Specialty care single and multi-period location–allocation models within the Veterans Health Administration

Optimal location of specialty care services within any healthcare network is increasingly important for balancing costs, access to care, and patient-centeredness. Typical long-range planning efforts attempt to address a myriad of quantitative and qualitative issues, including within-network access within reasonable travel distances, space capacity constraints, costs, politics, and community commitments. To help inform these decisions, single and multi-period mathematical integer programs were developed that minimize total procedure, travel, non-coverage, and start-up costs to increase network capacity subject to access constraints. These models have been used to help the Veterans Health Administration (VHA) explore relationships and tradeoffs between costs, coverage, service location, and capacity and to inform larger strategic planning discussions. Results indicate significant opportunity to simultaneously reduce total cost, reduce total travel distances, and increase within-network access, the latter being linked to better care continuity and outcomes. An application to planning short and long-term sleep apnea care across the VHA New England integrated network, for example, produced 10–15% improvements in each performance measure. As an example of further insight provided by these analyses, most optimal solutions increase the amount of outside-network care, contrary to current trends and policies to reduce external referrals.