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VA’s Mental Health Care As Good or Better than Private Sector Study Finds

by U.S. Medicine

December 8, 2011

WASHINGTON — Veterans with mental illness and substance abuse cost nearly three times as much to treat as the average veteran. According to a VA-commissioned study by the RAND Corp. looking at data from one year of care (2007), such veterans represented 15% of patients using VA healthcare services, but accounted for 32.9% of costs.

The study, conducted between 2006 and 2010, was commissioned to evaluate VA’s progress toward the goals of its Mental Health Strategic Plan. Those goals include:

*raising the importance of mental health,

*eliminating disparities in services,

*increasing mental health screening, assessments and referrals to care, and

* providing high-quality, evidence-based care.

According to RAND, the study represents the most comprehensive evaluation of a mental healthcare system ever undertaken. The evaluation focused on quality of care delivered to veterans with one or more of five mental-health or substance-abuse diagnoses: schizophrenia, bipolar disorder, PTSD, major depressive disorder (MDD) and substance-use disorder.

High Cost of Treatment

The researchers looked at data from three million veterans, eventually identifying 836,699 with at least one of those diagnoses. While those veterans represented 15% of the patient population in 2007, they cost 2.7 times that of the average veteran to treat — $12,337 per patient, or $12 billion total.

However, most of the healthcare received by these veterans was for non-mental health conditions. According to the researchers, this reflects the high degree to which veterans with mental health and substance use conditions suffer from physical health problems.

For example, in patients diagnosed only with schizophrenia, a little more than half the cost of treatment was attributable to non-mental health diagnoses. In those patients suffering from substance use disorder only, 80% of the cost of treatment was for non-mental health problems

The most common of these diagnoses were essential hypertension, which was found in 32% of the veterans studied and diabetes mellitus, which was found in 19%.

The most-expensive patients to treat were those with schizophrenia, who cost on average $22,694 per patient per year in FY 2008. The second highest were those patients with co-occurring substance-use disorder, who cost $20,903.

According to RAND, the total amount spent on mental-health care will only have increased since the data used in the study was compiled, because the number of veterans seeking mental-health care has nearly doubled in the last eight years.

VA’s Mental Health Care As Good or Better than Private Sector, Study Finds Cont.

High Quality, Low Consistency

However, the money spent on such care is being spent well, according to the study. Researchers found that the quality of VA mental-health care is generally as good as or better than that delivered by private healthcare plans.

VA outperformed private plans on seven of nine quality measures, including the use of: medication lab tests, lab screening tests, antipsychotics, long-term antipsychotics, long-term mood stabilizers, antidepressants and continuation phase antidepressants.

Where private plans outperformed VA were in treatment initiation and treatment engagement for substance-use disorder. 

The consistency of mental-health and substance-abuse care throughout the VA system has room for improvement, the study found. The difference in care between VA facilities was found to vary by as much as 23%. Performance in certain areas, including whether those with alcohol dependence received pharmacotherapy, was especially low.

One of the largest variations occurred in intensive case management, which is a best practice for treating severe schizophrenia or bipolar disorder. This varied by more than 20% across VISNS, ranging from 35% to 14%. There also was a 20% difference between the highest and lowest performing VISN in filling antidepressant medications.

Most veterans expressed satisfaction with their care at VA. On a 10-point scale, 42% rated VA mental health at 9 or 10, and 74% reported being helped by counseling or treatment they had received in the previous year.

The report notes that, even with the decrease in military operations in Iraq and Afghanistan, the number of veterans seeking mental-health and substance-use disorder treatment will continue to rise in the coming years, and that VA can act as a proving ground for quality care.

The researchers suggested that, if there is this much variation within an integrated system of care such as VA, then the variation outside VA is likely much greater. VA is in a position, the researchers said, to serve as a leader to other health-care systems for improving the quality and consistency of mental-health and substance-use care. The department can support greater standardization of clinical assessment and treatment and help inform the field about the best ways to conduct this type of care.

Veterans Health Administration Mental Health Program Evaluation

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