Differences in Risk Scores of Veterans Receiving Community Care Purchased by the Veterans Health Administration
- 24 September 2018
- journal article
- research article
- Published by Wiley in Health Services Research
- Vol. 53 (S3), 5438-5454
- https://doi.org/10.1111/1475-6773.13051
Abstract
Objective To assess differences in risk (measured by expected costs associated with sociodemographic and clinical profiles) between Veterans receiving outpatient services through two community care (CC) programs: the Fee program (“Fee”) and the Veterans Choice Program (“Choice”). Data Sources/Study Setting Administrative data from VHA's Corporate Data Warehouse in fiscal years (FY) 2014–2015. Study Design We compared the clinical characteristics of Veterans across three groups (Fee only, Choice only, and Fee & Choice). We classified Veterans into risk groups based on Nosos risk scores and examined the relationship between type of outpatient utilization and risk within each CC group. We also examined changes in utilization of VHA and CC in FY14–FY15. We used chi‐square tests, t tests, and ANOVAs to identify significant differences between CC groups. Principal Findings Of the 1,400,977 Veterans using CC in FY15, 91.4 percent were Fee‐only users, 4.4 percent Choice‐only users, and 4.2 percent Fee & Choice users. Mean concurrent risk scores were higher for Fee only and Fee & Choice (1.9, SD = 2.7; 1.8, SD = 2.2) compared to Choice‐only users (1.0, SD = 1.2) (p < .0001). Most CC users were “dual users” of both VHA and CC in FY14–FY15. Conclusions As care transitions from VHA to CC, VHA should consider how best to coordinate care with community providers to reduce duplication of efforts, improve handoffs, and achieve the best outcomes for Veterans.Keywords
Funding Information
- Health Services Research and Development (SDR-17-157)
This publication has 10 references indexed in Scilit:
- Caring for Those Who Serve: Potential Implications of the Veterans Affairs Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018Annals of Internal Medicine, 2018
- Advanced Analytics Studies Applied to US Department of Veterans Affairs' Corporate Data Warehouse (Initial Draft)Published by Office of Scientific and Technical Information (OSTI) ,2018
- Evaluating the Veterans Choice ProgramMedical Care, 2017
- Trends in the Purchase of Surgical Care in the Community by the Veterans Health AdministrationMedical Care, 2017
- Iraq and Afghanistan Veterans’ Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program ImplementationMedical Care, 2017
- Understanding Veteran Wait TimesAnnals of Internal Medicine, 2017
- Risk Adjustment Tools for Learning Health Systems: A Comparison of DxCG and CMS‐HCC V21Health Services Research, 2016
- Comparison of outcomes for veterans receiving dialysis care from VA and non-VA providersBMC Health Services Research, 2013
- Relationship between Clinical Conditions and Use of Veterans Affairs Health Care among Medicare‐Enrolled VeteransHealth Services Research, 2010
- Development and Validation of a Psychiatric Case-Mix SystemMedical Care, 2006