Is Fragmented Financing Bad for Your Health?

Pizer, Steven D.; Gardner, John A.

doi:10.5034/inquiryjrnl_48.02.02

Cited by 41 publications

(45 citation statements)

References 26 publications

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“…Medicare, Medicaid, private health insurance) [1] and many obtain care from multiple health care systems each year. While this “dual use” may allow for increased health services access and choice, it is associated with negative consequences: poor communication among providers [2], incomplete or duplicate diagnosis and treatment plans [3, 4], fragmented services, diminished continuity and coordination of care, increased emergency department and hospital utilization, adverse events [5], and increased costs [6–8]. …”

Section: Introductionmentioning

confidence: 99%

“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

Zucchero

McDannold

McInnes

2016

BMC Health Serv Res

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BackgroundWhile dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population.MethodsThree semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used.ResultsHCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received.ConclusionsSubstantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1722-x) contains supplementary material, which is available to authorized users.

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Section: Introductionmentioning

confidence: 99%

“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

Zucchero

McDannold

McInnes

2016

BMC Health Serv Res

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“…Previous research suggests that care fragmentation has deleterious effects on health, including increased emergency department (ED) visits among patients with diabetes and greater probability of hospitalization for ambulatory care sensitive conditions in a VA population, and conversely, that greater continuity is associated with lower probability of hospitalization, fewer ED visits, and higher patient satisfaction (43)(44)(45)(46)(47)(48). Fragmentation of care associated with dual use may influence outcomes through reduced continuity and associated coordination of care.…”

Section: Discussionmentioning

confidence: 99%

Reduced Overall and Event-Free Survival among Colon Cancer Patients Using Dual System Care

Tarlov

Lee

Weichle

et al. 2012

Cancer Epidemiology, Biomarkers &Amp; Prevention

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Background: Many veterans have dual Veterans Administration (VA) and Medicare healthcare coverage. We compared 3-year overall and cancer event-free survival (EFS) among patients with nonmetastatic colon cancer who obtained substantial portions of their care in both systems and those whose care was obtained predominantly in the VA or in the Medicare fee-for-service system.Methods: We conducted a retrospective observational cohort study of patients older than 65 years with stages I to III colon cancer diagnosed from 1999 to 2001 in VA and non-VA facilities. Dual use of VA and non-VA colon cancer care was categorized as predominantly VA use, dual use, or predominantly non-VA use. Extended Cox regression models evaluated associations between survival and dual use.Results Conclusions: Improved survival among VA and non-VA compared with dual users raises questions about coordination of care and unmet needs.Impact: Additional study is needed to understand why these differences exist, why patients use both systems, and how systems may be improved to yield better outcomes in this population. Cancer Epidemiol Biomarkers Prev; 21(12); 2231-41. Ó2012 AACR.

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“…Our project also used a method of summarizing Medicaid eligibility policy differences based on the Medicaid/private insurance "crowd-out" literature of the past 15 years [16][17][18][19]. This approach was useful in an analysis of the impact of fragmented financing on health outcomes for VA patients [20].…”

Section: Discussionmentioning

confidence: 99%

What can Medicaid data add to research on VA patients?

Gardner¹,

Frakt²,

Gilden³

et al. 2010

JRRD

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Abstract-This article is the first to describe Department of Veterans Affairs (VA) patients' use of Medicaid at a national level. We obtained 1999 national VA enrollment and utilization data, Centers for Medicare and Medicaid Services enrollment and claims, and Medicare information from the VA Information Resource Center. The research team created files for program characteristics and described the VA-Medicaid dually enrolled population, healthcare utilization, and costs. In 1999, VA-Medicaid dual enrollees comprised 10.2% of VA's annual patient load (350,000/3,450,000); 304,000 were veterans. These veterans differed marginally from VA's veteran patients, being on average half a year younger and having 1% fewer males. Dual enrollees with mental health diagnoses and care were almost three times as numerous as long-term care patients; these two groups accounted for ~60% of dual enrollees. Dual enrollees disproportionately included housebound veterans and veterans needing aid and assistance. Half the dual enrollees had 12 months of Medicaid eligibility, and total Federal expenditures per patient not in managed care programs averaged >$18,000 (median >$6,000). Dually enrolled women veterans cost ~55% less than men. Medicaid benefits complement VA and are more accessible in many states. VA researchers need to consider including Medicaid utilization and costs in their studies if they target populations or programs related to long-term care or mental disorders.

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Is Fragmented Financing Bad for Your Health?

Cited by 41 publications

References 26 publications

“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

“Walking in a maze”: community providers’ difficulties coordinating health care for homeless patients

Reduced Overall and Event-Free Survival among Colon Cancer Patients Using Dual System Care

What can Medicaid data add to research on VA patients?

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