Integrating Department of Defense and Department of Veterans Affairs purchased care : preliminary feasibility assessment / Carrie M. Farmer [and 11 others].

Format:

Book

Author/Creator:

Farmer, Carrie M., author.

Language:

English

Subjects (All):

Veterans--Medical care--United States.

Veterans.

Veterans--Medical care.

United States.

United States--Armed Forces--Medical care.

Armed Forces.

Medical care.

Physical Description:

xx, 110 pages : illustrations (some color), maps ; 23 cm

Place of Publication:

Santa Monica, Calif. : RAND Corporation, [2018]

Summary:

The U.S. Department of Defense (DoD) and U.S. Department of Veterans Affairs (VA) health systems provide services through a mix of direct care, delivered at government facilities, and purchased care, provided through the private sector, mainly by community-based providers who have entered into contracts with third-party administrators (TPAs). In the interest of expanding DoD-VA resource sharing that may lead to greater efficiencies and cost savings, the DoD/VA Joint Executive Committee is exploring options to integrate DoD and VA's purchased care programs. This preliminary feasibility assessment examined how an integrated approach to purchasing care could affect access, quality, and costs for beneficiaries, DoD, and VA and identified general legislative, policy, and contractual challenges to implementing an integrated purchased care program. An integrated approach to purchasing care is feasible under current legal and regulatory authorities, but policy changes may be needed - and the practicality of such an approach depends on the contract and network design. For example, legal/regulatory changes in how contracts are established would be required to achieve any real savings to the government. There are also differences in the populations served by TRICARE (DoD health care) and VA, particularly in terms of age and geographic location. Implementation would be further complicated by contractual differences in the TPA contracts for VA and DoD as they relate to network standards, provider payments, network participation requirements, and reporting requirements and incentive structures. As a result, there are significant uncertainties with respect to increased efficiency or cost savings for the government.

Contents:

Preface

Figures and tables

Summary

Acknowledgments

Abbreviations

Chapter one: Background

Scope and methods of feasibility assessment

Framing the feasibility study

Organization of this report

Chapter two: Overview of DoD and VA health care

Military health system

VA health care system

MHS and VHA populations

Chapter three: DoD and VA use of purchased care and overview of existing purchased care provider networks

Differences in purchased care use

Differences between TRICARE and VA purchased care provider networks

Chapter four: Legal and regulatory authorities underlying an integrated approach to purchased care for DoD and VA

Is integrating purchased care permissible under current legislation and regulations?

Different eligibility requirements in statute

Differences in appropriations processes

Chapter five: Barriers with respect to operational execution of an integrated purchased care approach

Contracting processes and relationships with TPAs

Roles of TRICARE and VA TPAs

Differences in contract terms

Potential to incorporate industry practices

Chapter six: Potential impact on patients and providers

Potential impact on patients

Potential expansion of provider choice

Potential impact on participating providers

Chapter seven: Potential impact on costs

TPA administrative costs of managing the contracts

Potential impact on costs to government

Chapter eight: Summary observations and recommendations

Stakeholder suggestions

Implications of the evolving policy landscape

Conclusions

Recommendations

References.

Notes:

"Prepared for the Defense Health Agency and Veterans Health Administration."

Includes bibliographical references.

ISBN:

1977401848

9781977401847

OCLC:

1078432343