The COVID-19 pandemic shifted the Veterans Affairs System toward being a payer and virtual care provider: is it sustainable?

Structured AbstractO_ST_ABSObjectiveC_ST_ABSTo examine how VA shifted care delivery methods one year into the pandemic. Study SettingAll encounters paid or provided by VA between January 1, 2019 and February 27, 2021. Study DesignWe aggregated all VA paid or provided encounters and classified them into community (non-VA) acute and non-acute visits, VA acute and non-acute visits, and VA virtual visits. We then compared the number of encounters by week over time to pre-pandemic levels. Data Extraction MethodsAggregation of administrative VA claims and health records. Principal FindingsVA has experienced a dramatic and persistent shift to providing virtual care and purchasing care from non-VA providers. Before the pandemic, a majority (63%) of VA care was provided in-person at a VA facility. One year into the pandemic, in-person care at VAs constituted just 33% of all visits. Most of the difference made up by large expansions of virtual care; total VA provided visits (in person and virtual) declined (4.9 million to 4.2 million) while total visits of all types declined only 3.5%. Community provided visits exceeded prepandemic levels (2.3 million to 2.9 million, +26%). ConclusionUnlike private health care, VA has resumed in-person care slowly at its own facilities, and more rapidly in purchased care with different financial incentives a likely driver. The very large expansion of virtual care nearly made up the difference. With a widespread physical presence across the U.S., this has important implications for access to care and future allocation of medical personnel, facilities, and resources.