Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #111907

Robert O. Morgan, PhD¹, Dolly A. John, MPH², Jessica Davila, PhD¹, Margaret Byrne, PhD³, Raji Sundaravaradan, BS⁴, Iris I.-Lien Wei, DrPH², Debora A. Paterniti, PhD⁵, Nora Osemene, PharmD⁶, and Laura Petersen, MD¹. (1) Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center and Baylor College of Medicine, 2002 Holcombe Blvd. (152), Houston, TX 77030, (713) 794-8635, rmorgan@bcm.tmc.edu, (2) Houston Center for Quality of Care and Utilization Studies, Veterans Affairs Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030, (3) Department of Epidemiology and Public Health, University of Miami School of Medicine, Highland Professional Building, 1801 NW 9th Avenue, Suite 200, Miami, FL 33136, (4) Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center, 2002 Holcombe Blvd. (152), Houston, TX 77030, (5) Center for Health Services Research in Primary Care, Dept. of Int. Med., UC-Davis Medical Center, 4150 V Street, Suite 2500, Sacramento, CA 95817, (6) College of Pharmacy and Health Sciences, Texas Southern University, 3100 Cleburne Avenue, Houston, TX 77004

Background. Changes in benefits provided by Medicare managed care plans (HMOs) may affect VA use among dually eligible veterans, possibly affecting the continuity and quality of their health care. The purpose of this study was to examine the relationship of Medicare HMO plan benefit levels on VA outpatient, inpatient, and ER service use by veterans enrolled in Medicare HMOs. Methods. We examined elderly (aged 65+) veterans who had any use of the VA health system within the past five years and who were enrolled in an Medicare HMO plan for some part of calendar year (CY) 2000 (N = 282,939). We merged national VA inpatient and outpatient data for CY 2000 with national Medicare enrollment and plan benefit data. Plan benefit packages were categorized as low, medium, and high based on physician and hospital co-pays, and pharmacy and supplemental benefits (vision, dental, hearing and podiatry). Logistic regression analyses were used to examine any use of the VA during CY 2000, followed by negative binomial regressions to examine magnitude of use among VA users. Analyses were adjusted for age, sex, race/ethnicity, VA priority level, income, Medicare state buy-in status and metropolitan versus non-metropolitan location. Results. Differences in Medicare HMO plan benefit levels significantly affected the likelihood that veterans would use the VA system for their health care. Veterans enrolled in plans with high benefit and medium benefit packages were less likely to use any VA outpatient services than those enrolled in a plan with low benefit levels (ORs = .68 [.65-.70] and .82 [.79-85], respectively). Among veterans who used outpatient care, those in high and medium benefit plans used slightly more outpatient care than veterans in low benefit plans (ORs = 1.08 [1.06-1.09] and 1.07 [1.05-1.08], respectively). Veterans enrolled in high benefit and medium benefit plans were also less likely to have a VA ER visit (ORs = .52 [.46-.58] and .83 [.73-.95] for high benefit and medium benefit versus low benefit enrollees, respectively). There was no association between plan benefit levels and VA inpatient use. Conclusions. VA use among Medicare HMO enrolled veterans varies directly with the extent of benefits offered by their plans, particularly for outpatient and ER care. Our findings strongly suggest that changes in Medicare HMO plan benefits are likely to influence whether veterans turn to the VA for care as an alternative or additional provider of care, ultimately affecting resource availability at individual VA medical centers.

Learning Objectives:

• At the end of this session, the attendees will be able to discuss the relationship of Medicare HMO plan benefit levels with VA outpatient, inpatient, and ER service use by veterans enrolled in Medicare HMOs.

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.