VA Maintains Access to Care as Need for SUD Treatment Grows
Due to the Affordable Care Act (ACA) and other recent laws and regulations, the U.S. is entering a period of expansion of financial support for healthcare in general and for mental health and substance use disorder (SUD) in particular. As part of VA's Mental Health Enhancement Initiative (started in 2005), VA enhanced funding of mental health programs and SUD-specific treatment. Moreover, between 2002 and 2010, VA directed approximately $152 million toward hiring additional SUD staff. Despite increased funding, the extent to which VA healthcare can sufficiently respond to greater demand – maintaining or improving access, recommended intensity, and adequate quality – is a growing concern. This study examined the relationship between dedicated SUD funding and SUD performance measures from 2005 and 2010 for VA medical centers. Dependent variables included the percent of Veterans diagnosed with SUD, and the percent of Veterans that received intensive treatment (residential or outpatient), as well as weeks in treatment. The key independent variable was dedicated SUD funding per year of the study.
- Overall, access and quality of care kept pace with the demand for SUD services in the VA healthcare system. There was a statistically significant and generally positive correlation between additional, dedicated SUD resources and access and treatment intensity.
- The number of VA patients with an SUD diagnosis grew from about 310,000 in 2005 to 439,000 in 2010 – an increase of 42%. Average dedicated SUD funding per facility grew from $65,870 in 2005 to $324,416 in 2007, falling to $147,151 in 2009 and 2010. However, not all VAMCs received funding in each year; for example, in 2006 and 2007, about 27% of medical centers received no dedicated funding, whereas in 2009 and 2010, about 65% did not receive dedicated funding.
- On average, about 8% of VA patients were diagnosed with SUD between 2005 and 2010. Of those, approximately 30% received intensive SUD care.
- The average number of weeks of intensive outpatient care increased in 2008 and 2010, but the average number of weeks of intensive inpatient care did not. This could be due to VA policy, which enhanced continuity of SUD care by providing a longer period of outpatient follow-up after residential care.
- Investigators did not examine the assocation of dedicated SUD treatment spending with the receipt of specfic evidence-based services.
- In 2011, VA implemented a mental health and SUD monitoring and quality improvement program that includes technical assistance and site visits to assist VA facilities in care delivery improvements.
This study was funded by HSR&D (CRE 12-023). Drs. Frakt and Pizer are part of Health Care Financing & Economics (HCFE) at the VA Boston Healthcare System. Dr. Trafton is part of HSR&D's Center for Innovation to Implementation in Palo Alto, CA.
Frakt A, Trafton J, and Pizer S. Maintenance of Access as Demand for Substance Use Disorder Treatment Grows. Journal of Substance Abuse Treatment. March 12, 2015; ePub ahead of print.