VA surpasses private sector in 7 of 9 quality measuresLike so many of his fellow veterans, retired Marine Staff Sgt. Troy Stump found his life forever changed after serving his country. While deployed to Afghanistan from 2011 to 2012, his armored personnel carrier was struck by an improvised explosive device, resulting in a traumatic brain injury and post-traumatic stress disorder (PTSD).
Not all of Stump’s fellow Marines made it home, and he credits the mental health care treatment he received at the VA for helping him learn to open up and begin coping with the effects of the trauma.
“It took a month of biweekly meetings before I could talk about what happened,” he said. “But my counselor, even though she was a little frustrated that I wouldn’t open up, stayed with me and was patient.”
A recent congressionally approved RAND Corp. study determined that the Department of Veterans Affairs had higher levels of performance in providing mental health care than private providers in seven out of nine quality measures.
The VA surpassed private-sector care in medication lab and laboratory screening assessments, prescribing antipsychotics, long-term antipsychotics, long-term mood stabilizers, antidepressants and continuationphase antidepressants.
Private-sector care edged out the VA in the category of treating substance-abuse disorder, specifically in treatment initiation and treatment engagement.
The study compared more than 830,000 veterans receiving mental health care from the VA with over 545,000 nonveterans receiving similar care in the private sector.
“It is likely that the superior performance observed in the VA system is in part the result of the additional structures that the VA has put in place to support and encourage high-quality care,” said RAND Corp. Senior Natural Scientist Dr. Katherine Watkins. “For example, the co-location of pharmacy and laboratory services near specialty and primary-care clinics facilitates patient access to these services, and the integrated electronic medical record means that all providers can instantly review and address patient laboratory results.”
Watkins explained that the availability of an entire network of experienced health care providers working in an integrated system is one of the reasons Stump’s counselor was able to help him.
“The VA has really thought about their care in terms of a delivery system, not just a system of individual providers,” Watkins said. “VA providers also have access to decision support tools, and the electronic medical record supports best practices through automated clinical reminders.
“For example, if I’m in private care in [Los Angeles], I won’t know about a new best practice unless I happen to find it, but in the VA system it’s distributed to all providers in their network,” said Watkins.
“DAV and the veterans we represent are pleased VA surpassed the private sector in seven areas in the Rand Corp. study. Treating substance-use disorder is an important component in veteran-related health care,” said DAV Washington Headquarters Executive Director Garry Augustine. “However, if some veterans can’t access the quality care they’ve earned, they may feel like they’ve been forgotten. This is something DAV will continue to address as their advocate.”
In addition to the RAND study, Psychiatric Services, a peer-reviewed journal of the American Psychiatric Association, published a report in April 2016 comparing the quality of mental health care provided by the VA with a comparable population in the private sector. According to the study, “In every case, VA performance was superior to that of the private sector by more than 30 percent. Compared with individuals in private plans, veterans with schizophrenia or major depression were more than twice as likely to receive appropriate initial medication treatment, and veterans with depression were more than twice as likely to receive appropriate long-term treatment.”
These findings were based on review of VA administrative data on more than 836,500 veterans and more than 545,400 patients seeking mental health care in the private sector. Patients in the study suffered from one or more serious mental health diagnoses including schizophrenia, bipolar disorder, PTSD, major depression and substance-use disorder. The authors conclude that “findings demonstrate the significant advantages that accrue from an organized, nationwide system of care. The much higher performance of the VA has important clinical and policy implications.”
Stump said he is grateful for the care he received within the VA system.
“I’m still a little jumpy at times. I startle easily, and I don’t do well in large crowds,” he said. “But, I can talk about and honor my Marines now, and I’m not keeping that bottled up. My VA counselor not giving up on me was an important part of my recovery.
“I don’t know where I’d be without her.”