VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts, USA.
University of Massachusetts Medical School, Worcester, Massachusetts, USA.
Health Serv Res. 2021 Jun;56(3):400-408. doi: 10.1111/1475-6773.13651. Epub 2021 Mar 29.
To inform how the VA should develop and implement network adequacy standards, we convened an expert panel to discuss Community Care Network (CCN) adequacy and how VA might implement network adequacy standards for community care.
DATA SOURCES/STUDY SETTING: Data were generated from expert panel ratings and from an audio-recorded expert panel meeting conducted in Arlington, Virginia, in October 2017.
We used a modified Delphi panel process involving one round of expert panel ratings provided by nine experts in network adequacy standards. Expert panel members received a list of network adequacy standard measures used in commercial and government market and were provided a rating form listing a total of 11 measures and characteristics to rate.
Items on the rating form were individually discussed during an expert panel meeting between the nine expert panel members and VA Office of Community Care leaders. Attendees addressed discordant views and generated revised or new standards accordingly. Recorded audio data were transcribed to facilitate thematic analysis regarding opportunities and challenges with implementing network adequacy standards in VA Community Care.
The five highest ranked standards were network directories for Veterans, regular reporting of network adequacy data to VA, maximum wait time/distance standards, minimum ratio of providers to enrolled population, and qualitative assessments of network adequacy. During the expert panel discussion with VA Community Care leaders, opportunities and challenges implementing network adequacy standards were highlighted.
Our expert panel shed light on priorities for network adequacy to be implemented under CCN contracts, such as developing comprehensive provider directories for Veterans to use when selecting community providers. Remaining questions focus on whether the VA could reasonably develop and implement network adequacy standards given current Congressional restraints on VA reimbursement to community providers.
为了明确 VA 应如何制定和实施网络充分性标准，我们召集了一个专家小组来讨论社区护理网络 (CCN) 的充分性，以及 VA 可能如何为社区护理实施网络充分性标准。
资料来源/研究背景：数据来自专家小组的评分以及 2017 年 10 月在弗吉尼亚州阿灵顿举行的一次音频记录的专家小组会议。
我们使用了一种经过修改的德尔菲小组流程，涉及九位网络充分性标准专家的一轮专家小组评分。专家小组成员收到了一份商业和政府市场中使用的网络充分性标准衡量标准清单，并收到了一份评分表，其中列出了总共 11 项衡量标准和特征进行评分。
评分表上的项目在九位专家小组成员和 VA 社区护理负责人之间的专家小组会议上分别进行了讨论。与会者解决了意见不一致的问题，并相应地提出了修订或新的标准。记录的音频数据被转录，以便对 VA 社区护理中实施网络充分性标准的机会和挑战进行主题分析。
排名前五的标准是退伍军人的网络目录、定期向 VA 报告网络充分性数据、最长等待时间/距离标准、提供者与在册人口的最低比例，以及网络充分性的定性评估。在与 VA 社区护理负责人的专家小组讨论中，强调了实施网络充分性标准的机会和挑战。
我们的专家小组阐明了在 CCN 合同下实施网络充分性的优先事项，例如为退伍军人开发全面的供应商目录，以便他们在选择社区供应商时使用。目前仍存在的问题是，考虑到国会对 VA 向社区供应商报销的限制，VA 是否能够合理地制定和实施网络充分性标准。
