Purchasing Versus Providing Care at the VHA: Quality Differences in Follow-Up After Psychiatric Hospitalization

Area of Science:

• Health Services Research
• Mental Health Services
• Healthcare Quality

Background:

• The Veterans Health Administration (VHA) has increased its reliance on community providers for healthcare services.
• This shift may impact care quality and lead to fragmentation, particularly concerning continuity between inpatient and outpatient mental health care.

Purpose of the Study:

• To compare outpatient follow-up visit rates for psychiatric hospitalizations delivered by the VHA versus those purchased by the VHA from community providers.
• To analyze these rates overall and stratified by individual VHA facility.

Main Methods:

• Utilized VHA electronic medical records and community care claims data for analysis.
• Compared 7-day and 30-day outpatient follow-up rates for VHA-purchased and VHA-delivered psychiatric hospitalizations.
• Examined rates across four diagnostic groups and individual VHA facilities.

Main Results:

• Over 30% of the 64,784 hospitalizations studied were VHA-purchased.
• VHA-purchased hospitalizations showed significantly lower follow-up rates: 30.1 percentage points lower at 7 days and 22.5 percentage points lower at 30 days.
• Lower follow-up rates were noted for neurocognitive disorder discharges; 30-day follow-up was lower at 121 out of 128 VHA facilities for purchased care.

Conclusions:

• Data on quality differences between VHA and community psychiatric care are valuable for VHA enrollees and program managers.
• Incorporating outpatient follow-up measures into VHA purchased care quality reports and value-based contracts could incentivize improved care quality.