Study Shows VA Healthcare Outperforms Private-Sector, Medicare-Managed Care among Older Patients
After a reorganization in the mid-1990s, the quality of VA healthcare compared favorably with the quality of care in some private-sector settings. Whether this performance advantage has persisted is unknown; as is its relation to geographic and socioeconomic variations in care. This study compared clinical performance from 2000 to 2007 between VA and Medicare-managed care plans, known as Medicare Advantage (MA). Using VA and Medicare data, investigators compared adherence to 12 quality indicators assessing diabetes, cardiovascular, and cancer screening care. Quality indicators included: HbA1c testing and control, LDL cholesterol testing and control, retinal eye exams, and BP control among patients with diabetes; ß-blocker prescriptions and LDL cholesterol testing and control after an acute coronary event; BP control among patients with hypertension; and mammography and colorectal cancer (CRC) screening. The study cohort included men 65 years and older and women between the ages of 65 and 69, comprising nearly 300,000 observations from VA patients (nationally representative random sample) in 142 VAMCs and nearly 6,000,000 observations from enrollees in 305 MA plans.
- VA outperformed Medicare Advantage (MA) health plans on 10 out of 11 widely used clinical performance indicators assessing diabetes, cardiovascular, and cancer screening care among patients ages 65 and older in the initial study year – and on all 12 measures by the final year. Moreover, for 10 of the 12 measures studied, even the best-performing MA plans lagged behind the lowest-performing VAMCs.
- The performance advantage for VA was substantial. For example, in 2006 and 2007, adjusted differences between VA and MA ranged from 4.3 percentage points for cholesterol testing in coronary heart disease to 30.8 percentage points for CRC screening.
- VA delivered care that was less variable by site, geographic region, and socioeconomic status.
- For 9 of the 12 measures, socioeconomic disparities were lower in the VA than in MA.
- Twelve quality indicators were assessed; therefore, investigators were unable to evaluate many unmeasured aspects of quality.
- Investigators were unable to identify individuals who used both VA and non-VA healthcare.
- Some measures for VA and MA were limited to three or fewer years of concurrent data collection.
This study was partly supported by an HSR&D Career Development Award to Dr. Trivedi. Drs. Trivedi and Grebla are part of HSR&D’s Center on Systems, Outcomes & Quality in Chronic Disease & Rehabilitation, Providence, RI.
Trivedi A and Grebla R. Quality and Equity of Care in the Veterans Affairs Healthcare System and in Medicare Advantage Health Plans. Medical Care March 18, 2011;e-pub ahead of print.