Short-Term VA Health Care Expenditures Following a Health Risk Assessment and Coaching Trial

Abstract

Background: Short-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed.

Objective: To compare VA health care expenditures among veterans who participated in a behavioral intervention trial that randomized patients to complete a HRA followed by health coaching (HRA + coaching) or to complete the HRA without coaching (HRA-alone).

Design: Four-hundred seventeen veterans at three Veterans Affairs (VA) Medical Centers or Clinics were randomized to HRA + coaching or HRA-alone. Veterans randomized to HRA-alone (n = 209) were encouraged to discuss HRA results with their primary care team, while veterans randomized to HRA + coaching (n = 208) received two brief telephone-delivered health coaching calls.

Participants: We included 411 veterans with available cost data.

Main measures: Total VA health expenditures 6 months following trial enrollment were estimated using a generalized linear model with a gamma distribution and log link function. In exploratory analysis, model-based recursive partitioning was used to determine whether the intervention effect on short-term costs differed among any patient subgroups.

Key results: Most participants were male (85%); mean age was 56, and mean body mass index was 34. From the generalized linear model, 6-month estimated mean total VA expenditures were similar ($8665 for HRA + coaching vs $9900 for HRA-alone, p = 0.25). In exploratory subgroup analysis, among unemployed veterans with good sleep and fair or poor perceived health, mean observed expenditures in the HRA + coaching group were higher than in the HRA-alone group ($12,814 vs $7971). Among unemployed veterans with good sleep and good general health, mean observed expenditures in the HRA + coaching group were lower than in the HRA-alone group ($5082 vs $11,612).

Conclusions: Compared to completing and receiving HRA results, working with health coaches to set actionable health behavior change goals following HRA completion did not reduce short-term health expenditures.

Trial registration: Clinicaltrials.gov identifier: NCT01828567.

Keywords: behavioral; expenditures; health care costs; veterans.

Conflict of interest statement

Dr. Maciejewski owns Amgen stock due to his spouse's employment. All other authors have no conflicts.

Figures

Figure 1

Overall observed costs of health risk assessment (HRA) + coaching and HRA-alone at 6 months were similar, but treatment effects were heterogeneous. Subgroups of trial participants with differential treatment effects were derived using model-based recursive partitioning (MoB). We used the default value of statistical significance for the fluctuation tests (alpha = 0.05); post pruned via AIC fit index; set minimum node sample size as 40; and specified max LM-type test as the fluctuation test for ordered factor variables. All other control parameters were kept at their default values. The effective sample size used in the model-based recursive partitioning analysis was reduced to 400 due to missing data in baseline covariates. MoB generated a tree based upon three variables. Employment status was the strongest predictor of treatment response. An additional split on the MOS-6 Sleep Scale Score occurred within those not employed full or part time, and those with “good sleep” had an additional split based upon self-rated health.