Health Services Research & Development

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2017 HSR&D/QUERI National Conference Abstract

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1052 — Are There Cost Offsets From Comprehensive Support of Family Caregivers? Impact on 3-year Veteran Health Care Costs

Lead/Presenter: Courtney Van Houtven, COIN - Durham
All Authors: Van Houtven CH (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, NC) Smith VA (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC; Department of Medicine, Duke University Medical Center, NC) Stechuchak KM (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Berkowitz T (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Shepherd-Banigan M (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Miller KE (Health Services Research and Development Service, Durham VA Medical Center, Durham, NC) Campbell-Kotler M (Caregiver Support Program, Department of Veterans Affairs Washington D.C.) Henius J (Caregiver Support Program, Department of Veterans Affairs Washington D.C.) Kabat M (Caregiver Support Program, Department of Veterans Affairs Washington D.C.)

Objectives:
The Program of Comprehensive Assistance for Family Caregivers (PCAFC) supports caregivers of Veterans from the post-9/11 era who need assistance with activities of daily living or supervision or protection because of the residual effect of injuries sustained during their service. In March 2017 VA Secretary David Shulkin proposed extending the program to caregivers of Veterans of all eras; thus, even though the population of caregivers and Veterans from the post-9/11 era have unique characteristics compared to earlier era Veteran-caregiver dyads, understanding 3-year cost implications of PCAFC is vital to help inform this policy proposal. The purpose of this analysis was to rapidly examine the impact of PCAFC on 3-year Veteran-provided and -purchased (fee, CHOICE) health care costs.

Methods:
A pre-post cohort design including a non-equivalent control group was used to estimate differences in total VA health care costs of Veterans with caregivers enrolled in PCAFC and those with caregivers not enrolled in PCAFC in six month intervals for 3 years after application to PCAFC. The treatment group consisted of Veterans (n = 15,650) whose caregivers applied to and were approved for participation in PCAFC since its inception (May 2011) through March 2014. The control group was an inverse probability of treatment weighted sample of Veterans whose caregivers applied for, but were not accepted into, PCAFC through March 2014 (n = 8,339).

Results:
Veterans in the PCAFC group were estimated to have $13,400 in VA health care costs in the first 6 months after PCAFC application, compared to $11,058 in the control group. Over time, VA health care costs for both groups decreased, but this difference persisted and was statistically significant. For example, at 3-years (30-36 month interval), the Veterans in the PCAFC group were estimated to have $8,763 in health care costs compared to $6,613 in the control group.

Implications:
Veterans in PCAFC had higher total VA health care costs up to 3 years post PCAFC application.

Impacts:
Findings suggest that comprehensive supports for family caregivers do not offset total Veteran health care costs at 3 years for post-9/11 Veterans. Future analyses should focus on psychiatric inpatient treatment, nursing home utilization, and suicide risk.