Which veterans enroll in a VA health information exchange program?

Objective: To characterize patients who voluntarily enrolled in an electronic health information exchange (HIE) program designed to share data between Veterans Health Administration (VHA) and non-VHA institutions. Materials and Methods: Patients who agreed to participate in the HIE program were compared to those who did not. Patient characteristics associated with HIE enrollment were examined using a multivariable logistic regression model. Variables selected for inclusion were guided by a health care utilization model adapted to explain HIE enrollment. Data about patients’ sociodemographics (age, gender), comorbidity (Charlson index score), utilization (primary and specialty care visits), and access (distance to VHA medical center, insurance, VHA benefits) were obtained from VHA and HIE electronic health records. Results: Among 57 072 patients, 6627 (12%) enrolled in the HIE program during its first year. The likelihood of HIE enrollment increased among patients ages 50–64, of female gender, with higher comorbidity, and with increasing utilization. Living in a rural area and being unmarried were associated with decreased likelihood of enrollment. Discussion and Conclusion: Enrollment in HIE is complex, with several factors involved in a patient’s decision to enroll. To broaden HIE participation, populations less likely to enroll should be targeted with tailored recruitment and educational strategies. Moreover, inclusion of special populations, such as patients with higher comorbidity or high utilizers, may help refine the definition of success with respect to HIE implementation

Regional data exchange to improve care for veterans after non-VA hospitalization: a randomized controlled trial

BACKGROUND: Coordination of care, especially after a patient experiences an acute care event, is a challenge for many health systems. Event notification is a form of health information exchange (HIE) which has the potential to support care coordination by alerting primary care providers when a patient experiences an acute care event. While promising, there exists little evidence on the impact of event notification in support of reengagement into primary care. The objectives of this study are to 1) examine the effectiveness of event notification on health outcomes for older adults who experience acute care events, and 2) compare approaches to how providers respond to event notifications. METHODS: In a cluster randomized trial conducted across two medical centers within the U.S. Veterans Health Administration (VHA) system, we plan to enroll older patients (≥ 65 years of age) who utilize both VHA and non-VHA providers. Patients will be enrolled into one of three arms: 1) usual care; 2) event notifications only; or 3) event notifications plus a care transitions intervention. In the event notification arms, following a non-VHA acute care encounter, an HIE-based intervention will send an event notification to VHA providers. Patients in the event notification plus care transitions arm will also receive 30 days of care transition support from a social worker. The primary outcome measure is 90-day readmission rate. Secondary outcomes will be high risk medication discrepancies as well as care transitions processes within the VHA health system. Qualitative assessments of the intervention will inform VHA system-wide implementation. DISCUSSION: While HIE has been evaluated in other contexts, little evidence exists on HIE-enabled event notification interventions. Furthermore, this trial offers the opportunity to examine the use of event notifications that trigger a care transitions intervention to further support coordination of care. TRIAL REGISTRATION: ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered 23 February 2016

Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA

Analysis of the 2008-2010 American Community Survey indicates that 535,000 uninsured veterans and 174,000 uninsured spouses of veterans -- or 4 in 10 uninsured veterans and 1 in 4 uninsured spouses -- have incomes below 138 percent of poverty and could qualify for Medicaid or new subsidies for coverage under the Affordable Care Act. Most have incomes below 100 percent of poverty and will only have new coverage options if their state expands Medicaid. Since uninsurance is related to greater problems accessing care, increased Medicaid enrollment could improve the likelihood that their health care needs are being met

Health Care for Veterans: Answers to Frequently Asked Questions

The Veterans Health Administration (VHA), within the Department of Veterans Affairs (VA), operates the nation’s largest integrated direct health care delivery system, provides care to approximately 6.6 million unique veteran patients, and employs more than 287,000 full-time equivalent employees. While Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP) are also publicly funded programs, most health care services under these programs are delivered by private providers in private facilities. In contrast, the VA health care system could be categorized as a veteran-specific national health care system, in the sense that the federal government owns the medical facilities, employs the health care providers, and directly provides the majority of health care services to veterans. It should be noted that VA health care is not a health insurance plan similar to what many individuals or employers purchase in the private health insurance market and does not have the same health insurance plan characteristics, such as coinsurances, deductibles, and premiums. This report provides responses to frequently asked questions about health care provided to veterans through the VHA. It is intended to serve as a quick reference to provide easy access to information. Where applicable, it provides the legislative background pertaining to the question

Patient Protection and Affordable Care Act (ACA): Resources for Frequently Asked Questions

[Excerpt] This report provides resources to help congressional staff respond to constituents’ frequently asked questions (FAQs) about the Patient Protection and Affordable Care Act (ACA). The report lists selected resources regarding consumers, employers, and other stakeholders, with a focus on federal sources. It also lists CRS reports that summarize ACA’s provisions. The resources are arranged by topic. This list is not a comprehensive directory of all resources on the ACA, but rather is intended to address a few questions that may arise frequently

Veterans’ Benefits: The Impact of Military Discharges on Basic Eligibility

[Excerpt] This report discusses the discharge or separation requirement for veteran status or, more specifically, how the VA assesses character of service to determine whether a former service member’s separation from the military can be considered other than dishonorable. In some instances, the military characterization of discharge is relatively uncomplicated, creating a binding entitlement to VA benefits (i.e., an honorable or general discharge [under honorable conditions]), assuming the individual meets other eligibility requirements for veteran status. However, if the characterization of discharge may preclude access to veteran’s benefits, the VA must develop the case, through an assessment of service records and other evidence related to a claimant’s time in the military. This report includes a hypothetical example (in Appendix C) illustrating the complexities associated with making character of service determinations by the VA

Private Health Insurance Provisions of H.R. 3962

[Excerpt] This report summarizes key provisions affecting private health insurance, including provisions to raise revenues, in Division A of H.R. 3962, the Affordable Health Care for America Act, as introduced in the House of Representatives on October 29, 2009. H.R. 3962 is based on H.R. 3200, America’s Affordable Health Choices Act of 2009, which was originally introduced on July 14, 2009, and was reported separately on October 14, 2009, by three House Committees— Education and Labor, Energy and Commerce, and Ways and Means. Division A of H.R. 3962 focuses on reducing the number of uninsured, restructuring the private health insurance market, setting minimum standards for health benefits, and providing financial assistance to certain individuals and, in some cases, small employers. In general, H.R. 3962 would require individuals to maintain health insurance and employers to either provide insurance or pay a payroll assessment, with some exceptions. Several insurance market reforms would be made, such as modified community rating and guaranteed issue and renewal. Both the individual and employer mandates would be linked to acceptable health insurance coverage, which would meet required minimum standards and incorporate the market reforms included in the bill. Acceptable coverage would include (1) coverage under a qualified health benefits plan (QHBP), which could be offered either through the newly created Health Insurance Exchange (the Exchange) or outside the Exchange through new employer plans; (2) grandfathered employment based plans; (3) grandfathered nongroup plans; and (4) other coverage, such as Medicare and Medicaid. The Exchange would offer private plans alongside a public option. Based on income, certain individuals could qualify for subsidies toward their premium costs and cost-sharing (deductibles and copayments); these subsidies would be available only through the Exchange. In the individual market (the nongroup market), a plan could be grandfathered indefinitely, but only if no changes were made to the terms and conditions of that plan, including benefits and cost-sharing, and premiums were only increased as allowed by statute. Most of these provisions would be effective beginning in 2013. The Exchange would not be an insurer; it would provide eligible individuals and small businesses with access to insurers’ plans in a comparable way. The Exchange would consist of a selection of private plans as well as a public option. Individuals wanting to purchase the public option or a private health insurance not through an employer or a grandfathered nongroup plan could only obtain such coverage through the Exchange. They would only be eligible to enroll in an Exchange plan if they were not enrolled in Medicare, Medicaid, and acceptable employer coverage as a full-time employee. The public option would be established by the Secretary of Health and Human Services (HHS), would offer three different cost-sharing options, and would vary premiums geographically. The Secretary would negotiate payment rates for medical providers, and items and services. The bill would also require that the Health Choices Commissioner to establish a Consumer Operated and Oriented Plan (CO-OP) program under which the Commissioner would make grants and loans for the establishment of not-for-profit, member-run health insurance cooperatives. These co-operatives would provide insurance through the Exchange. Only within the Exchange, credits would be available to limit the amount of money certain individuals would pay for premiums and for cost-sharing (deductibles and copayments). (Although Medicaid is beyond the scope of this report, H.R. 3962 would extend Medicaid coverage for most individuals under 150% of poverty; individuals would be ineligible for Exchange coverage if they were eligible for Medicaid.

Are We Heading Toward Socialized Medicine?

Defines socialized medicine, examines claims that the State Children's Health Insurance Plan and Democratic presidential candidates' reform plans would lead to government-run health care, and compares the plans with Republicans' market-oriented proposals

Military Survivor Benefit Plan: Background and Issues for Congress

[Excerpt] This report describes the categories of beneficiaries eligible for survivor benefits under the military Survivor Benefit Plan (SBP), the formulas used in computing the income level (including the integration of SBP benefits with other federal benefits), and the costs of SBP participation incurred by the retiree and/or the beneficiary. While this report focuses primarily on SBP, survivors of military members may be eligible for other benefits, including life insurance, TRICARE health benefits, Annuity for Certain Military Surviving Spouses (ACMSS), the Minimum Income Widow Annuity, Department of Defense (DOD) death gratuity, commissary and exchange privileges, and other federal benefits, such as Social Security