Users Of Veteran-Directed Care And Other Purchased Care Have Similar Hospital Use And Costs Over Time

Abstract

The Veteran-Directed Care (VDC) program facilitates independent community living among adults with multiple chronic conditions and functional limitations. Family caregivers value the choice and flexibility afforded by VDC, but rigorous evidence to support its impact on health care costs and use is needed. We identified veterans enrolled in VDC in fiscal year 2017 and investigated differences in hospital admissions and costs after initial receipt of VDC services. We compared VDC service recipients to a matched comparison group of veterans receiving homemaker or home health aide, home respite, and adult day health care services and found similar decreases in hospital use and costs from before to after enrollment in the groups. Further investigation into trends of nursing home use, identification of veterans most likely to benefit from VDC, and relative costs of operating VDC versus other purchased care programs is needed, but our results suggest that VDC remains a valuable option for supporting veterans and caregivers.

Keywords: Caregivers; Veterans; costs; older adults; participant-directed care; workforce.

EXHIBIT 2. Percent of veterans with acute and ambulatory care–sensitive (ACS) hospital admissions, by month before and after the start of service receipt

SOURCE Authors’ analysis of aggregated encounter data for 2015–18 from the Veterans Health Administration. NOTES The months are thirty-day periods relative to the service initiation date of the Veteran-Directed Care (VDC) program or another purchased care program. Only hospitalizations from the Veterans Health Administration were included. VDC veterans and the “active comparison group” and “inactive comparison group” are explained in the notes to exhibit 1.

EXHIBIT 3. Mean cost of veterans’ inpatient care, by month before and after the start of service receipt

SOURCE Authors’ analysis of aggregated encounter data and all-cause hospitalization cost data for 2015–18 from the Veterans Health Administration. NOTES Veteran-Directed Care (VDC) veterans and the “active comparison group” and “inactive comparison group” are explained in the notes to exhibit 1. The months are explained in the notes to exhibit 2. Costs include only those attributed to an acute hospitalization in the Veterans Health Administration. Two hospitalizations were excluded as extreme outliers. Cost data for twenty-seven hospitalizations that lasted after the end of the study were excluded.