VA Allegations Shed Light On Alternative PTSD Treatment Mechanisms

JUN 19

Widespread allegations into the mismanagement of healthcare claims of American Veterans have been in the news flow for months.  These include excessive patient wait times across VA Healthcare Systems (HCS), and raised questions regarding access to care for the growing Veteran population in the U.S. and drawn attention to the prevalence of Post-Traumatic Stress Disorder (PTSD) and other behavioral health issues.

Recently, President Obama announced plans to withdraw the majority of U.S. troops from Afghanistan by the end of 2016. At the height of American involvement the U.S. had more than 100,000 troops stationed in that country. The influx of U.S. servicemen and women returning from Afghanistan will further burden a VA Healthcare System already experiencing an increase in benefit claim submissions for additional provisions for Vietnam Veterans exposed to Agent Orange. The coupling of an increased claims backlog with budgetary pressures will cause frustration for Vets waiting for care when they may need it most.

To lend perspective to the issues of claims backlogs at the VA, a year ago 611,073 claims were in the VA backlog and had been outstanding for more than 125 days. While considerable progress has been made to expedite the delivery of care, today the VA claims backlog exceeds 280,000. Notably, these claims are waiting for a rating decision from the VA dictating the details of a decision or award. Vets seeking behavioral health services to treat conditions like PTSD will still need to wait to see a primary care provider (PCP) for treatment, or receive a referral for more intensive care to be overseen by a Mental Health Treatment Coordinator (MHTC).

The VA has been proactive in addressing PTSD through education and the rollout of programs such as PTSD Coach, a mobile application that provides information about the condition, self-assessment and symptom management tools, and ways to get help. Telemedicine has also grown in popularity as an alternative for Veterans living a significant distance from a VA HCS, as have the use of Community Based Outpatient Centers (CBOCs) like those operated by Humana’s Valor Healthcare.  But is this enough?

Some Numbers Behind PTSD

According to a recent quarterly report from the Post-Deployment Health Group at the Office of VA Public Health:

  • 1,759,433 – Total Veterans that served in Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF) or Operation New Dawn (OND).
  • 338,294 – The number of Veterans from the group above who were seen for potential or provisional PTSD at VHA facilities following their return from Iraq or Afghanistan.
  • 20% – The proportion of Veterans diagnosed at a VA Medical Center, Veterans Integrated Service Network or Vet Center. The actual figure is likely much higher and will grow as Vets waiting for care are afforded access.
  • ~30% – The estimate of Vietnam Veterans suffering from PTSD by The National Center for PTSD.

We expect the VA to further leverage and expand its CBOC network over the short-to-medium term while investing federal funds in infrastructure and program development. Much of this is likely to be a product of the swift legislative action that has resulted from the VA fallout. Sens. Bernie Sanders (I-Vt.) and John McCain (R-Ariz.) recently struck a compromise to put forth legislation to reform the VA Health System with provisions such as a ‘choice card’ that would enable Vets to see non-VA providers in select cases and further allow Veterans to actively seek outside care if they cannot see a VA physician in a timely fashion or if the distance to a facility is prohibitive.

Our team has been following the emergence of exposure therapy for PTSD treatment and the companies innovating in this important area of healthcare. Recently, our Healthcare Executive Roundtable invited the Virtual Reality Medical Center, based in San Diego, California to our spring meeting for a discussion on this important subject. Other companies helping vets cope with PTSD through the use of virtual reality include Virtually Better and Oculus, who was acquiredby Facebook for $2bn in March.  PTSD is one aspect of the behavioral health continuum, and an area we’ll continue to assess.  Let us know what you think.

Jonathan Hill
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