Value For Veterans (V4V)

NCT ID: NCT05026684

Last Updated: 2022-04-29

Basic Information

• Recruitment Status: UNKNOWN
• Clinical Phase: NA
• Total Enrollment: 150 participants
• Study Classification: INTERVENTIONAL
• Study Start Date: 2021-07-15
• Study Completion Date: 2022-06-30

Brief Summary

The COVID-19 pandemic has transformed the delivery of ambulatory care in the US. One of the most notable changes to ambulatory care practice has been the rapid expansion of telemedicine services. Such expansion sought to preserve access to necessary care for patients while protecting them and their clinicians from undue risk of exposure to COVID-19.

This multiphase, Veteran-centered approach to developing and evaluating a novel behavioral intervention to provide full cost transparency to Veterans will achieve the following aims:

Aim 1: Create an automated system to generate personalized estimates of Veterans' full costs (travel costs, time costs, and out-of-pocket costs) for different types of primary care visits.

Aim 2: Develop and refine a novel behavioral intervention that will help Veterans and their clinicians use personalized information about the full costs of different types of primary care visits in the VHA.

Aim 3: Evaluate the acceptability, feasibility, and preliminary effectiveness of the developed intervention to Veterans and their clinicians.

Detailed Description

Within VA Primary Care, the COVID-19 pandemic has resulted in an abrupt shift from mostly face-to-face visits to almost exclusively telephone and VA Video Connect (VVC) appointments. As the COVID-19 curve has flattened and personal protective equipment (PPE) supplies have stabilized, VA Medical Centers such as the VA Ann Arbor Healthcare System are now grappling with how to match these opportunities for different vehicles for delivering ambulatory care to patients' needs and preferences. One highly promising, Veteran-centered way to match opportunities for face-to-face, telephone, and VVC visits in the COVID-19 era is to consider the value each visit type yields for an individual Veteran. Value for a given health care service is broadly defined as its health outcomes (i.e., benefits) per dollars spent (i.e., costs). From the perspective of patients, costs entail not just out-of-pocket (OOP) expenses but also travel and time costs. These costs are even more salient for many Veterans in the current economic downturn which, unfortunately, is unlikely to abate until the US fully emerges from the COVID-19 pandemic. Careful consideration of these full costs -- which can vary widely across face-to-face, telephone, and VVC visits -- by both Veterans and their clinicians could result in higher-value ambulatory care visits. For example, when services could be provided by telephone rather than a face-to-face visit, the former would result in much higher value for Veterans because there are no copays or travel costs for telephone visits. Similarly, when a face-to-face visit is necessary, transparent cost information could encourage Veterans and their clinicians to maximize the necessary services delivered, amplifying the benefits realized for the relatively higher patient cost of that particular type of visit.

Despite the clear benefits of making patient costs more transparent, and of broader policy initiatives within VA to better inform Veterans' health care choices, Veterans and their clinicians currently lack the personalized cost information that they need to make high-value choices about ambulatory visit modalities. This project will make transparent the full costs to Veterans of different types of ambulatory visits in order to optimize the value of their health care investments in the COVID-19 era and beyond.

Conditions

Delivery of Health Care

Study Design

• Allocation Method: NA
• Intervention Model: SINGLE_GROUP
• Primary Study Purpose: HEALTH_SERVICES_RESEARCH
• Blinding Strategy: NONE

Study Groups

Experimental group

Personalized cost information group.

Group Type: EXPERIMENTAL

Personalized cost handout

Intervention Type: OTHER

Patients will be given a personalized cost handout to make transparent the full costs to Veterans of different types of ambulatory visits in order to optimize the value of their health care investments.

Interventions

Personalized cost handout

Patients will be given a personalized cost handout to make transparent the full costs to Veterans of different types of ambulatory visits in order to optimize the value of their health care investments.

Intervention Type: OTHER

Eligibility Criteria

Inclusion Criteria

• Age 18 years or older with an upcoming face-to-face, telephone, or VVC appointment with a consenting Primary Care provider at the Ann Arbor VA.

Exclusion Criteria

• Under the age of 18.
• Mild cognitive impairment, dementia, psychotic disorder, or unable to provide informed consent.

• Minimum Eligible Age: 18 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

VA Center for Clinical Management Research

UNKNOWN

Sponsor Role: collaborator

VA Ann Arbor Healthcare System

FED

Sponsor Role: lead

Responsible Party

Responsibility Role: SPONSOR

Locations

VA Ann Arbor Healthcare System

Ann Arbor, Michigan, United States

Site Status: RECRUITING

Countries

United States

Central Contacts

Jeffrey T. Kullgren, MD, MS, MPH

Role: CONTACT

Jeffrey.Kullgren@va.gov

(734) 845-3502

Nora A. Metzger, MSW

Role: CONTACT

nora.metzger2@va.gov

734-222-7682

Facility Contacts

Jeffrey T. Kullgren, MD, MS, MPH

Role: primary

Jeffrey.Kullgren@va.gov

734-845-3613

Nora Metzger, MSW

Role: backup

nora.metzger2@va.gov

734-222-7682

References

Wosik J, Fudim M, Cameron B, Gellad ZF, Cho A, Phinney D, Curtis S, Roman M, Poon EG, Ferranti J, Katz JN, Tcheng J. Telehealth transformation: COVID-19 and the rise of virtual care. J Am Med Inform Assoc. 2020 Jun 1;27(6):957-962. doi: 10.1093/jamia/ocaa067.

Reference Type: BACKGROUND

PMID: 32311034 (View on PubMed)

Mann DM, Chen J, Chunara R, Testa PA, Nov O. COVID-19 transforms health care through telemedicine: Evidence from the field. J Am Med Inform Assoc. 2020 Jul 1;27(7):1132-1135. doi: 10.1093/jamia/ocaa072.

Reference Type: BACKGROUND

PMID: 32324855 (View on PubMed)

Porter ME. What is value in health care? N Engl J Med. 2010 Dec 23;363(26):2477-81. doi: 10.1056/NEJMp1011024. Epub 2010 Dec 8. No abstract available.

Reference Type: BACKGROUND

PMID: 21142528 (View on PubMed)

Farmer CM, Hosek SD, Adamson DM. Balancing Demand and Supply for Veterans' Health Care: A Summary of Three RAND Assessments Conducted Under the Veterans Choice Act. Rand Health Q. 2016 Jun 20;6(1):12. eCollection 2016 Jun 20.

Reference Type: BACKGROUND

PMID: 28083440 (View on PubMed)

Yabroff KR, Guy GP Jr, Ekwueme DU, McNeel T, Rozjabek HM, Dowling E, Li C, Virgo KS. Annual patient time costs associated with medical care among cancer survivors in the United States. Med Care. 2014 Jul;52(7):594-601. doi: 10.1097/MLR.0000000000000151.

Reference Type: BACKGROUND

PMID: 24926706 (View on PubMed)

Kullgren JT, Fagerlin A, Kerr EA. Completing the MISSION: a Blueprint for Helping Veterans Make the Most of New Choices. J Gen Intern Med. 2020 May;35(5):1567-1570. doi: 10.1007/s11606-019-05404-w. Epub 2019 Oct 24.

Reference Type: BACKGROUND

PMID: 31646457 (View on PubMed)

Department of Veterans Affairs FY 2018 - 2024 Strategic Plan. Published online February 12, 2018. Accessed April 10, 2018. https://www.va.gov/oei/docs/VA2018-2024strategicPlan.pdf

Reference Type: BACKGROUND

Wait Times at Individual Facilities Search - VA Access to Care. Accessed May 2, 2018. https://www.accesstopwt.va.gov/

Reference Type: BACKGROUND

How Does Your Medical Center Perform? Accessed May 2, 2018. https://www.va.gov/qualityofcare/apps/mcps-app.asp

Reference Type: BACKGROUND

Final Report of the Commission on Care.; 2016. https://s3.amazonaws.com/sitesusa/wp-content/uploads/sites/912/2016/07/Commission-on-Care_Final-Report_063016_FOR-WEB.pdf

Reference Type: BACKGROUND

John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018.; 2018. Accessed June 12, 2018. https://www.congress.gov/115/bills/s2372/BILLS-115s2372enr.xml

Reference Type: BACKGROUND

Kullgren JT, Cliff EQ, Krenz C, West BT, Levy H, Fendrick AM, Fagerlin A. Consumer Behaviors Among Individuals Enrolled in High-Deductible Health Plans in the United States. JAMA Intern Med. 2018 Mar 1;178(3):424-426. doi: 10.1001/jamainternmed.2017.6622.

Reference Type: BACKGROUND

PMID: 29181512 (View on PubMed)

Kullgren JT, Cliff BQ, Krenz CD, Levy H, West B, Fendrick AM, So J, Fagerlin A. A Survey Of Americans With High-Deductible Health Plans Identifies Opportunities To Enhance Consumer Behaviors. Health Aff (Millwood). 2019 Mar;38(3):416-424. doi: 10.1377/hlthaff.2018.05018.

Reference Type: BACKGROUND

PMID: 30830816 (View on PubMed)

Kullgren JT. Helping Consumers Make High-Value Health Care Choices: The Devil Is in the Details. Health Serv Res. 2018 Aug;53 Suppl 1(Suppl Suppl 1):2655-2661. doi: 10.1111/1475-6773.12860. Epub 2018 Apr 16. No abstract available.

Reference Type: BACKGROUND

PMID: 29659010 (View on PubMed)

Thabane L, Ma J, Chu R, Cheng J, Ismaila A, Rios LP, Robson R, Thabane M, Giangregorio L, Goldsmith CH. A tutorial on pilot studies: the what, why and how. BMC Med Res Methodol. 2010 Jan 6;10:1. doi: 10.1186/1471-2288-10-1.

Reference Type: BACKGROUND

PMID: 20053272 (View on PubMed)

Kullgren JT, Krupka E, Schachter A, Linden A, Miller J, Acharya Y, Alford J, Duffy R, Adler-Milstein J. Precommitting to choose wisely about low-value services: a stepped wedge cluster randomised trial. BMJ Qual Saf. 2018 May;27(5):355-364. doi: 10.1136/bmjqs-2017-006699. Epub 2017 Oct 24.

Reference Type: BACKGROUND

PMID: 29066616 (View on PubMed)

Kullgren JT, Youles B, Shetty S, Richardson C, Fagerlin A, Heisler M. ForgIng New paths in DIabetes PrevenTion (FINDIT): Study Protocol for a Randomized Controlled Trial. Trials. 2017 Apr 8;18(1):167. doi: 10.1186/s13063-017-1887-6.

Reference Type: BACKGROUND

PMID: 28388933 (View on PubMed)

Other Identifiers

VAAnnArbor

Identifier Type: -

Identifier Source: org_study_id