2015 National Conference

3163 — Did Massachusetts Health Reform Impact VA Primary Care Use?

Wong ES, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Maciejewski ML, Center for Health Services Research in Primary Care, Durham VA Medical Center, Durham, NC; Hebert PL, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Batten A, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Nelson KM, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Fihn SD, Office of Analytics and Business Intelligence, Veterans Health Administration, Seattle, WA; Liu CF, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA;

Objectives:
Massachusetts Health Reform (MHR), implemented in June 2006, introduced a mandate requiring minimum health insurance coverage and new health insurance options available to eligible Massachusetts residents. These new options under MHR may have prompted some VA enrollees to shift care from VA to non-VA sources. This study examined whether MHR was associated with changes in Veterans' use of VA primary care (PC).

Methods:
Using VA administrative data, we identified 230,811 VA users residing in Massachusetts and neighboring New England (NE) states (Connecticut, Maine, New Hampshire, Rhode Island and Vermont) from October 2004 to September 2008. The dependent variable was the number of PC face-to-face visits per patient per quarter. We applied difference-in-difference methods to compare pre-post changes in PC use among Massachusetts and other NE Veterans, respectively. We modeled visit counts using negative binomial regression adjusting for demographics, comorbidity, local economic conditions, non-VA healthcare supply and patient fixed-effects. Analyses were stratified by age [ < 65 (non-elderly) and 65+ (elderly)].

Results:
Before reform, mean PC visits per patient per quarter were 0.81 and 0.76 for non-elderly Massachusetts and other NE Veterans, respectively. Among elderly Veterans before reform, mean PC visits per patient per quarter were 0.82 and 0.75 for Massachusetts and other NE Veterans, respectively. In adjusted analyses, MHR was associated with a 0.012 (p = 0.004) and 0.007 (p = 0.022) quarterly PC visit increase for non-elderly and elderly Veterans, respectively. Among continuous VA users present through all post-MHR quarters, MHR was associated with a 0.032 (p < 0.001) and 0.021 (p < 0.001) quarterly PC visit increase for non-elderly and elderly Veterans, respectively.

Implications:
MHR was associated with small, but significant increases in PC use. The positive association was concentrated among Veterans who remained continuous users of VA following MHR.

Impacts:
The impact of the Affordable Care Act, which includes many components present in MHR, on Veterans' future utilization of VA remains largely unknown. Our findings suggest some Veterans may choose to seek care through non-VA options. However, among active VA users after reform, VA may become an increasingly important source of care.