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

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

The study, which included 6,643 older, chronically ill veterans who were enrolled in both federal health systems, was recently published in Health Services Research.

Researchers conducted the study in response to concerns that dual enrollment may lead to poorly coordinated medical care and 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,” Amal Trivedi, MPH, MD, physician and health services researcher at the Providence Veterans Affairs (VA) Medical Center and Brown University and senior author on the study, stated in a press release.

Trivedi and lead author Alicia Cooper, PhD, assistant professor of marketing in the Division of Business at Dillard University collaborated with researchers from two other VA sites and three universities.

Nurse practitioner Jyoti Desai (right) and nurse Barbara Murphy see an older primary care patient at the Philadelphia VA Medical Center.

Source: Leonardi T.

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

Researchers found despite the dual enrollment, about a quarter of the seniors in the study actually used only VA for outpatient care. Veterans in the VA-only group were more likely to be black, younger (within the 65 years or older age bracket), and have lower incomes. They were also in poorer health overall. In the study, in addition to the 25%of veterans who relied strictly on VA care, despite their dual enrollment, another 20% used almost all VA care, and no Medicare Advantage 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.

The researchers compared the outcomes of the veterans only using VA care with the outcomes of dually enrolled veterans who used both systems for outpatient care.

“The use of Medicare Advantage plans has grown sharply in the last few years,” Trivedi stated in the release. “We have found that about 10% of the enrolled VA population is now also in one of these plans.”

The researchers found that there appeared to be no 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 did not look at outcomes such as hospitalization or death.

“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,” Trivedi stated.


Trivedi A, et al. Health Serv Res. 2015;doi:10.1111/1475-6773.12303.

Disclosure: The researchers report the study was funded by the VA Health Services Research & Development Service.

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