VA Out-of-Network Care Workshop 

Final Activities: 

• Read the Workshop Summary Report.
• Access the workshop details, agenda and presentations.

Background

The Department of Veterans Affairs (VA) invests over $4 billion per year in care provided in the private sector, but has limited capacity to assess the quality of care provided by non-VA providers. To better inform veterans who are seeking healthcare services and to better manage those services, the Veterans Health Administration (VHA) partnered with the National Quality Forum (NQF) to convene a multi-stakeholder group to develop a conceptual approach for assessing the quality of VA out-of-network care. The issue of out-of-network care is not limited to the VHA and is important to a wide range of stakeholders seeking to manage the health and healthcare of a population, including private sector health plans, large health systems, and the Department of Defense. The convening activity involved 30 individuals representing a broad spectrum of interested entities, including federal and nonfederal health providers, payers, health plans, and other entities accountable for the care of a defined population.

Workshop Charge

The charge of the Assessing Quality of VA Out-of-Network Care Workshop was to develop a conceptual approach and guiding principles to quality measurement for out-of-network care.

The workshop discussion built on previous work done in this area and was designed to result in recommendations for the conceptual approach. This conceptual approach addressed:

1. Guiding principles for measuring the quality of out-of-network care
2. The type and focus of measures best suited (e.g., care coordination)
3. Potential data sources (e.g., data exchanges)
4. Methodology issues (e.g., sample size)
5. Access issues (e.g., rural health care)

Discussion covered the current state of monitoring and measuring the quality of out-of-network care and the key considerations for the development of a conceptual approach. The workshop focused on measures best suited for assessing the quality of out-of-network care, measurement issues such as data sources and small sample size, and understanding trade-offs between access and quality. The Department of Health and Human Services’ National Quality Strategy as well as the NQF-endorsed® Patient-Focused Episodes of Care Framework were used as cross-checks to encourage alignment with broader conceptual approaches and guiding principles.

Timeframe

Participants convened for a one-day, hands-on workshop on June 29, 2011. A workshop summary report detailing the conceptual approach and guiding principles were produced after the workshop and released in the fall of 2011.

Contact Information 

For more information, contact Anisha Dharshi at 202-783-1300 or via email at adharshi@qualityforum.org.