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.

In response to widespread concerns regarding Veterans' access to VA care, Congress enacted the Veterans Access, Choice and Accountability Act of 2014, which required VA to establish the Veterans Choice Program (VCP). Since the inception of VCP, more than two million Veterans have received care from community providers, representing approximately 25% of Veterans enrolled in VA care. However, expanded access to non-VA care has created challenges in care coordination between VA and community health systems. In March 2018, the VA Health Services Research and Development Service hosted a VA State of the Art conference (SOTA) focused on care coordination. The SOTA convened VA researchers, program directors, clinicians, and policy makers to identify knowledge gaps regarding care coordination within the VA and between VA and community systems of care. This article provides a summary and synthesis of relevant literature and provides recommendations generated from the SOTA about how to evaluate cross-system care coordination. Care coordination is typically evaluated using health outcomes including hospital readmissions and death; however, in cross-system evaluations of care coordination, measures such as access, cost, Veteran/patient and provider satisfaction (including with cross-system communication), comparable quality metrics, context (urban vs. rural), and patient complexity (medical and mental health conditions) need to be included to fully evaluate care coordination effectiveness. Future research should examine the role of multiple individuals coordinating VA and non-VA care, and how these coordinators work together to optimize coordination.