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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

1012 — Use of the VA Health Care System by Medicare Advantage Enrollees

Trivedi ANGrebla RC, and Jiang L, Providence VA Medical Center; Yoon J, VA Palo Alto Healthcare System; Mor V, Providence VA Medical Center; Kizer KW, UC Davis;

Objectives:
Using national data from 2004 to 2009, we determined the prevalence of dual enrollment in VA and Medicare Advantage (MA), the concurrent use of medical and surgical services in each setting, and the costs of VA services provided to MA enrollees.

Methods:
We merged VA and MA administrative data to derive the national population of Veterans with at least one month of simultaneous enrollment in an MA plan. To estimate the cost of VA services, we used HERC average cost methods and VA’s direct payments for third party and pharmaceutical care. For each dual enrollee, we calculated the proportionate reliance on VA inpatient and outpatient care.

Results:
The number of Veterans concurrently enrolled in an MA plan increased from 485,651 in 2004 to 924,792 in 2009. Over 60% of dual enrollees used VA healthcare services each year. In 2009, 11% of all VA enrollees and 8% of all MA enrollees were dually enrolled. The total inflation-adjusted cost of VA care for MA enrollees was $12.4 billion over 6 years, increasing from $1.0 billion to $3.2 billion. Mean annual non-drug spending increased from $3,151 in 2004 to $4,703 in 2009. Among dual enrollees, 12% exclusively used VA, 39% exclusively used the MA plan, and 49% used both VA and MA. Exclusive VA users were more likely to be black, reside in the south, and have more intensive use of outpatient visits and acute hospital care (p <0.001 for each comparison). Among dual enrollees, VA financed 45% of outpatient visits, 19% of acute medical admissions, 24% of acute medical hospital days, 11% of acute surgical admissions, and 10% of acute surgical inpatient days. In 2009, VA collected $9.4 million in reimbursements from MA plans, representing 0.3% of the total cost of care for this population.

Implications:
From 2004 to 2009, VA spent a substantial and rapidly increasing amount of funds to care for MA enrollees.

Impacts:
MA plans may benefit from an unrecognized public subsidy as their “risk” of paying for health services for Veterans is greatly mitigated because these same services are delivered by another tax-funded healthcare program.


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