Value For Veterans (V4V) (V4V)

April 28, 2022 updated by: VA Ann Arbor Healthcare System

Achieving Greater Value for Veterans Through Full Cost Transparency

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.

Study Overview

Status

Recruiting

Conditions

Intervention / Treatment

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.

Study Type

Interventional

Enrollment (Anticipated)

150

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

  • United States
    • Michigan
      • Ann Arbor, Michigan, United States, 48105
        • Recruiting
        • VA Ann Arbor Healthcare System
        • Contact:
        • Contact:
        • Principal Investigator:
          • Jeffrey T Kullgren, MD, MS, MPH

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years and older (ADULT, OLDER_ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

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.

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: HEALTH_SERVICES_RESEARCH
  • Allocation: NA
  • Interventional Model: SINGLE_GROUP
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
EXPERIMENTAL: Experimental group
Personalized cost information group.
Other: 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.

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Level of confidence in understanding costs of different visit type options
Time Frame: Within one week of appointment
Measured by telephone survey
Within one week of appointment

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Conversations about different visit type options
Time Frame: Within one week of appointment
Measured by telephone survey
Within one week of appointment
Perceived helpfulness of intervention
Time Frame: Within one week of appointment
Measured by telephone survey
Within one week of appointment
Interest in receiving information in future
Time Frame: Within one week of appointment
Measured by telephone survey
Within one week of appointment

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

VA Ann Arbor Healthcare System

Collaborators

VA Center for Clinical Management Research

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

July 15, 2021

Primary Completion (ANTICIPATED)

May 30, 2022

Study Completion (ANTICIPATED)

June 30, 2022

Study Registration Dates

First Submitted

August 9, 2021

First Submitted That Met QC Criteria

August 27, 2021

First Posted (ACTUAL)

August 30, 2021

Study Record Updates

Last Update Posted (ACTUAL)

April 29, 2022

Last Update Submitted That Met QC Criteria

April 28, 2022

Last Verified

April 1, 2022

More Information

Terms related to this study

Keywords

Other Study ID Numbers

  • VAAnnArbor

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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