Use of General Primary Care, Specialized Primary Care, and Other Veterans Affairs Services Among High-Risk Veterans

Evelyn T. Chang
Donna M. Zulman
Karin M. Nelson
Ann-Marie Rosland
David A. Ganz
Stephan D. Fihn
Rebecca Piegari
Lisa V. Rubenstein
Peer-Reviewed Article
June 2020

Understanding where and how high-risk patients receive care can inform efforts to improve care for this population. This study observed care patterns for more than 350,000 high-risk patients within the Veterans Health Administration, an integrated health care system providing a range of medical services.

Nearly 90 percent of high-risk veterans, identified through a validated risk prediction model, were assigned to general primary care. Specialized primary care settings served individuals with special needs, such as those with HIV infection, homeless veterans, and those with serious mental illness. High-risk patients assigned to general primary care, as compared to those in specialized primary care, had: (1) more frequent primary care visits; (2) more medical specialty care visits; and (3) fewer mental health visits. Overall, high-risk patients received care through in-person, telephone, and text messaging at higher rates than low-risk patients. These results provide lessons for integrated health systems on improving care for high-need patients, including through enabling high-quality complex patient care within primary care and mental health services, and maximizing electronic and telephone care. 

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