Review and Evaluation of the Va Enrollee Health Care Projection Model

by Harris, Katherine M.; Galasso, James P.; Eibner, Christine

• ISBN13: 9780833045706
• ISBN10: 0833045709
• Format: Paperback
• Copyright: 2008-12-16
• Publisher: RAND Corporation

Summary

The Department of Veterans Affairs relies on the Enrollee Health Care Projection Model (EHCPM) to project veteran enrollment, enrolled veterans1 use of health care services, and the cost of providing those services. This evaluation of the EHCPM examines its accuracy and validity, identifies potential model enhancements, and assesses the risks and benefits posed by the VA1s reliance on the model for budgeting and planning.

Table of Contents

Preface	p. iii
Figures	p. ix
Tables	p. xi
Summary	p. xiii
Acknowledgments	p. xxi
Abbreviations	p. xxiii
Introduction and Background	p. 1
Overview of the Current VA Health Care System	p. 1
Eligibility Reform	p. 3
Budget and Strategic Planning Under Eligibility Reform	p. 4
Opportunities and Challenges of Policy Models	p. 5
Actuarial Models	p. 6
Limitations of VA Data for Forecasting Demand	p. 6
The EHCPM: Description, History, and Uses	p. 8
Evaluation Methodology	p. 11
Key Activities	p. 11
Criteria for Evaluating Policy Models	p. 13
Validity	p. 13
Accuracy	p. 15
Tractability	p. 17
Transparency	p. 18
Limitations	p. 20
Model Overview	p. 21
Milliman Health Cost Guidelines	p. 21
Overview of Model Structure	p. 23
Enrollment Projection Model	p. 24
Utilization Projection Model	p. 26
Unit Cost Projection Model	p. 34
Utilization and Cost Trends	p. 41
Budget Reconciliation	p. 43
Findings on Model Structure and Validity	p. 45
Enrollment Projection Model	p. 46
Utilization Projection Model	p. 48
Derivation of VA-Specific Utilization Benchmarks	p. 48
Morbidity and Reliance Adjustments for Non-Medicare Eligible Enrollees	p. 49
Benchmarking to Community Management Practices	p. 50
Unit Cost Projection Model	p. 52
Prototype Staffing Model	p. 54
Scenario 1	p. 55
Scenario 2	p. 56
Scenarios 3 and 4	p. 57
Utilization and Cost Trends	p. 57
Findings on Model Accuracy	p. 61
Accuracy of the Utilization Projection Model	p. 63
Quality Assurance Procedures	p. 64
Findings on Tractability and Transparency	p. 65
High-Level Structure	p. 65
Complexity	p. 66
Proprietary Model Elements	p. 66
Documentation	p. 67
Benefits and Risks of the EHCPM	p. 69
Benefits of the Current EHCPM	p. 69
Risks of the Current EHCPM	p. 71
Conclusions	p. 75
EHCPM Use in Short-Term Budget Projection	p. 75
EHCPM Use in Strategic Planning and Policy Analysis	p. 75
Future Modifications to the EHCPM	p. 76
Appendixes
Results of Validation Studies	p. 79
Priority-Level Definitions	p. 87
Model Uses Described in "VA Enrollee Health Care Projection Model Training Companion Manual," June 2006	p. 89
References	p. 91
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