HERC: About Us
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Overview

The mission of the VA Health Economics Resource Center (HERC) is to increase the quality of VA health economics research and cost-effectiveness studies so that the nation and the nation’s veterans may get the best possible health care value from available resources. HERC was created in 1999 to respond to the VA Health Systems Research (HSR) request for proposals to create a resource center on health economics.

Located in Menlo Park, California, HERC helps VA researchers determine the cost of VA care, assess cost-effectiveness, and evaluate the efficiency of VA programs and providers. We conduct two seminar series on health economics, coordinate monthly economic cyber seminars, and operate an economics consulting service. Our consulting service is primarily for VA researchers who have a specific question not already addressed by resources on our website. Due to the great demand for health economics expertise, HERC economists do not ordinarily respond to requests for consulting assistance by becoming involved as co-investigators. We maintain a database of VA health economists.

We estimate the cost of all VA health care encounters, develop guidebooks to VA data, and issue technical reports with analyses of economic data. The expertise of HERC economists is developed through their participation and leadership in economic studies that are funded by VA HSR, the VA Quality Enhancement Research Initiative (QUERI), the VA Cooperative Studies Program (CSP), the National Institutes of Health, and other research sponsors. VA staff can learn more about HERC and the services we offer at https://vaww.hsrd.research.va.gov/for_researchers/cyber_seminars/archives/video_archive.cfm?SessionID=6538 (VA intranet only).

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VA Research

HERC is dedicated to increasing VA's capacity to conduct high-quality health economics research and cost-effectiveness studies. We are the economics resource center for the Health Systems Research (HSR) Service and the Quality Enhancement Research Initiative (QUERI) Program, as well as the economics coordinating center for the Cooperative Studies Program (CSP). 

Health Systems Research (HSR)

The VA Health Systems Research (HSR) broad portfolio supports research on innovative strategies that lead to accessible, high quality, and cost-effective care for veterans and the nation. HERC receives core support from HSR to act as a national center that helps VA researchers determine the cost of VA care, assess cost-effectiveness, assess the budget impact of adopting and implementing new technologies, and evaluate the efficiency of VA programs and providers. We operate an economics consulting service for VA researchers and offer health economics seminars. We work to improve methods and data available to VA economics researchers, including developing micro-costing methods, evaluating VA cost and utilization databases, estimating the cost of all VA health care encounters, and analyzing VA Managerial Cost Accounting (MCA; formerly Decision Support System) cost data. We publish guidebooks and technical reports.

HERC economists conduct investigator-initiated research funded by VA HSR Service and assist with cost-effectiveness analysis in projects funded by HSR and the HSR QUERI Program.

Quality Enhancement Research Initiative (QUERI)

The Quality Enhancement Research Initiative (QUERI) is a quality improvement program that is a central component of VA's commitment to improving the quality of Veterans' healthcare by implementing effective clinical practices into routine care. QUERI supports economic analyses of implementation research to support future decisions.

HERC supports QUERI by (a) facilitating scientifically rigorous economic analyses of QUERI implementation research, (b) assisting QUERI strategic goals that are working to reduce the time from research to practice and (c) developing resources and tools to guide QUERI researchers interested in economics.

Cooperative Studies Program (CSP)

The VA Cooperative Studies Program (CSP) conducts multi-site randomized clinical trials of innovations in health care. HERC economists help plan, implement, and analyze data from trials coordinated by CSP that evaluate economic hypotheses.

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Current Projects

HERC works on projects in many subjects. Our work focuses on the following priorities: community care data; data access, sharing, and governance; the transition to the Cerner electronic medical records system; the MEPS Veteran sample; the Choose Home initiative; and a comparison of VA and non-VA cost and utilization.

HERC staff lead and collaboration on research and operations projects that span many of the priority areas in the Office of Research and Development (ORD) Health Systems Portfolio. The table below lists some of our projects and their Health Systems Portfolio priority area.

Table 1. Select HERC Projects by Health Systems Portfolio Priority Area
HSR Topic Area

HERC Projects

Health Care System Organization and Delivery

Health Care and Clinical Management

Long-Term Care, Aging, and Support Services

Quality, Safety, and Value

 

HERC is engaged in several projects that support the goals of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act. The table below features select projects and the priorities they support.

Table 2. Select Projects Supporting the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act
Priority Select Projects

Non-institutional care alternatives to nursing home care

HERC is conducting evaluations to help VA rebalance its long-term care services towards non-institutional long-term care by piloting and evaluating strategies that help identify Veterans with long-term care needs, supporting family caregivers, and understanding barriers and facilitators to using VA non-institutional long-term care services. Findings from these evaluations inform VA programs and policies that directly impact the Veterans VA serves. For example, HERC’s evaluation of the VA-wide Home-Based Primary Care program found that the program resulted in fewer hospitalizations and nursing home placements and that the program saves VA money.

HERC researchers are also working with Durham and Bronx VA colleagues to understand the effect of homemaker/home health aide (H/HHA) use on Veteran outcomes and cost of care and to identify best practices for increasing uptake of H/HHA services among Veterans with long-term care needs. HERC researchers have ongoing projects with Ci2i colleagues evaluating how various health care delivery strategies, including digital health tools, can complement non-institutional care services to enable older Veterans age in place.
  • Elizabeth Dole Center of Excellence for Veteran and Caregiver Research (HSR) Relevant aims: Identify barriers and facilitators to accessing non-institutional long-term care services for caregivers of Veterans with long-term care needs.
  • Helping VA Optimize its Long-Term Care Services (HSR CDA-19-120) Relevant aims: 1) Quantify the effect of supply-side factors on VA home- and community-based long-term care service use; 2) Apply natural language processing methods to improve operational models’ ability to predict Veterans’ long-term care needs, facilitating earlier intervention with non-institutional care services.
  • Does VA Home-Based Primary Care Reduce Costs Among Veterans Eligible for Independence at Home? (HSR IIR 16-240) Relevant aims: Home-Based Primary Care is a program to provide primary care to frail patients who are home-bound, or close to home bound. This project evaluated the program across VA.
  • Homemaker Home Health Aide Use and Veteran-Centered Outcomes (HSR IIR22-134) Relevant aims: 1) Identify drivers of homemaker/home health aide (H/HHA) uptake among newly referred Veterans; 2) Estimate the effect of earlier versus later versus no H/HHA use on Veteran outcomes and cost of care.
  • Long-Term Care Service Mix in the VHA after Home Care Expansion (HSR PPO-17082) Relevant aims: Quantify the long-term effects of the VA’s Millennium Act home care expansion efforts on Veterans’ use of non-institutional long-term care, institutional long-term care, and informal caregiving.
  • Enhancing Veterans’ Access to Care through Video Telehealth Tablets (QUERI PEC 18-205) Relevant aim: Understand how social risks affect older Veterans’ ability to use digital health tools to age in place.
  • Social and Behavioral Determinants of Health in High-Risk Veterans (HSR IIR-20-114) Relevant aims: 1) Identify how social, material, and personal resources affect the ability of older Veterans at high risk for institutional placement to age in place; 2) Understand how data not routinely collected in the electronic health record can improve operational tools used to identify Veterans who may benefit from non-institutional long-term care services.

Support to family caregivers under the Program of Comprehensive Assistance for Family Caregiver (PCAFC)

HERC is part of the Caregiver Support Program (CSP) Partnered Evaluation Initiative focused on evaluating the effects of the FY21 PCAFC expansion. This evaluation will provide evidence on the CSP’s impact on caregiver quality of life, and HERC is leading the evaluation of PCAFC’s effect on Veterans’ cost, utilization, and home time outcomes and supporting aims related to quality of life outcomes.
  • VA Caregiver Support Program Partnered Evaluation Initiative (QUERI PEC-14-272) Relevant aims: 1) Describe how caregiver quality of life is affected by the FY21 expansions to the PCAFC (survey evaluation); 2) Describe how caregiver quality of life is affected by the Program for General Caregiver Support Services (mixed methods); 3) Quantify the effects of the FY21 PCAFC expansion on VA long-term care costs and utilization.

Staffing models

HERC is involved with several projects that provide evidence to optimize nurse staffing for improved patient outcomes.
  • How nursing staff skill mix, education and experience modify patient acuity-based estimates of required unit staffing (HSR IIR 16-238) Relevant aims: 1) Examine how shift-level staffing affects patient outcomes, 2) Examine the gap between targeted and actual nursing hours for each shift for 66 VA facilities.
  • Understanding the relationship between nurse staffing and outcomes: impact of individual nurse education, expertise, and effort level on individual patient outcomes (HSR IIR 21-275) Relevant aims: Examine the association of nurse staffing levels and individual nurse characteristics with patient outcomes and test how the associations are modified by varying unit-shift circumstances.
  • VA Inpatient Units Staffing Model (QUERI Center for Policy Evaluation) Relevant aims: Develop nurse inpatient unit staffing models and provide metrics for the frequency that each inpatient nursing unit is understaffed.

Homelessness and access to care

HERC is conducting evaluations to understand the impact of homelessness and transitions to housing on health care utilization and the use of preventative medical services.
  • Evaluation of the Link Between VA Homelessness Support and Veterans' Use of Preventive Care (QUERI) Relevant aims: Examine the effect of the Housing and Urban Development-Veterans Affairs Supportive Housing (HUD-VASH) program on the likelihood that a Veteran receives preventive health services.
  • Investigating Surgical Outcomes, Experiences, and Care Utilization in Unhoused Adults with Cancer (Benioff Homelessness and Housing Initiative Resource Allocation Program) Relevant aims: This project aims to understand gaps in surgical care for unhoused Veterans.

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Last updated: April 16, 2025