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Serving 2.8 million veterans at a $23.9 billion cost in FY2023, the VA Community Care Program expands healthcare access by partnering with local community providers while ensuring quality healthcare that complements the VA's core services. |
Committed to providing high-quality healthcare to millions of veterans, the Department of Veterans Affairs (VA) has been statutorily allowed to grow the care it provides beyond the brick-and-mortar local Veteran Affairs Medical Centers (VAMCs). This evolution includes granting authorization to individual veterans to receive care in their local community from private medical providers. Managed by the Veterans Health Administration (VHA) Office of Integrated Veteran Care (IVC), the VA Community Care Program offers an alternate avenue for veterans to access timely healthcare and greater flexibility when appropriate.
A key component of the VA Community Care Program is the seamless care coordination between the private provider and the VA. Through information sharing systems and established lines of communication, the VA remains fully involved in the care and treatments the veteran receives. For example, Community Care providers must adhere to the VA formulary and, with rare exception, prescriptions must be filled at the VAMC or through the VA’s Consolidated Mail Outpatient Pharmacy (CMOP).
The VA continuously adds new providers to its network and evaluates the care provided by existing providers. Private providers interested in joining the VA’s Community Care Network (CCN) must sign up through the VA’s third-party administrators. Through a process of auditing provider claims, completing performance assessments, and confirming communicated best practice adherence, the VA ensures patient satisfaction as well as guarantees the provider follows VA’s quality standards.
Since the program was first initiated, there has been a significant expansion in both program utilization as well as program cost. According to the VA, approximately 2.8 million (or 30 percent) of the 9.5 million enrollees accessed community care providers at a cost of $23.9 billion in Government Fiscal Year 2023. This continued, exponential growth has led to unexpected budget constraints within the VA and renewed dedication to molding the VA to better fit the current and active needs of its served population. One such evolution is the National TeleOncology service in which veterans around the country can differently access VA oncologists for both diagnoses and treatment through telehealth appointments by traveling to their local VAMC to connect through the clinic or in their home. By matching the patient to the best Oncologist within the VA healthcare system for that patient’s condition without geographic constraints, the VA is able to serve the veteran within the existing health system in a more cost-efficient manner instead of referring him or her out through the VA Community Care Program.
The VA Community Care Program does not replace the VA's core functions but complements the existing system and allows the VA to offer a different range of services. By prioritizing access and quality, the VA fosters strong relationships both with its veterans and local community providers.