November 8, 2011

Holsinger: Veterans Health Care Program Could Be Model for Medicare

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Roll Call

The Joint Committee on Deficit Reduction has the daunting task of finding $1.2 trillion or more in spending cuts or tax increases in just 45 days. I don’t envy the task. With partisan gridlock an ever-present threat, Members are searching for win-win scenarios, with no easy cuts readily apparent.

Fortunately, when it comes to Medicare, there just might be one.

I realize the preceding words will strike many as doubtful, if not downright inconceivable. But the fact is, proven solutions exist that would not only reduce Medicare spending but benefit patients and taxpayers alike. Even better, these solutions already exist within a federal program as well as a number of states.

The Department of Veterans Affairs is the home to one of these solutions. For the many lawmakers who have made veterans a priority, this will likely come as no surprise. After all, the VA has led the way in various areas of health care, including implementing electronic medical records back in the 1980s. Of interest to the joint committee, however, is the VA’s extraordinary Home Based Primary Care program.

Like Medicare, the VA is challenged by a rapidly aging beneficiary population. Also like Medicare, the VA knows that a small percentage of its beneficiaries require the most extensive ” and expensive ” care. But there the similarity ends because, unlike Medicare, the VA boasts an innovative program that has achieved a stunning 24 percent net cost reduction for its participants.

The Home Based Primary Care program targets aging veterans who are battling complex chronic diseases. Importantly, HBPC serves these veterans not in costly hospital or nursing home settings but in their own homes. As a result, participating veterans receive timely care by an interdisciplinary care team without the risk of infection that is unfortunately so common in institutional settings.

HBPC’s results are impressive. In addition to its participants’ net cost reduction of 24 percent, the program has substantially reduced hospital and nursing home admissions. And it has achieved the highest patient satisfaction rating in VA history, with more than 80 percent of veterans rating their care as “very good” or “excellent.”

Like the VA, state governments also serve as a useful model for the joint committee. Like the VA and Medicare, states are contending with rapidly aging populations, a small component of which accounts for the bulk of health care spending. As a result, Medicaid is now the fastest-growing expenditure in most states, and institutional care has become a budget buster.

In response, many states are undertaking innovative reforms, one of the most impressive of which can be found in Ohio. There, Gov. John Kasich (R) is administering a Medicaid waiver that screens patients who are at risk of going into a nursing home or hospital to determine if additional clinical support and resources could help them stay in their homes instead.

Like the VA, Ohio’s program has used home-based care to harness costs and improve the quality of life for seniors. It has helped the state save millions of dollars and reduced, along with other measures, the growth of its Medicaid costs by half. At the same time, it is popular with Ohio Medicaid participants and has been endorsed by the Ohio AARP. Talk about a win-win!

Reflecting on the power of home-based care, Kasich said it best: “In the past if somebody wanted to stay in their home, there were limited opportunities for them to do it. That day is gone. I can’t think of anything more important to a senior than to be able to stay in their home with assistance rather than being put in a facility that they’re not comfortable with.”

Political win-wins do not come about often in the current budgetary environment. All the more reason the joint committee should pay close attention to what the VA and many states have already achieved. By following their lead, Congress can book many billions in Medicare savings while improving beneficiary outcomes and satisfaction.

I believe this not only because of my experience running the U.S. Veterans Health Administration and serving as Kentucky’s secretary of Health and Family Services ” I believe it as a son. Many seniors are just like my 102-year-old mother, who wants nothing more than to live in dignity in her home. Even though I’m a retired Army general, I’m not brave enough to suggest that my mother go to an institution to receive care she could get at home. Why shouldn’t all seniors have such a high-quality, low-cost option made available to them?

By letting people like my mother age gracefully in their own homes, we can all win.

Dr. James W. Holsinger Jr. is professor of preventive medicine and health services management at the University of Kentucky College of Public Health.