VA Patient-Centered Community Care and Veterans Choice Program: Worth it for Providers?

August 23rd, 2017 - Jared Staheli

Categories: Insurance Gastroenterology

As the opportunities for providers outside the VA system expand in order to meet demand, you may be interested in offering services to veterans and the VA, if you are not already. With overwhelming bipartisan support, the opportunities are not likely to abate, but are those opportunities worth it for you?

First, it is important to understand the differences between Patient-Centered Community Care (PC3) and the Veterans Choice Program (VCP). While both use outside providers to care for veterans with the goal of reducing wait times and/or increasing accessibility, the mechanism for doing so is different. PC3 works by referring veterans out to providers who have contracted with TriWest or Health Net (VA administrators). The VCP, on the other hand, starts with the veteran contacting TriWest or Health Net with a request to see the physician of their choice. VCP providers do not sign a contract with TriWest/Health Net as they would if they were a PC3 provider.

Though they are separate programs, the VA considers the VCP supplementary to PC3 and is working on plans to consolidate the way the programs work. As it stands now, PC3 providers are automatically qualified to participate in the VCP, but not the other way around.

When deciding whether participation is worth it, there are a few points to consider:

Reimbursement rates for these programs are equivalent to Medicare rates. It is true that Medicare rates are typically lower than the rates of private insurance carriers, but like Medicare, these lower rates come in exchange for a larger potential pool of clients.
The VA considers it important that providers have a basic understanding of military culture and the unique problems veterans face. If you are going to participate, the VA offers some basic training modules for providers. Because in many instances, even with the VCP, the contractor chooses the provider the veteran is sent to, it is important that you exhibit competency in this regard if you want to work with these patients. Click here for a VA fact sheet on this topic.
Because this is a new program (PC3 began in 2013 and VCP in 2014), and there are plans for reform and consolidation, there will likely be many changes over the coming years. Though there will certainly be efforts made to limit the effect on physicians as the programs are in flux, you may be required to spend additional time and effort keeping up to date and in compliance.

However, if you want to participate, the first step is contacting the appropriate contractor. Click here to see which contractor has jurisdiction over your location.

For more provider information, click here to see the Provider Toolkit page from the VA, which includes handbooks from Health Net and TriWest.

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