New research reveals that veterans with mental health disorders consistently report lower satisfaction with private care compared to their peers without such conditions, emphasizing a critical need for better coordination in their treatment, according to VA researchers.
The study analyzed survey data from 231,869 veterans who received care through private providers covered by the Department of Veterans Affairs (VA). It found that those with mental health issues rated their care lower across nine categories, including quality of care, communication with clinicians, and scheduling.
This research builds on earlier findings showing that veterans with behavioral health conditions also have worse experiences with medical services within the VA system. The authors, representing multiple VA medical facilities and universities, stress the importance of improving care coordination for this vulnerable group.
“This is a clear call to enhance care coordination to ensure veterans receive the medical attention they need,” said Eric Roberts, an associate professor at the University of Pennsylvania School of Medicine, in an interview with Military.com.
The study, published on May 21 in JAMA Network Open, found that veterans’ satisfaction with community care slightly improved from 2016 to 2021, particularly in areas like quality of care and appointment scheduling. However, those with mental health conditions consistently rated their care lower than veterans without such diagnoses.
While the study did not establish a direct cause-and-effect relationship, it highlighted the unique challenges faced by veterans with mental health issues when accessing private care. The researchers suggested that targeted care coordination could improve their overall experience.
The findings come as the VA is working to expand veterans’ access to private healthcare. The 2018 Mission Act significantly broadened eligibility for private care, enabling veterans to seek treatment from community providers if they face long travel times or difficulty scheduling appointments within the VA system.
In a recent congressional hearing, VA Secretary Doug Collins acknowledged past shortcomings in referring veterans to private care, pointing to resistance from previous administrations. “Evidence has emerged showing that VA medical centers were not encouraging referrals to community care, contrary to the Mission Act,” Collins said during a House appropriations subcommittee hearing on May 15.
In 2022, VA Secretary Denis McDonough reported that 33% of the VA’s healthcare demand was met through private care, up from 25% the previous year. However, McDonough also expressed concerns about shifting funding away from VA facilities, noting that veterans who receive care within the VA system typically have better health outcomes, including lower suicide rates.
Secretary Collins has maintained that the VA health care system will remain a primary resource for veterans, though the way he is funding private care has raised concerns among lawmakers. Recently, Collins moved $343 million in savings from canceled contracts to fund the community care program, but some members of Congress argue that he should have sought approval for this reallocation.
“It’s a matter of following the law. You’re required to seek our approval,” said Rep. Debbie Wasserman Schultz (D-Fla.), ranking member of the House Appropriations Military Construction, Veterans Affairs and Related Agencies subcommittee.
Roberts, the researcher from the University of Pennsylvania, called for the VA to consider how it can better support veterans with mental health conditions as the reliance on private care grows. He noted that these veterans often need additional help navigating the complexities of the healthcare system.
The VA has programs in place to coordinate care, but the study suggests that mental health conditions should be considered when identifying veterans who may require more intensive care coordination.
“Additional attention should be given to vulnerable populations, including veterans with mental health conditions, when coordinating care between the VA and community providers,” the study authors concluded.
In a separate article published on May 24 in The New England Journal of Medicine, two VA pulmonologists warned that further expansion of private care, especially without referral requirements, could lead to fragmented care. They cautioned that without integrated health records, private doctors may miss important details, leading to care gaps and potential errors in medication or tests.
In the May 15 hearing, Collins reassured lawmakers that the private care program would maintain high standards, insisting that community care is still part of the VA system. “We’re not taking VA care from one place and giving it to another,” he said. “We’re paying for VA care, whether it’s in a VA facility or in the community.”
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