Treatment for Posttraumatic Stress Disorder in Military and Veteran Populations Final Assessment (2014) / Chapter Skim
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5 High-Value Care
5 High-Value Care
Pages 89-104
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From page 89... ...
This report adopts the definition of value from the 2008 IOM report Evidence-Based Medicine and the Changing Nature of Health Care as the quality of care achieved, in terms of outcomes, relative to the cost of delivering health care and related services (IOM, 2008)
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From page 90... ...
Direct costs associated with preventing and treating PTSD include psychotherapy and pharmacotherapy, but there are other costs that may affect annual operating costs of the departments such as compensation (salary, bonuses, and incentives) for new and current staff members, training and hiring costs, information technology requirements, and administrative charges.
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From page 91... ...
. Total costs for PTSD care delivered by purchased care providers increased dramatically from 2007
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From page 92... ...
These costs do not include those associated with training, recruiting, or retaining mental health providers. bCosts among users of the service only.
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From page 93... ...
However, in light of the recent troop drawdown, that is unlikely. Instead, with fewer active-duty service members and fewer deployments, the number of new PTSD cases among service members might decline, resulting in a leveling out or potentially a decrease in total $350,000,000 $300,000,000 $250,000,000 $200,000,000 Total PTSD costs Direct care costs $150,000,000 TRICARE costs $100,000,000 $50,000,000 $0 2004 2005 2006 2007 2008 2009 2010 2011 2012 FIGURE 5-1 Costs of direct care for PTSD, cost of TRICARE for PTSD, and total cost of care for PTSD over time, 2004–2012.
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From page 94... ...
The committee was unable to identify any such projections and so was not able to estimate future PTSD costs. If data on the projected number of service members were available, DoD could use that number and the incidence of PTSD to generate the projected number of service members who may have PTSD and then multiply that product by the average cost per service member who has PTSD to get an estimate of total PTSD costs.
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From page 95... ...
Intensive outpatient services could be appropriately offered and reimbursed if this obvious deficiency in TRICARE's mental health coverage were corrected. Patient treatment outcomes are not systematically tracked in either DoD programs or TRICARE network programs although the costs of the
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From page 96... ...
Care provided by on-base DoD programs may indeed be more cost effective than purchased care programs, but without an analysis of comparable long-term patient outcomes among programs, this cannot be determined. DoD pays for direct care and purchased care services by volume -- for example, number of patients seen -- and not value.
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From page 97... ...
Cost of Care The cost of PTSD care in VA includes services provided in general medical and mental health clinics, other general treatment and rehabilitation venues, and specialized PTSD programs. Several recent studies have examined the medical and societal costs of the current conflicts in Iraq and Afghanistan (Bilmes, 2007; Goldberg, 2007; Tanielian and Jaycox, 2008)
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From page 98... ...
The VA Northeast Program Evaluation Center reported that in 2012, 108,745 veterans received care in specialized outpatient PTSD programs (SOPPs) , at a total cost of $178,077,961, or $1,638 per patient.
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From page 99... ...
SOURCE: NEPEC, 2014. TABLE 5-3 Number of OEF and OIF Veterans Who Have PTSD and PTSD Costs OEF/OIF Veterans Using VA OEF/OIF Veterans Who Have PTSD PTSD OEF/OIF % of Those Costs Year Veterans N % N Using VA (millions)
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From page 100... ...
Determining and Achieving High-Value Care Direct Care VA has no consistent system for tracking patient outcomes and connecting them to costs of care, so whether VA provides high-value care for PTSD cannot be determined. In addition, without standardized system-wide metrics of patient outcomes and costs in VA, DoD, and other health care systems, it is impossible to compare the value of PTSD services provided by these organizations.
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From page 101... ...
Data on purchased care costs of PTSD were not included in VA's response to the committee's data requests. However, a previous study of use and costs of VA health care service for veterans in the year after service in Afghanistan and Iraq found that purchased care was responsible for 5.5% of mental health costs for male veterans and 3.8% for female veterans (Leslie et al., 2011)
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From page 102... ...
2012. The Veterans Health Administration's treatment of PTSD and traumatic brain injury among recent combat veterans.
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From page 103... ...
2011. Health economics resource center: Outpatient average cost dataset for VA care: Fiscal Year 2010 update.
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From page 104... ...
2011. Programs addressing psychological health and traumatic brain injury among U.S.
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