The mission of the Department of Veterans Affairs has been, since its inception, “To care for him who shall have borne the battle,” yet the mode of providing that care has recently undergone sweeping transformation. With passage of the Veterans Access, Choice and Accountability Act of 2014 (Public Law 113- 146) (“Choice Act”), Veterans' options for VA-sponsored health care have increased. Veterans can now access care in VA hospitals or in non-VA settings through traditional VA community care and the recent Veterans Choice Program (VCP). Ultimately, expanding non-VA options may lead to greater choices for patients to potentially obtain care that is more accessible, timely, higher quality, and that may lead to better outcomes. Sicker veterans who use hospital care for inpatient stays are some of the sickest and most vulnerable VA patients, so planning for their care is paramount to ensuring access to high-quality care. A comprehensive examination of the use of VA and non-VA care, total VA spending, and outcomes is needed to guide the development and expansion of community care programs like the VCP. Therefore, we will estimate the change in utilization and spending on VA-provided and VA-sponsored care in the context of other non-VA care (primarily Medicaid expansion). We will also study which patient characteristics and VA hospital characteristics influenced Veterans' choice of VA or community care providers. Finally, we will examine the impact of the VCP on hospital mortality for hospitalized patients. We will use innovative methods to link non- VA hospital discharge data with VA data for 11 geographically diverse states to answer these questions. To obtain a comprehensive picture of veterans' utilization, we will obtain hospital and other provider data from 11 state agencies (AZ, CA, CT, FL, IL, LA, MA, MO, NY, PA, SC). State patient discharge data includes data from all non-federal hospitals in the state including inpatient care. We will measure all VA-sponsored community care from state discharge data because these data report more comprehensive and standardized information, such as the type of care and provider, than that available in Fee Basis claims data. We will link state data to VA data and use quantitative methods to examine overall changes in VA-provided hospital care, VA-sponsored hospital care, and hospital care covered by other payers before and after VCP implementation. Utilization and spending of inpatient stays provided/sponsored by VA and non-VA providers will be estimated from Calendar Year (CY) 2011 to CY2017. We will estimate the impact of the VCP on total hospital spending after adjusting for patient and VA hospital factors. We will also look at factors influencing choice of hospitals and hospital mortality among hospitalized patients and whether it decreased after implementation of the VCP. Next steps involve sharing findings with operational partners to guide VA strategic planning, budget and reimbursement models, and p...