Improving Healthcare for Veterans: Breaking Down the Silos of Medicare and the Department of Veteran

Medical record data has become increasingly crucial in delivering efficient and effective care, especially for medically complex older adults. One recent study, published in The Journal of the American Geriatrics Society, sheds light on the challenges associated with fragmented care and the opportunities associated with better communication across healthcare systems. Specifically, this study looked at care provided to veterans enrolled in both the Department of Veteran’s Affairs (VA) and Medicare. In this blog post, we will explore the issue of siloed care among members that utilize the VA, the study’s findings, and how sharing data with Medicare plans can significantly improve health outcomes for America’s Veterans.

The Challenge of Multi-System Care

The referenced study highlights the significant challenge faced by providers in modern healthcare systems – fragmentation of patient data across various providers and facilities. Older adults often seek care in multiple healthcare systems, making it challenging for medical professionals to have access to comprehensive, up-to-date information about the patient’s health. This lack of "information continuity" is particularly concerning for older high-risk members who frequently manage multiple chronic conditions and receive care from several healthcare systems – such as the VA and their Medicare Advantage (MA) plan.

The VA provides low-cost or free care for Veterans across the United States, making it an attractive healthcare option for those who have served our country. The challenge arises due to the fact that the VA does not coordinate benefits with Medicare (or Medicare Advantage). This means that for Veterans who maintain both coverages (as recommended by CMS and the VA), care is not being systematically communicated. When Veterans seek healthcare outside of the VA system, such as through their Medicare Advantage plan, providers often access fragmented and incomplete medical records, leading to misdiagnoses, duplicated care, missed chronic conditions, delayed diagnosis and treatment, missed preventive care, potential medication errors, and overall suboptimal healthcare delivery.

In many cases, Veterans choose to receive all of their care at the VA. This may make the member appear, inaccurately, to their Medicare Advantage plan as a healthy, non-user. It is estimated that up to 5% of Medicare Advantage plan members use the VA for some or all of their care - care that is NOT systematically communicated to their plan!

Study Findings

The findings of this study were significant. It demonstrated that the addition of VA data to Medicare data for older high-risk adults led to an improvement in clustering model accuracy. This means that by combining data from different healthcare systems, medical professionals and health plans can gain a more comprehensive understanding of a patient's health.

Furthermore, the integration of multi-system data had a substantial impact on the clinical profiles of patient groups. This suggests that healthcare interventions can be more finely tuned and effective when informed by a more complete patient dataset. When data is shared, these clinical management tools can do a better job of understanding members and ensuring health equity for all members1.

Data sharing is the key to breaking down these silos and improving the healthcare experience for older Veterans. By integrating data from VA healthcare with Medicare Advantage plans, healthcare providers can gain a more comprehensive view of a patient's health history, including diagnoses, medications, and preventative care exams. This comprehensive view improves efficiency and accuracy for the member, provider, and their Medicare Advantage plan.

The Veteran Lynk Difference

BeneLynk's Veteran Lynk solution identifies Veterans utilizing the VA within your MA population and retrieves their medical records from the VA facility/facilities utilized. This innovative program serves as a vital link between Veterans, the Veterans Health Administration, and their Medicare Advantage plan. By acting as this bridge, BeneLynk ensures that Veterans receive the comprehensive care they need, with the right medical data accessible to their healthcare providers across different systems. This approach streamlines the care management process, promoting better-informed decision-making, more personalized treatments, and, ultimately, improved health outcomes for our Veterans. In essence, BeneLynk's Veteran Lynk solution empowers Veterans to navigate their healthcare journey with greater ease and confidence, ensuring that they receive the full spectrum of care to which they are entitled.

In addition, BeneLynk believes that the best way to identify and assist our Veteran members is by recruiting and hiring from this population. We have found that Veterans and military spouses have incredible qualities that make them valuable members of the team. We have also found this shared life experience leads to a strong connection and builds trust between the health plan and member.

Conclusion

In a healthcare landscape that is becoming increasingly data-driven, this study serves as a valuable reminder of the positive impact that comprehensive patient information can have on clinical decision-making and health equity. It also emphasizes the necessity of information continuity for older adults, especially those who seek care in multiple healthcare systems such as the VA and MA.

Veterans deserve the best healthcare possible, and breaking down the silos that have historically existed within the VA system is a significant step in achieving that goal. By sharing data with Medicare Advantage plans, we can vastly improve the health outcomes of older Veterans. The benefits are clear: improved care coordination, accurate diagnoses, personalized treatment plans, and ultimately, better overall health for our nation's heroes.

1. Hutchins et al., “The Impact of Dual VA–Medicare Use on a Data‐driven Clinical Management ...” American Geriatrics Society, Journal of the American Geriatrics Society, 29 Sept. 2023, agsjournals.onlinelibrary.wiley.com/doi/10.1111/jgs.18608?af=R.