Study finds no health drawbacks to veterans' dual use of VA, Medicare Advantage

April 27, 2015
Nurse practitioner Jyoti Desai (right) and nurse Barbara Murphy see an older primary care patient at the Philadelphia VA Medical Center. Credit: Tommy Leonardi

In a study that looked at a handful of quality measures for chronic disease care, veterans who used both Department of Veterans Affairs (VA) care and a Medicare Advantage plan during 2008 or 2009 did no better or worse than those who used only VA care.

That's the gist of research on more than 6,600 older, chronically ill who were enrolled in both federal health systems. The study appeared online April 6, 2015, in the journal Health Services Research.

The researchers studied the issue because of concerns that dual enrollment may lead to poorly coordinated medical care, as well as duplicate taxpayer spending.

"Although dual use does not appear to have any negative impact on quality of care, we found no evidence that it improves the quality of care veterans are getting. That point needs to be considered in light of the duplicate federal spending that comes along with dual enrollment," says Dr. Amal Trivedi, senior author on the study.

Trivedi is a physician and health services researcher at the Providence VA Medical Center and Brown University. He and lead author Dr. Alicia Cooper, who is with the state of Vermont, collaborated with researchers from two other VA sites and three universities.

The study focused on measures of good care for diabetes, hypertension, and high cholesterol—for example, well-controlled blood sugar or blood pressure.

Some dually enrolled Veterans used only VA

All the 6,643 veterans in the study were enrolled during 2008 or 2009 in both VA and a Medicare Advantage plan. Despite the dual enrollment, about a quarter of them actually used only VA for their . Veterans in the VA-only group were more likely to be black, younger (within the 65-plus age bracket), and lower-income. They were also in poorer health overall.

The researchers compared the outcomes of this group against the outcomes of dually enrolled veterans who used both systems for outpatient care.

The Medicare Advantage network involves private managed health plans that contract with the federal government. They receive a fixed dollar amount each year for every enrollee, regardless of how much medical care the patient actually consumes. If the patient gets all or most of his medical care through VA, the Medical Advantage plan is able to pocket the money from Uncle Sam without having to spend it.

In the study, in addition to the 25 percent of veterans who relied strictly on VA care, despite their dual enrollment, another 20 percent used almost all VA care, and no Medicare Advantage care.

Concerning these patients, the study authors wrote: "The MA plans in which these individuals are enrolled stand to profit greatly under the circumstances, providing few or no services despite having been prospectively paid for the beneficiaries' annual care."

Past study highlighted duplicate spending

In a 2012 study published in the Journal of the American Medical Association, Trivedi's group estimated that in the five-year period from 2004 to 2009, VA spent $13 billion to provide Medicare-covered services to veterans who in theory could have received those same services through their Medicare Advantage plans.

Trivedi says the trend toward dual enrollment has been growing. "The use of Medicare Advantage plans has grown sharply in the last few years," he says. "We've found that about 10 percent of the enrolled VA population is now also in one of these plans."

The good news from the current study is that there doesn't appear to be a significant drawback, medically speaking, to veterans' receiving care through both systems, at least in terms of intermediate outcomes relating to blood pressure, blood sugar, or cholesterol control. The study didn't look at outcomes such as hospitalization or death.

The issue has not been well-studied, but some experts believe patients could be at greater risk when providers across the two systems don't communicate with each other about diagnoses and care plans, and pharmacies don't coordinate on medications.

Trivedi: "In VA, we like to deliver comprehensive care to veterans, but we recognize that veterans have choices for care outside of VA. That can potentially be a benefit if there are some complementary services and if both systems interact well and share information. But there can also be some potential quality challenges, particularly if information is not well-shared, or if there is fragmentation in care."

The new study allays some of that concern, at least with respect to outpatient care for everyday chronic diseases. On the other hand, the authors note that even among the 5,000 or so veterans in the study who used both systems to some extent, most relied more heavily on VA, with relatively few Medicare Advantage visits. This might have blunted any differences in outcomes between the VA-only and dual-use groups.

Still, the authors say the lack of any clear clinical advantage from dual use only sharpens worries over duplicate spending.

In their 2012 paper, Trivedi's group proposed two possible remedies. One would be to monitor Medicare Advantage plans for VA enrollees, and adjust the plans' payments downward according to some formula. The other would be to allow VA to seek reimbursement from the Medicare system for services it provides to veterans who are enrolled in Medicare Advantage plans. Current law prohibits VA from doing so.

To watch a video of Dr. Trivedi discussing his VA-funded research on dual VA-Medicare enrollees, visit http://www.hsrd.research.va.gov/news/video and look under the category "Healthcare Equity."

Explore further: Study examines federal government payments to separate managed care programs for same patients

Related Stories

Study examines federal government payments to separate managed care programs for same patients

June 26, 2012
An analysis that included 1.2 million veterans enrolled in the Veterans Affairs health care system and Medicare Advantage plan finds that the federal government spends a substantial and increasing amount of potentially duplicative ...

VA says it will relax 40-mile rule for private medical care

March 24, 2015
Responding to pressure from Congress and veterans groups, the Department of Veterans Affairs is relaxing a rule that makes it hard for some veterans in rural areas to prove they live at least 40 miles from a VA health site.

Lower use of cancer-related imaging in VA health system

December 3, 2014
(HealthDay)—Cancer-related imaging use is lower in the Department of Veterans Affairs (VA) health care system than in fee-for-service Medicare, and use is not associated with geographic variation, according to research ...

A VA exit strategy

August 29, 2014
As the federal government plans its exit strategy from the war, now may be the time for it to rethink its role in providing health care to veterans, says a Perspective piece in the New England Journal of Medicine.

VA makes major gains in quality, but racial disparity persists

April 7, 2011
As recently as the 1990s, the Veterans Affairs health care system had a subpar reputation for quality, but two new studies of standard quality metrics, both led by Amal Trivedi, assistant professor of community health at ...

Research calls for new policies to support women veterans' health care needs

March 16, 2015
As more women veterans seek health care in the Veterans Administration (VA) system, effective approaches are needed to ensure that their unique needs are recognized and met. A special April supplement to Medical Care collects ...

Recommended for you

Air pollution linked to poorer quality sperm

November 22, 2017
Air pollution, particularly levels of fine particulate matter (PM2.5), is associated with poorer quality sperm, suggests research published online in Occupational & Environmental Medicine.

Sunrise and sunset guide daily activities of city-dwellers

November 21, 2017
Despite artificial lightning and social conventions, the dynamics of daylight still influence the daily activities of people living in modern, urban environments, according to new research published in PLOS Computational ...

Older men need more protein to maintain muscles

November 21, 2017
The amount of protein recommended by international guidelines is not sufficient to maintain muscle size and strength in older men, according to a new study.

Exercising and eating well are greater contributors to health than standing at work

November 21, 2017
By now you've probably heard the edict from the health community: Sitting is the new smoking. Perhaps you've converted to a standing desk, or maybe you have a reminder on your phone to get up once an hour and walk around ...

Motorcycle crashes cause five times as many deaths as car accidents, six times the health costs

November 20, 2017
Motorcycle accidents are costly in terms of lives and health care costs. Compared with car accidents, motorcycle accidents cause 3 times the injuries, 6 times the medical costs and 5 times the deaths, found new research in ...

Dog ownership linked to lower mortality

November 17, 2017
A team of Swedish scientists have used national registries of more than 3.4 million Swedes aged 40 to 80 to study the association between dog ownership and cardiovascular health. Their study shows that dog owners had a lower ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.