Before committing to referring veterans to community care, we recommend a thorough review of what health care services are available in the community. This review should also consider:
Whether community providers are equipped and trained to provide treatment in the context of common comorbidities in the veteran population (eg, traumatic brain injury [TBI], posttraumatic stress disorder [PTSD])44 Whether local veterans have preferences for VA versus community care (eg, based on local transportation options) The extent to which services may be available via telehealth from other VA sites. For example, VA has funded a series of telehealth hubs4 and a National Telemental Health Center5 that can provide specialized services across state lines—services that may be easier to arrange than community care. The average wait times associated with those community services. In some cases, community care may involve longer wait times than would be experienced within VA.
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Before committing to shared care between health care organizations we recommend careful consideration of:
Potential differences between the patient populations traditionally treated by each organization (eg, comorbid conditions, symptom severity), and the implications of those differences for shared care Logistical considerations relevant to accessing care, such as transportation (for in-person visits) or hardware/software/connectivity (for telehealth) Variability in average wait times between the 2 organizations
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We recommend considering the amount of coordination that will likely be required to maintain ongoing health care services across institutions.
For example, referring veterans for dental care in the community may require little direct contact between clinicians at either institution. In contrast, if ongoing coordination is needed, we recommend explicitly establishing who within VA has primary responsibility for that coordination, and whom to contact at the community site. Succession plans for these key staff may minimize the impact of turnover or reassignment.45
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We similarly recommend considering the amount of coordination that will likely be required to maintain ongoing health care services across organizations. These may include:
Considering who within each organization has primary responsibility for coordinating the patient’s care at that institution Considering which organization overall has primary responsibility for the patient’s care, and how care coordination staff at that organization will communicate with their counterparts within the other organization(s) Developing succession plans for key care coordination staff to prevent loss of institutional knowledge
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| Veterans, VA staff, and community staff expressed a desire for increased medical record interoperability between VA and community providers. It is uncertain how the upcoming transition of the VA medical record system to the Cerner platform46 will impact such interoperability. |
Health Information Exchanges (HIE) can increase the ease with which providers at different organizations can communicate regarding patient care |
