Differences Between VHA-Delivered and VHA-Purchased Behavioral Health Care in Service and Patient Characteristics

Area of Science:

• Health Services Research
• Veterans Health
• Behavioral Health Services

Background:

• Federal legislation expanded access to community care for Veterans Health Administration (VHA) enrollees.
• Understanding the differences in care delivery between VHA and community settings is crucial.

Purpose of the Study:

• To examine differences in the amount and type of behavioral health care delivered in VHA versus community settings.
• To analyze patient characteristics and area factors influencing care site selection.
• To compare provider qualifications in VHA versus community behavioral health care.

Main Methods:

• Retrospective cross-sectional study of VHA enrollees' behavioral health stays and visits (FY 2016-2019).
• Analysis included 204,094 inpatient stays and over 55 million outpatient visits.
• Standardized mean differences and linear probability models assessed patient, provider, and condition severity factors.

Main Results:

• Twenty percent of inpatient behavioral health stays were community-purchased; severe conditions were more likely treated in VHA inpatient care.
• Community care comprised 3% of outpatient behavioral health visits, with increasing utilization over time.
• Outpatient veterans using community care saw clinicians with less training (SMD=1.06) compared to VHA care.

Conclusions:

• Significant use of community care for inpatient behavioral health and increasing outpatient use requires enhanced VHA-community coordination.
• Coordination is vital for appropriate inpatient follow-up and addressing outpatient needs.
• VHA's expertise and legislative mandate necessitate integrated behavioral health care for veterans.