'Where's My Choice?'
Researchers say Veteran's Choice Program can expand care for Veterans with hepatitis C, but more work needs to be done with care coordination. (Photo for illustrative purposes only, ©iStock/monkeybusinessimages)>
Researchers say Veteran's Choice Program can expand care for Veterans with hepatitis C, but more work needs to be done with care coordination. (Photo for illustrative purposes only, ©iStock/monkeybusinessimages)
Dr. Jack Tsai, an investigator with the VA New England Mental Illness Research, Education, and Clinical Center (MIRECC) in West Haven, Connecticut, and his team interviewed a group of VA providers and Veterans about their experiences in providing or receiving care for hepatitis C through the Veteran's Choice Program.
The study was published in the July 2017 issue of the journal Medical Care.
The Choice Program was created to give Veterans access to community-based care if they live more than 40 miles from a VA health care facility, or are unable to see a VA provider within 30 days. Specialty care for Veterans is also part of the program.
The program employs a system of third-party administrators to help manage the referral process so that Veterans can be treated for hepatitis C in the community. They also serve as the intermediary between VA providers, community physicians, and Veterans—helping with eligibility determination, scheduling visits, records exchange, claims submissions, and payment.
The investigators interviewed in-person or by phone 38 Veterans with hepatitis C and 10 VA health care providers who treat hepatitis C patients, at three different VA medical centers. Interview subjects were randomly chosen from a list of all hepatitis C patients who received their care from VA or the Choice Program.
The interviews were semi-structured and asked Veterans about their hepatitis C care, their experiences with the Choice Program, and perceived barriers to treatment. VA providers were asked about their experiences with the Choice Program, the hepatitis C treatment process, and funding shortages for hepatitis C medications.
Four themes were identified:
1. Difficulties in enrollment, support, and billing with third-party administrators.
2. Lack of choice about the location of hepatitis C care (VA providers vs. community providers).
3. Fragmented care that led to care coordination challenges between VA and community providers.
4. Uncertainty about referring care to community providers among VA providers.
"The Choice Program has the potential to increase Veteran access to HCV treatment, but Veterans and VA providers have described substantial problems in the initial years of the program," the researchers wrote. "Enhancing care coordination, incorporating shared decision making, and establishing a wide network of community providers may be important areas for further development in designing community-based specialist services for needy Veterans."
Veterans who seek health care through the Veteran Health Administration (VHA) have three times the rate of hepatitis C, compared with the general U.S. population (9.5 percent vs. 2.4 percent). The volume of patients who need care for hepatitis C and the cost for newer, but significantly more expensive, drugs to treat the virus have placed a greater demand on the VHA to provide and pay for appropriate care for this population.