Review of Access to Telehealth and Provider Experience in VHA Prior to and During the COVID-19 Pandemic

The VA Office of Inspector General (OIG) conducted a review to assess implementation and use of VA Video Connect (VVC) prior to and during the COVID-19 pandemic. The OIG explored why providers used telephone communication more frequently than VVC at the onset of the pandemic and how the Veterans Health Administration (VHA) resolved technology issues. Experiences of a subset of providers who used VVC from October 2016 through July 2021 were examined to identify benefits of and barriers to VVC use. VHA leaders did not specify a pandemic in the telehealth strategic plans but identified the exigent nature of the pandemic in the March 2020 COVID-19 Response Plan, which served as the impetus for VVC utilization and sustainability. The OIG’s review of presumed in-person, telephone, and VVC encounters found VVC encounter use increased prior to the pandemic but was the least used modality of care; telephone and VVC encounter use increased as presumed in-person encounters decreased at the onset of the pandemic; and telephone encounter use decreased and presumed in-person and VVC encounters continued to increase following the initial months of the pandemic. VHA telehealth strategic plans focused on improving technology to support VVC, increasing provider capability, and identifying preparations for the provision of health care remotely. However, VHA was not readily able to support the increased demand of VVC use. During provider interviews, providers stated the pandemic served as a turning point; identified benefits of using VVC, such as convenience and increased patient engagement; and described barriers to VVC use such as patient obstacles with VVC technology, VVC appointments not emulating in-person appointments, and provider difficulty with scheduling VVC appointments. The OIG made three recommendations to the Under Secretary for Health related to provider knowledge and utilization of VVC technology, clinical and administrative support, and VVC scheduling processes.