Quality of care is challenging to define and measure. The definition of quality of care that will be used for this discussion is how well health services increase desired outcomes, given current knowledge. Quality is assessed using predefined metrics. The VA uses a tool called Strategic Analytics for Improvement and Learning (SAIL) to assess performance on the desired metrics. The VA keeps track of each hospital’s performance quarterly. The VA also gives each hospital an End of Year Hospital Star Rating based on these metrics. A hospital may receive a rating of 1 to 5. As there are many metrics the VA uses, the star rating will be used to discuss how well the VA addresses the care component of the Triple Aim. Per the VA website, at the end of 2019 57% of VA hospitals improved their EOY Star Rating from the previous year (“Quality of Care”, 2019). More than half of the VA’s hospitals improved their performance between 2018 and 2019. Also, 81% of patients surveyed were satisfied with their care, as compared to 77% of Medicaid patients (Klein, 2014). Based on this information, it can be said that the VA is improving the quality of care and meeting the first criterion of the Triple Aim.
Population health can be defined as the health outcomes of a group (Kindig & Stoddart, 2003). The VA refers to it as “Improving the health of each veteran, by understanding the health of all Veterans” (“Population Health Services”, 2015). The VA hospital system has a department that has created performance measures that it uses to make decisions that impact the health of all veterans. For example, the Population Health Services office of the VA uses Clinical Case Registry software to help doctors monitor, track, and coordinate care for veterans with chronic conditions. Using data that is gathered from this software, the VA makes informed decisions regarding care for its members. The VA is addressing the population health component of the Triple Aim.
Cost of Care
As of 2016, the VA reported annual out-of-pocket costs of $320 for its members (“The Affordable Care Act, VA, and You”, 2016). The VA boasts that it does not charge monthly premiums, enrollment fees, or annual deductibles. Members may pay copays for medication and primary, specialty, or inpatient care. As of 2020, the VA’s copay rates remain the same. Also, the VA only charges its members one copay per day, regardless of the number of appointments a member has (“The Affordable Care Act, VA, and You”, 2016). The VA has an 80% discount on prescription drugs, as compared to Medicare Part D (Oprysko, 2019). The VA also does not charge a copay for mental health counseling, care related to service, lab tests, EKG, and wellness programs. Members with at least 50% disability, or who cannot afford care, receive free care. As reducing each individual’s cost of care is an element of the Triple Aim, it can be said that the VA is meeting this criterion.
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