Improving Quality of Care for Veterans in Federally Qualified Health CentersNYHealth awarded UNION Community Health Center a grant to develop a model to better facilitate coordinated care between community health centers and the VA.
Union Community Health Center
January 2021 – January 2022
In recent years, veterans have increasingly relied on health care provided in the private sector (i.e., in non-VA settings).
Since 2015, the U.S. Department of Veterans Affairs (VA) has increased the amount of private care it purchases for eligible veterans, from 20% of all appointments to more than 30%. Additionally, the passage of the Mission Act in 2018 streamlined eligibility standards, increasing the number of VA patients who are eligible to receive private care. Despite this trend, an NYHealth-funded RAND Corporation report found that only 2% of private providers in New York State fully met readiness criteria for effectively serving the veteran population. To improve provider readiness, the RAND report recommended increasing provider understanding of and engagement with the VA, improving provider screening practices, and increasing provider familiarity with military culture and service-connected health conditions. In 2020, NYHealth awarded Union Community Health Center (UCHC) a grant to help address these gaps by developing a model to better facilitate coordinated care between community health centers and the VA. UCHC is the only federally qualified health center (FQHC) in the Bronx that is authorized to provide urgent/rapid care outside of a VA clinic or hospital and that is eligible for VA reimbursement.
Outcomes and Lessons Learned
- Created and filled a Veterans Liaison position focused on identifying and addressing gaps in services for veterans using VA-purchased private care.
- Learned that VA providers were often unaware of the option to or unable to initiate direct referrals to FQHC and that local VA health care facilities often did not communicate to veterans about care options outside of VA systems.
- Implemented a health center-wide protocol to screen for veteran status.
- Strengthened UCHC’s community referral connection by participating in the HealthShare Referral Manager system, VA’s secure online portal for managing referrals and authorizations.
- Established and cultivated a network of community providers and government agencies to expand referral opportunities for veterans using UCHC services.
- Developed and implemented clinical, financial, and operational processes to assist all veterans in obtaining primary care provider referrals from VA.
- Connected UCHC patients with local community resources and VA benefits.
- Coordinated veteran cultural competency trainings for key health center staff members.
The outbreak of the COVID-19 pandemic coincided with early efforts of this project, creating unforeseen strain on both UCHC and the Bronx VA Medical Center. UCHC grappled with a delay in recruitment for the Veterans Liaison position; a drastic reduction in patient visits for both UCHC and VA; a sharp increase in no-show rates for appointments; and a disproportionate impact of the pandemic on Bronx residents—the main community that UCHC serves and one of the hardest hit by the pandemic. Despite these initial challenges, UCHC experienced an 80% increase in the number of veterans served since 2020 and became the first urgent care community provider to be listed in the VA directory for Bronx County.
In July 2022, UCHC released a white paper focused on the lessons learned from this project, identifying emerging problems and providing policy recommendations for how to address these issues in the future. UCHC staff briefed members of Congress on these findings to help inform hearings focused on examining access to and utilization of VA’s Community Care Network.
Co-Funding and Additional Funds Leveraged: N/A