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

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.

Duke Scholars

Author Caroline Sloan Medicine, General Internal Medicine

Author Maren Karine Olsen Biostatistics & Bioinformatics, Division of Biostatistics

Author Eugene Zaverio Oddone Medicine, General Internal Medicine

Author Matthew Leonard Maciejewski Population Health Sciences