Since 2014, Department of Veterans Affairs (VA) has dramatically shifted the ways in which Veterans can receive care. While a substantial majority of Veteran care is provided at one of the 170 VA Medical Centers and 1074 outpatient sites of care nationwide, the Veterans Access, Choice and Accountability Act (Choice Act) (2014) and the VA MISSION Act (MISSION Act) (2018) provided Veterans increased opportunities to receive care from community providers by partnering with federal and private providers, clinics, and hospitals. Both MISSION and Choice represented the attempts of Congress to address reports of long wait times for certain VA services, especially in parts of the country where growth of the Veteran population outpaced VA capacity and in rural areas where Veterans had to drive long distances to see a subspecialist.

The VA faces a plethora of care coordination challenges. Many Veterans have multiple conditions and providers, and many get a portion of their care in the community, a number that will only grow as recent legislation expands options for private care. These challenges have spawned new VA initiatives for redesigning care to meet them, described in this supplement in an editorial by Hosenfeld and colleagues. The VA Health Services Research and Development (HSR&D) service, in partnership with VA’s Office of Primary Care, and Office of Community Care, sponsored a State of the Art (SOTA) conference with the goals of (a) summarizing what is known about care coordination relevant to Veterans’ care; (b) identifying care coordination approaches ready for wider dissemination and implementation within VA; and (c) identifying a research agenda and recommendations, as appropriate, for increasing VA’s knowledge and use of evidence-based approaches for coordinating care. Held in March 2018, the SOTA was jointly planned by VA HSR&D and Offices of Primary Care, Community Care, Nursing Services, and Care Management and Social Work, and convened VA and non-VA health services researchers, clinicians, and policy makers. This supplement presents recommendations from the SOTA as well as original research papers on care coordination strategies within VA and between VA and non-VA providers.