Impact of Policy on VA Healthcare Utilization

Graph showing outpatient behavioral health visit numbers before and after Medicaid enrollment (n=7249), 2006-09.

Significant internal and external changes have affected the utilization of healthcare services in the Department of Veterans Affairs (VA). The VA is the largest integrated healthcare system in the U.S., with 9 million enrollees and 6 million users per year. Vanneman and colleagues have spearheaded research on the outcomes of increasing the portion of care currently outsourced to the private sector by the VA, as brought about by the Veterans Choice Act of 2014 and the MISSION Act of 2018.

The group has also worked to project the impacts of the Affordable Care Act for VA enrollees who newly gain Medicaid coverage. One notable finding is that total utilization of outpatient behavioral health services increases after veterans enroll in Medicaid  – suggesting that Medicaid is best viewed as a complement rather than a substitute for VA outpatient behavioral health care.

References:

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Iraq and Afghanistan veterans’ use of Veterans Health Administration and purchased care before and after Veterans Choice Program implementationVanneman ME, Harris AHS, Asch SM, Scott WJ, Murrell SS, Wagner TH. Med Care. 2017 Jul;55 Suppl 7 Suppl 1:S37.

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The impact of medicaid enrollment on Veterans Health Administration enrollees’ behavioral health services useVanneman ME, Phibbs CS, Dally SK, Trivedi AN, Yoon J. Health Serv Res. 2018 Dec;53 Suppl 3:5238.

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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’Brien WJ, Vanneman ME. Health Serv Res. 2018 Dec;53 Suppl 3:5438.

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Recommendations for the evaluation of cross-system care coordination from the VA State-of-the-art Working Group on VA/Non-VA Care. Mattocks KM, Cunningham K, Elwy AR, Finley EP, Greenstone C, Mengeling MA, Pizer SD, Vanneman ME, Weiner M, Bastian LA. J Gen Intern Med. 2019 May;34(Suppl 1):18.