Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient Services

Hebert, Paul L.; Batten, Adam S; Gunnink, Eric; Reddy, Ashok; Wong, Edwin S.; Fihn, Stephan D.; Liu, Chuan‐Fen

doi:10.1111/1475-6773.13033

Cited by 22 publications

(28 citation statements)

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“…These visits were counted based on the number of evaluation and management visits in Medicare and VHA. 18,19 We then investigated the association of change a Tests the significance of change in the Pi 2 score as a whole.…”

Section: Discussionmentioning

confidence: 99%

Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

et al. 2020

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IMPORTANCE In 2010, the US Veterans Health Administration (VHA) implemented one of the largest patient-centered medical home (PCMH) models in the United States, the Patient Aligned Care Team initiative. Early evaluations demonstrated promising associations with improved patient outcomes, but limited evidence exists on the longitudinal association of PCMH implementation with changes in health care utilization. OBJECTIVE To determine whether a change in PCMH implementation is associated with changes in emergency department (ED) visits, hospitalizations for ambulatory care-sensitive conditions (ACSCs), or all-cause hospitalizations. DESIGN, SETTING, AND PARTICIPANTS This cohort study used national patient-level data from the VHA and Centers for Medicare & Medicaid Services between October 1, 2012, and September 30, 2015. A total of 1 650 976 patients from 897 included clinics were divided into 2 cohorts: patients younger than 65 years who received primary care at VHA sites affiliated with a VHA ED and patients 65 years or older who were enrolled in both VHA and Medicare services. EXPOSURES Clinics were categorized on improvement or decline in PCMH implementation based on their Patient Aligned Care Team implementation progress index (Pi 2) score. MAIN OUTCOMES AND MEASURES Change in the number of ED visits, ACSC hospitalizations, and all-cause hospitalizations among patients at each clinic site. RESULTS The study included a total of 1 650 976 patients, of whom 581 167 (35.20%) were younger than 65 years (mean [SD] age, 49.03 [10.28] years; 495 247 [85.22%] men) and 1 069 809 (64.80%) were 65 years or older (mean [SD] age, 74.64 [7.41] years; 1 050 110 [98.16%] men). Among patients younger than 65 years, there were fewer ED visits among patients seen at clinics that had improved PCMH implementation (110.8 fewer visits per 1000 patients; P < .001) and clinics that had somewhat worse implementation (69.0 fewer visits per 1000 patients; P < .001) compared with clinics that had no change in Pi 2 score. There were no associations of change in Pi 2 scores with all-cause hospitalizations or ACSC hospitalizations among patients younger than 65 years. In patients 65 years or older, those seen at clinics that had somewhat worse PCMH implementation experienced fewer ED visits (20.1 fewer visits per 1000 patients; P = .002) and all-cause hospitalizations (12.4 fewer hospitalizations per 1000 patients; P = .007) compared with clinics with no change in Pi 2 score. There was no association between change in Pi 2 score with ACSC hospitalizations among patients 65 years or older. (continued) Key Points Question Is a change in patientcentered medical home implementation associated with changes in high-cost health care utilization in the US Veterans Health Administration health care system? Findings In this cohort study including 1 650 976 veterans, neither improvement nor decline in patientcentered medical home implementation was consistently associated with changes in the numbers of emergency department visits, ambulatory caresensitiv...

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Section: Discussionmentioning

confidence: 99%

Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

et al. 2020

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“…An integrated purchased care approach may affect costs in other ways, too. Evidence suggests that new programs of care, particularly those that affect access, can affect veterans' reliance on and utilization of VA health care (Hebert et al, 2018;Eibner et al, 2015). If access under the joint contract improves, more beneficiaries-particularly veterans without TRICARE eligibility-may be likely to use the purchased care system and rely more heavily overall on VA for their care.…”

Section: Changes In Utilizationmentioning

confidence: 99%

Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment

Farmer¹,

Tanielian²,

Buttorff³

et al. 2018

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“…; Hebert et al. ; Lei et al. ), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well‐established documentation and file structures (Hynes et al.…”

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confidence: 99%

“…The papers in this special issue used a range of non-VA datasets, several presented for the first time in a research application. Medicare data were the most commonly linked data (used in Wang et al 2018;Thorpe et al 2018;Vaughan Sarrazin et al 2018;Trivedi et al 2018;Reddy et al 2018;Nelson et al 2018a, b;Vanneman et al 2018;Liu et al 2018;Chui et al 2018;Hebert et al 2018;Lei et al 2018), because these data have been available to VA researchers within the VA under an agreement with Centers for Medicare and Medicaid Services via the VIReC for more than fifteen years and have well-established documentation and file structures (Hynes et al 2007). Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018).…”

mentioning

confidence: 99%

“…Other non-VA datasets used by authors in this special issue included US Renal Data System (USRDS) (Wang et al 2018), state data from California birth records (Shaw et al 2018), and Oregon prescription drug monitoring program (PDMP) data (Carlson et al 2018). These papers leveraged the linked data they created to address a range of topics, including VA and non-VA health care use and costs (Wang et al 2018;Vaughan Sarrazin et al 2018;Hebert et al 2018;Vanneman et al 2018;Liu et al 2018;Lei et al 2018), medication use (Thorpe et al 2018;Carlson et al 2018;and Chiu et al 2018), and the impact of homelessness on health care use and costs (Nelson et al 2018, andTrivedi et al 2018). One study focused on health care use in VA and VA community care (Rosen et al 2018).…”

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HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

Hynes

Maciejewski

Atkins

2018

Health Services Research

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Objective This commentary summarizes the methods and topics addressed in the special issue of HSR focused on linkage of United States Department of Veterans Affairs (VA) and non‐VA datasets. The issue illustrates that researchers are increasingly linking diverse datasets as a valuable method for obtaining outcomes, treatments, and covariates to evaluate and examine health care delivery that includes non‐VA services. The issue serves as a reference to VA and non‐VA investigators alike who employ data linkage methods to address high‐impact clinical and health policy evaluations that span different care systems and different datasets.

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Reliance on Medicare Providers by Veterans after Becoming Age‐Eligible for Medicare is Associated with the Use of More Outpatient Services

Abstract: Expanded access to fee-for-service care in the community may be expensive, while the VA will likely continue to care for the most vulnerable veterans.

Cited by 22 publications

References 16 publications

Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

Association of High-Cost Health Care Utilization With Longitudinal Changes in Patient-Centered Medical Home Implementation

Integrating Department of Defense and Department of Veterans Affairs Purchased Care: Preliminary Feasibility Assessment

HSR Commentary: Linking VA and Non‐VA Data to Address Important US Veteran Health Services Research Issues

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