Evaluating Provider Ability to Deliver High-Quality Care to Veterans

NYSHealth awarded RAND Corporation a grant to understand the current state of New York’s health care workforce in providing high-quality care to veterans in private, community-based settings.

Grantee Name

RAND Corporation

Funding Area

Veterans’ Health

Publication Date

January 2020

Grant Amount

$370,000

Grant Date:

January 2017 - November 2017

Veterans’ Health

Veterans represent a special population of men and women who have served their country and have faced extraordinary health risks during their deployments.

Because many of them have served on overseas missions—including combat—veterans with service-connected health issues are a clinically complex and potentially vulnerable population. Although the U.S. Department of Veterans Affairs (VA) aims to meet the health care needs of all eligible veterans, many seek care outside of the VA, in part because of a personal preference to receive care from community-based, private, non-VA providers.

In 2017, NYSHealth awarded RAND Corporation a grant to understand the current state of New York’s health care workforce in providing high-quality health care to veterans in private, community-based settings.

Outcomes and Lessons Learned

  • Developed and administered a survey to assess civilian providers’ readiness and capacity to address the health-related needs of veterans and their family members.
  • Developed a seven-point criteria to define provider “readiness” and assessed three main factors:
    • Whether providers can accept and schedule new patients within two weeks.
    • If the care provided is culturally competent (e.g., whether providers are familiar with military culture and how that might shape veteran preferences for care).
    • The quality of care veterans receive from private services (e.g., whether providers regularly screen for conditions that are more common among veterans, such as suicidal ideation).
  • Fielded the survey to 746 licensed health care professionals (such as physicians, physician assistants, psychologists, psychiatrists, mental health counselors, social workers, and physical and occupational therapists) within New York State to assess their knowledge, attitudes, perceptions, and behaviors with respect to treating veterans and providing high-quality care for service-related health problems.
  • Analyzed survey findings to produce a research brief, “Ready or Not? Assessing the Capacity of New York State Health Providers to Meet the Needs of Veterans,” in which RAND found that:
      • Only 2.3% of providers in New York fully meet RAND’s readiness criteria for delivering culturally competent care to veterans.
      • 25% of providers reported receiving some training from the VA and only 13% indicated that they had participated in any formal training regarding military and veteran culture, despite the fact that 4 out of 5 providers reported having veterans in their case loads.
      • 65% of providers feel that they are “somewhat” or “well prepared” to manage care for at least one-half of conditions common among veterans.
      • Only 17% surveyed were registered as VA Community Care providers.
      • Only 1 in 5 providers screened their patients for any military or veteran affiliation and less than half screened for common conditions among veterans.
      • Less than half of providers who have not received specialty training to address the needs of veterans expressed interest in receiving additional training.
      • Only 1 in 5 providers have an understanding of programs and services available to support healthy adjustment for military-affiliated patients.
      • Less than one-third of providers reported knowing how to refer a patient to the VA.

The report recommends four steps to improve private providers’ readiness to treat veterans:

  1. Increase familiarity with and preparedness related to military culture and service-connected health conditions.
  2. Improve screening.
  3. Improve engagement with the VA and available resources for veterans.
  4. Institute quality monitoring.

RAND disseminated the research and its recommendations widely, including via webinars, conferences, social media, and other online resources. The report gained substantial media coverage statewide and nationally with more than 20 articles citing the report, including in USA Today, Newsday, Modern Healthcare, Stars and Stripes, Syracuse’s The Post-Standard, and Watertown Daily Times.

The report received national attention among policymakers as well. In March 2018, RAND briefed senior officials at the VA, including then VA Secretary David Shulkin, the Acting Executive in Charge of the Veterans Health Administration, and the National Director of Suicide Prevention. Dr. Shulkin subsequently cited the study as a reason that he favored a go-slow approach to privatizing health care for military veterans. RAND also incorporated the report’s findings into congressional testimony it presented to the Senate Veterans Affairs Committee related to the VA Mission Act implementation. Additionally, the report was cited during numerous other congressional briefings and testimonies, including at hearings on VA hiring practices, veteran suicide, and veterans’ health benefits. It was also shared with congressional staff on the Veterans Affairs and Health Committees and the VA Deputy Under Secretary for Health.

The report continues to inform further studies, such as one conducted by the Center for Health and Research Transformation at the University of Michigan, which aims to replicate the survey among health care professionals throughout the state of Michigan.

NYSHealth continues to build on the project by supporting a range of efforts to help health care providers offer culturally competent, coordinated care for veterans, including grants to Union Community Health Center, Resilience Center for Veterans and Families, and New York Legal Assistance Group.

Co-Funding and Additional Funds Leveraged: N/A