VIReC’s VA/CMS Data for Research Project conducts research on Veterans’ use of Medicare and Medicaid services. Results of this research have been published in the articles listed below. Expand the abstract for a detailed description of each publication.
Humensky, J; Carretta, H; de Groot, K; Brown, MM; Tarlov, E; Hynes, DM. Service Utilization of Veterans Dually Eligible for VA and Medicare Fee-For-Service: 1999–2004. Medicare & Medicaid Research Review, 2012; 2(3): E1–E22.
Objective: To examine care system choices for Veterans dually-eligible for VA and Medicare FFS following changes in VA eligibility policy, which expanded availability of VA health care services.
Data Sources: VA and Medicare FFS enrollment and outpatient utilization databases in 1999 and 2004. Study Design: Multinomial logistic regression was used to examine odds of VA-only and Medicare-only utilization, relative to dual utilization, in 1999 and 2004. Observational cohort comprising a 5% random sample of dually-eligible Veterans: 73,721 in 1999 and 125,042 in 2004.
Principal Findings: From 1999 to 2004, persons with the highest HCC risk scores had decreasing odds of exclusive VA reliance (OR=0.26 in 1999 and 0.17 in 2004, p<0.05), but had increasing odds of exclusive Medicare reliance (OR=0.43 in 1999 and 0.56 in 2004, p<0.05).Persons in high VA priority groups had decreasing odds of exclusive VA reliance, as well as decreasing odds of exclusive Medicare reliance, indicating increasing odds of dual use. Newly eligible Veterans with the highest HCC risk scores had higher odds of dual system use, while newly eligible Black Veterans had lower odds of dual system use.
Conclusions: Veterans newly eligible for VA healthcare services, particularly those with the highest risk scores, had higher odds of dual system use compared to earlier eligibles. Providers should ensure coordination of care for Veterans who may be receiving care from multiple sources. Provisions of the Patient Protection and Affordable Care Act may help to ensure care coordination for persons receiving care from multiple systems.
Hynes, DM; Koelling, K; Stroupe, KT; Arnold, N; Mallin, K; Sohn, MW; et al. Veterans' Access to and Use of Medicare and Veterans Affairs Health Care. Med Care, Mar 2007; 45(3):214-223.
Objectives: We examined the impact of access to care characteristics on health care use patterns among those veterans dually eligible for Medicare and Veterans Affairs (VA) services.
Methods: We used a retrospective, cross-sectional design to identify veterans who were eligible to use VA and Medicare health care in calendar year 1999. We analyzed national VA utilization and Medicare claims data. We used descriptive and multivariable generalized ordered logit analyses to examine how patient, geographic, and environmental factors affect the percent reliance on VA and Medicare inpatient and outpatient services.
Results: Of the 1.47 million veterans in our study population with outpatient use, 18% were VA-only users, 36% were Medicare-only users, and 46% were both VA and Medicare users. Among veterans with inpatient use, 24% were VA only, 69% were Medicare only, and 6% were both VA and Medicare users. Multivariable analysis revealed that veterans who were black or had a higher VA priority were most likely to rely on the VA. Patient with higher risk scores were most likely to rely on a combination of VA and Medicare health care. Patients who lived farther from VA hospitals were less likely to rely on VA health care, particularly for inpatient care. Patients living in urban areas with more health care resources were less likely to rely on VA health care.
Conclusions: VA health care provides an important safety net for vulnerable populations. Targeted approaches that carefully consider the simultaneous impacts of VA and Medicare policy changes on minority and high-risk populations are essential to ensure veterans have access to needed health care
VA Information Resource Center.
Research Findings From The VA Medicare Data Merge Initiative: Veterans' Enrollment, Access and Use of Medicare and VA Health Services - Report to the Under Secretary for Health, Department of Veterans Affairs. Rpt. No. XVA-69001.
Hines, IL: U.S. Dept. of Veterans Affairs, Health Services Research and Development Service, VA Information Resource Center, Sep 3 2003.