The significant increase in spending on general population and military veteran health care in the United States is a multi-faceted and complex issue that deserves attention. Prior to the COVID-19 pandemic, in 2019, National Health Expenditures in the U.S. amounted to $3.8 trillion or roughly $11,582 per person. Also, in 2019, The Department of Veterans Affairs (VA) spent $78 billion on medical care, which is approximately $11,800 per patient. This figure is more than double the $33 billion that the VA spent in 2000, even though the total veteran population declined by 34 percent during that same time frame.
High volumes of spending raise questions about resulting health outcomes, quality of health services and return on investment. What is one strategy to maximize the return of investment on the health care dollar and improve patient outcomes? Invest in non-clinical drivers of health. Research indicates that clinical health care only accounts for about 20 percent of a person’s health outcomes, while up to 55 percent results from social determinants of health.
Social determinants of health (SDOH) are defined by the Centers for Disease Control and Prevention (CDC) as “the conditions in the places where people live, learn, work, and play that affect a wide range of health risks and outcomes.” Also referred to as “social risk factors” and resulting in “health-related social needs,” an individual’s housing stability, transportation reliability and food security are closely intertwined with health outcomes. However, funding and delivery of services to meet these needs in the health care, human services and veteran’s sectors are siloed.
The growing recognition of the impact of SDOH on a person’s health has resulted in providers, communities and elected officials taking steps toward integrating the delivery of health and human services through care coordination. The term “care coordination” can encompass a range of efforts, from the simplest — a resource directory list — to a more complex coordination effort such as an established navigation network of community-based organizations with human navigators that leverage technology to screen and then make direct referrals for services. With federal money funding various interventions, it is critical to create standards for “care coordination” services that are client-centered, optimize efficiency, increase transparency as well as accountability and ultimately improve health outcomes.
Recent legislative efforts demonstrate that the VA is moving in the right direction when it comes to care coordination. The 2018 MISSION Act established the VA Center for Care and Payment Innovation, authorizing the VA to pilot value-based payment and delivery models aimed at reducing health care costs and improving quality of care. The Hannon Act of 2019 established the Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program, which provides resources to community navigators that partner with community-based organizations to address health-related social needs with the ultimate goal of lowering veteran suicide rates.
As the largest health system in the United States, the VA is uniquely positioned to implement innovative solutions and should capitalize on partnerships and statutory authorizations to launch pilots that link health and social services.
The VA will not be starting from scratch, the Centers for Medicaid and Medicare (CMS) has attempted this through a variety of pilot programs and there are many lessons to be learned through peers in the Department of Health and Human Services.
Luckily for the VA, there are several organizations already in existence in the veteran service sector that have a decade-long track record of the successful implementation and operation of human service-focused care coordination networks.
For example, Syracuse University’s Institute for Veteran and Military Families launched the first of their 18 AmericaServes networks in 2014 to connect veterans and their families more efficiently to social needs. These networks have years of data and operational experience to contribute to this conversation. They leverage human navigators, deploy robust social determinants of health screeners, use a closed-loop tech platform that enables them to capture process metrics for continual improvement, as well as prioritize client protections and rights. In total, AmericaServes networks have fulfilled over 110,000 unique service requests for more than 48,000 individuals. The Pittsburgh network alone — PAServes — has closed more than 24,000 unique services requests.
Headquartered in Houston, Texas but now serving military veterans nationwide, Combined Arms has similarly gained national recognition for deploying their innovative technology platform to create a community of veterans and match transitioning service members to community resources. Combined Arms partners with over 200 vetted organizations and has connected veterans with over 1,000 resources (including professional, educational, wellness, benefits and more) that help them thrive in their transition to civilian life.
The VA is one of the most effective and trusted health systems in the country. What they now need is strong partners who has a demonstrated expertise in human service-focused care coordination to holistically serve their patients. The VA should look to existing veteran care coordination networks as partners. Uniting health and human service systems through effective care coordination is the next step in reducing duplicity of efforts, maximizing return on investment for health care dollars for veterans and civilians alike, as well as improving outcomes for those who have served our nation.
Megan Andros is a veteran fellow at Stanford’s Hoover Institution and a senior program officer at The Heinz Endowments. The Heinz Endowments has been a financial supporter of Syracuse University’s Institute for Veterans and Military Families (IVMF) and their program PAServes.
Reiley Burris is a research assistant and is pursuing a master’s degree in public health at George Washington University’s Milken Institute School of Public Health.