Completing the MISSION: a Blueprint for Helping Veterans Make the Most of New Choices
The June 6, 2019, implementation of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act commenced a new era in health care for Veterans in which the more than 9 million Veterans who use VA care can now choose community (i.e., non-VA) clinicians or facilities when certain new criteria are met. This expansion of Veterans’ health care options could give many Veterans more freedom to decide which settings best meet their individual needs and expectations, and could also lead to unintended consequences for Veterans who do not have all of the information they need to make personalized decisions about VA and community care. In this Perspective article, we recommend initial steps that VA leaders and VA clinicians need to take, and community clinicians should be aware of, in order to ensure that Veterans’ expanded health care options translate into improvements in their access and outcomes.
We thank Megan Adams, MD, JD, of the VA Center for Clinical Management Research and the University of Michigan for her valuable feedback on an earlier version of this manuscript.
Support was provided by the Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development (HSR&D) Service. Dr. Kullgren is a VA HSR&D Career Development awardee (CDA 13-267) at the Ann Arbor VA.
Compliance with Ethical Standards
Conflict of Interest
Dr. Kullgren has received consulting fees from SeeChange Health and HealthMine, and honoraria from AbilTo, Inc., the Robert Wood Johnson Foundation, the American Diabetes Association, and the Kansas City Area Life Sciences Institute. Dr. Kerr is on the clinical advisory board for BIND Health Insurance.
The views expressed in this article are those of the authors and do not reflect the position or policy of the Department of Veterans Affairs or the United States government.
- 1.John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018.; 2018. https://www.congress.gov/115/bills/s2372/BILLS-115s2372enr.xml. Accessed June 12, 2018.
- 2.VA launches new health care options under MISSION Act. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5264. Accessed July 5, 2019.
- 7.VA Office of Public and Intergovernmental Affairs. VA announces access standards for health care. https://www.va.gov/opa/pressrel/pressrelease.cfm?id=5187. Published January 30, 2019. Accessed January 30, 2019.
- 8.Veterans Community Care Program. Fed Regist. June 2019. https://www.federalregister.gov/documents/2019/06/05/2019-11575/veterans-community-care-program. Accessed July 5, 2019.
- 9.Wait Times at Individual Facilities Search - VA Access to Care. https://www.accesstopwt.va.gov/. Accessed May 2, 2018.
- 10.How Does Your Medical Center Perform? https://www.va.gov/qualityofcare/apps/mcps-app.asp. Accessed May 2, 2018.
- 13.Taylor EA, Carman KG, Lopez A, Muchow AN, Roshan P, Eibner C. Consumer Decisionmaking in the Health Care Marketplace. RAND Corporation; 2016. https://www.rand.org/content/dam/rand/pubs/research_reports/RR1500/RR1567/RAND_RR1567.pdf.
- 14.Care Coordination - Community Care. https://www.va.gov/COMMUNITYCARE/providers/Care_Coordination.asp. Accessed February 6, 2019.
- 16.Gadbois EA, Gordon SH, Shield RR, Vivier PM, Trivedi AN. Quality Management Strategies in Medicaid Managed Care: Perspectives From Medicaid, Plans, and Providers. Med Care Res Rev. 2019:1077558719841157. https://doi.org/10.1177/1077558719841157.
- 18.Steinhauer JVA. Prepares for Major Shift in Veterans’ Health Care. The New York Times. https://www.nytimes.com/2019/06/05/us/politics/va-health-care-veterans.html. Published June 5, 2019. Accessed July 7, 2019.