3085 — VA Use and Reliance among Dual Users with Multiple Chronic Diseases

Ross JS (REAP-Bronx), Zhu CW (REAP-Bronx), Livote E (REAP-Bronx), Siu AL (REAP-Bronx)

Objectives:
To examine whether reliance upon the Veterans Affairs (VA) medical system is changing among Medicare-VA dual users, those using both healthcare systems to obtain care, and the impact of multiple comorbid chronic diseases.

Methods:
We performed a repeated, cross-sectional analysis of healthcare cost data from the 1999 through 2003 panels of the Medicare Current Beneficiary Survey (MCBS), a nationally-representative sample of Medicare beneficiaries. We limited our sample to male veterans who incurred both VA and Medicare costs, substituting individual VA cost data reported in the MCBS with Health Economics Resource Center (HERC) costs. We calculated average yearly costs by payer, adjusted to 2006 dollars, and our main outcome measure was the proportion of overall costs paid for by the VA (VA reliance). We analyzed VA reliance over time, categorizing the sample by comorbidities using self-reported medical history (0-1, 2-3, or 4+ comorbid chronic diseases).

Results:
There were 1459 unique dual users, contributing 2592 observations. Average age was 75.6 years, 87.7% were white, 22.5% lived alone, and most reported multiple comorbidities (12.5% 0-1, 43.5% 2-3, and 44.0% 4+). Veterans with 4+ comorbidities accounted for 56.1% of overall and 55.3% of VA costs. From 1999 to 2003, the proportion of veterans dually using VA and Medicare services increased (11.8% to 22.6%), most substantially among those with multiple comorbid diseases, although average total costs trended lower ($16,334 to $13,907). Overall, VA reliance decreased from 38.2% in 1999 to 16.7% in 2003 (p < 0.001); VA reliance decreased from 1999 to 2003 among individuals reporting 2-3 comorbidities (41.0% to 16.2%; p < 0.001) and among individuals reporting 4+ comorbidities (37.8% to 16.2%; p = 0.005), but not among individuals reporting 0-1 comorbid disease (23.8% to 22.3%; p = 0.31). Reliance on other payers did not significantly change over this period.

Implications:
The number of dual VA-Medicare users has increased, particularly among adults with multiple chronic diseases, although average VA reliance has decreased.

Impacts:
Older veterans with multiple comorbidities have become increasingly likely to dually use VA and Medicare services, while relying less on the VA for care (on average), which may lead to difficulties monitoring and managing disease and ensuring high quality care.