March 1, 2018
Only about 2 percent of the physicians and other health care providers in New York State are equipped to provide timely and quality care to veterans in the community, according to a new RAND Corporation study.
Scoring the civilian medical workforce across seven measures of readiness to treat veterans, the study found that most providers fell short on items such as being familiar with the military culture or routinely screening for conditions common among veterans.
The study is the first to gather information about the readiness of community-based providers across a wide array of professional types to address the health needs facing veterans. The issue is important because federal officials are considering whether to encourage more veterans to use their benefits to receive care in the community rather than from the Veterans Affairs health system.
“These findings reveal significant gaps and variations in the readiness of community-based health care providers to provide high-quality care to veterans,” said Terri Tanielian, the study's lead author and a senior behavioral scientist at RAND, a nonprofit research organization. “It appears that more work needs to be done to prepare the civilian health care workforce to care for the unique needs of veterans.”
New York State is home to more than 800,000 veterans, half of whom are younger than 65 years of age. The VA spends about $6.3 billion annually on benefits and services for veterans in the state, with nearly one-half spent on medical services.
The New York State Health Foundation asked RAND to assess the readiness and capacity of the state's civilian health workforce to deliver high-quality care to veterans.
“We know from earlier RAND research that about half of New York's veterans prefer to get care in their own communities, rather than at the VA,” said David Sandman, president and CEO of the New York State Health Foundation. “Given this demand for community-based care, we wanted to better understand whether providers are prepared to meet veterans' needs. This report offers both a snapshot of where we are today and a roadmap for improvement.”
The study is based on a survey of 746 health care providers from across the state, who were asked about their practice habits and familiarity with the VA health system. Those questioned included physicians, nurse practitioners, psychologists and other types of licensed health professionals.
Health providers were asked about seven measures of readiness: whether they were accepting new patients, whether they were prepared to treat conditions common among veterans, whether they used clinical practice guidelines in providing care, whether they screen for conditions common among veterans, whether they accommodate patients with disabilities, whether they were familiar with military culture, and whether they screen patients for military and veteran affiliation.
Researchers developed the measures of preparedness by consulting the medical literature about issues important for offering high-quality and timely care to veterans.
While more than 90 percent of the health providers said they could accommodate new patients, the proportion of providers prepared to care for veterans falls sharply as researchers applied the other measures across the health workforce.
Apart from whether providers are ready to provide high-quality care for veterans, researchers found that it may be difficult for veterans in New York to find health providers prepared to accept VA coverage.
Fewer than 5 percent of the health care providers surveyed reported being part of VA Community Care, the network of providers who accept VA benefits. Mental health providers were the least likely to be enrolled in the program.
Researchers suggest that training programs are needed to increase health providers' military cultural competence and knowledge of the VA. In addition, efforts are needed to encourage providers to appropriately screen veteran patients for common service-connected conditions.
The study, “Ready or Not? Assessing the Capacity of New York State Health Care Providers to Meet the Needs of Veterans,” is available at www.rand.org. Other authors of the study are Carrie M. Farmer, Rachel M. Burns, Erin L. Duffy and Claude Messan Setodji.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on health care costs, quality and public health preparedness, among other topics.