Health Care Utilization Patterns Among High-Cost VA Patients With Mental Health Conditions.
OBJECTIVE
To inform development of intensive management programs for high-cost patients, this study investigated the relationship between psychiatric diagnoses and patterns of health care utilization among high-cost patients in the Department of Veterans Affairs (VA) health care system.


METHODS
The costliest 5% of patients who received care in the VA in fiscal year 2010 were assigned to five mutually exclusive hierarchical groups on the basis of diagnosis codes: no mental health condition, serious mental illness, substance use disorder, posttraumatic stress disorder (PTSD), and depression. Multivariable linear regression was used to examine associations between diagnostic groups and use of mental health and non-mental health care and costs of care, with adjustment for sociodemographic characteristics. The proportion of costs generated by mental health care was estimated for each group.


RESULTS
Among 261,515 high-cost VA patients, rates of depression, substance use disorder, PTSD, and serious mental illness were 29%, 20%, 17%, and 13%, respectively. Individuals in the serious mental illness and substance use disorder groups were younger and had fewer chronic general medical conditions and higher adjusted rates of mental health care utilization; they also had a greater proportion of costs generated by mental health care (41% and 31%, respectively) compared with individuals in the PTSD and depression groups (18% and 11%, respectively).


CONCLUSIONS
Optimal management of high-risk, high-cost patients may require stratification by psychiatric diagnoses, with integrated care models for patients with multiple chronic conditions and comorbid mental health conditions and intensive mental health services for patients whose primary needs stem from mental health conditions.
Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.
Grace
G
Hunter
Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.
Jean
J
Yoon
Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.
Daniel M
DM
Blonigen
Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.
Steven M
SM
Asch
Ms. Hunter is a medical student at Stanford University School of Medicine, Stanford, California, where Dr. Zulman and Dr. Asch are with the Division of General Medical Disciplines. Dr. Zulman and Dr. Asch are also with the Center for Innovation to Implementation, Department of Veterans Affairs (VA) Palo Alto Health Care System, Palo Alto, California, where Dr. Blonigen is affiliated. Dr. Yoon is with the Health Economics Resource Center, VA Palo Alto Health Care System. Send correspondence to Dr. Zulman (e-mail: dzulman@stanford.edu ). This work was presented at the annual research meeting of AcademyHealth, San Diego, June 8-10, 2014, and at the regional meeting of the Society for General Internal Medicine, Stanford, California, January 31, 2014.
Donna M
DM
Zulman
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology / Q000706:statistics & numerical data*