Differences in Risk Scores of Veterans Receiving Community Care Purchased by the Veterans Health Administration.

Rosen AK, Wagner TH, Pettey WBP, Shwartz M, Chen Q, Lo J, O WJ, Vanneman ME. Differences in Risk Scores of Veterans Receiving Community Care Purchased by the Veterans Health Administration. Health services research. 2018 Dec 1; 53 Suppl 3:5438-5454.

Related HSR&D Project(s)

• RCS 17-154 – Career Scientist Award
• SDR 18-318 – Make Versus Buy- Examining the Evidence on Access, Utilization and Cost: Are We Buying the Right Care for the Right Amount?

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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 and 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 and Choice users. Mean concurrent risk scores were higher for Fee only and Fee and 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.