VA Flashcards

1
Q

VA Overview

A
  • single largest managed care organization in the US –> 9.2 million enrolled veterans
  • single source for care to veterans (primary care is the backbone)

Government Agency
- focused on COST AVOIDANCE
- revenue recovery through 3rd party billing (exception of Medicare)
- politics can influence

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2
Q

VA Customers

A

veterans served at least 2 full years of active duty
- spouses/children generally NOT covered

Autoqualify
- disabilities
- agent orange
- radiation
- burn pits
- purple heart recipients
- former prisoner of war

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3
Q

What does a veteran look like?

A

generally think of:
- white, older, male

Trends:
- decline in total population of veterans (baby boomers dying off)
- increases in black & hispanic
- increases in female

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4
Q

VA Organizational Structure

A

Secretary of Veterans Affair (appointed by president)
- Veterans Health Administration
- Veterans Benefit Administration
- National Cemetery Administration

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5
Q

Statistics of VA

A
  • 18 regional networks –> IN is 10
  • 171 medical centers
  • 1400 outpatient clinics
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6
Q

VA Funding

A
  • primarily federal income taxes
  • funding is distributed using capitation model called VERA (Veterans Equitable Resource Allocation)

FY24 Budget: 325.1 billion

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7
Q

VERA

A
  • per capita distribution model based on # of Veterans in area
  • veterans have a primary facility they are linked to
  • medical complexity of each Veteran is considered

Pros: protection from govt shutdowns
Cons: funding not realized for 3 years from date of service

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8
Q

Rx Fullfillment

A
  • nationally integrated EMR
  • follow federal pharmacy regulations –> not state laws
  • pharmacists can be licensed in ANY state
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9
Q

Mail Order Pharmacy

A
  • primarily for refills
  • highly automated operation

Chicago: non-controlled (5)
Charleston: controlled (2)

CANNOT FILL C-II
WORKS TO REDUCE OVERHEAD COSTS

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10
Q

Emergency Pharmacy Services

A
  • strategi national stockpile –> not just reserved for veterans
  • Disaster Emergency Medical Personnel System
  • Mobile pharmacy (5)
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11
Q

Medication Care Management

A
  • treated as mid-level practioners –> prescriber status

Roles
- review all meds with each fill by EMR
- counseled on meds prior to dispensing
- formulary substitutions & conversions without MD approval
- adjust quantities
- supply items (diapers, catheters, bandages)

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12
Q

VA National Formulary

A
  • closed & national formulary
  • national P&T Committee sets formulary for all VA in US
  • national contracts to leverage cost containment (payer & provider)

Copays:
- Tier 1: 5$
- Tier 2: 8$
- Tier 3: 11$
Max OOP: $700/year
NO COPAYS FOR CONDITIONS DIRECTLY LINKED TO SERVICE
IF PA, RHPH PROVIDES PA

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13
Q

PA Requests

A
  • entered by prescriber
  • adjudicated by VA pharmacist and decision made
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14
Q

MISSION ACT

A
  • redefined how Veterans can receive medical care outside of the VA

Impact on Pharmacy:
- increased outside Rx’s
- urgent and emergent refills
- workflow more similar to community pharmacy

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15
Q

Population Health Tools

A

DATA RICH
- Primary Care Almanac: stratifies patients based on disease state outliers
- Patient Aligned Care Teams: stratifies patients based on diagnosis
- Care Assessment Needs: estimated probability of admission or death in a specified time period

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