of the VA Mission Act were mixed. Greater options for care in the community and increased opportunities to obtain care via telehealth were enhancements to the care system. Disparate impact, challenges with care coordination, the need for increased support services and the lack of a readily accessible common set of performance metrics offer opportunities for improvement. Discussion: Proposals to effectively improve the VA Mission Act must be empirically driven, encompass both the macro and micro levels, and keep patient care as the centerpiece. Integral to achieving this goal will be a deliberate long-range plan that involves all internal and external stakeholders and facets of care delivery that considers all the potential indirect and direct impacts on the care being provided to veterans.