Veterans Affairs utilization following new Medicaid enrollment remained relatively unchanged, and the VA continued to provide the large majority of care for dually enrolled veterans. There was variation among patients as Medicaid eligibility and other program factors influenced their use of Medicaid services.

Neck and back pain are pervasive problems. Some have suggested that rising incidence may be associated with the evidence of rising prevalence.To describe the trends in diagnosis of painful neck and back conditions in a large national healthcare system.A retrospective observational cohort study to describe the incidence and prevalence of diagnosis of neck and back pain in a national cohort.Patients were identified by International Classification of Diseases, 9th Revision (ICD-9) codes in Department of Veterans Affairs (VA) national utilization datasets in calendar years 2002 to 2011.Descriptive statistics were used to analyze the data. Prevalent cases were compared with all veterans who sought health care in each year. Incident cases were identified following a 2 years clean period in which the patient was enrolled and received care, but not services for any back or neck pain conditions.From 2004 to 2011, 3% to 4% of the population was diagnosed with incident back pain problems, the rate increasing on average, 1.75% per year. During the same period, 12.3% to 16.2% of the population was diagnosed with a prevalent back pain problem, the rate increasing on average 4.09% per year.In a national population, the prevalence rate for diagnosis of neck and back pain grew 1.8 to 2.3 times faster than the incidence rate. This suggests that the average duration of episodes of care is increasing. Additional research is needed to understand the influences on the differential rate of change and to develop efficient and effective care systems.

Objective To examine Veterans Health Administration (VA) enrollees' use of VA services for treatment of behavioral health conditions (BHCs) after gaining Medicaid, and if VA reliance varies by complexity of BHCs. Data Sources/Study Setting VA and Medicaid Analytic eXtract utilization data from 31 states, 2006‐2010. Study Design A retrospective, longitudinal study of Veterans enrolled in VA care in the year before and year after enrollment in Medicaid among 7,249 nonelderly Veterans with serious mental illness (SMI), substance use disorder (SUD), posttraumatic stress disorder (PTSD), depression, or other BHCs. Data Collection/Extraction Methods Utilization and VA reliance (proportion of care received at VA) for BH outpatient and inpatient services in unadjusted and adjusted analyses. Principal Findings In adjusted analyses, we found that overall Veterans did not significantly change their use of VA outpatient BH services after Medicaid enrollment. In beta‐binomial models predicting VA BH outpatient reliance, veterans with SMI (IRR = 1.38, p < .05), PTSD (IRR = 1.62, p < .01), and depression (IRR = 1.36, p < .05) had higher reliance than veterans with other BHCs after Medicaid enrollment. Conclusions While veterans did not change the amount of VA outpatient BH services they used after enrolling in Medicaid, the proportion of care they received through VA or Medicaid varied by BHC.

Background-Not much is known about nonelderly veterans and their reliance on care from the Veterans Affairs (VA) health care system when they have access to non-VA care. Objectives-To estimate VA reliance for nonelderly veterans enrolled in VA and Medicaid. Research Design-Retrospective, longitudinal analysis of Medicaid claims data and VA administrative data to compare patients' utilization of VA and Medicaid services 12 months before and for up to 12 months after Medicaid enrollment began. Subjects-Nonelderly veterans (below 65 y) receiving VA care and newly enrolled in Medicaid, calendar years 2006-2010 (N=19,890). Measures-VA reliance (proportion of care received in VA) for major categories of outpatient and inpatient care.

New drugs therapies have revolutionized the treatment of hepatitis C virus (HCV) infection. The objectives of this study were to evaluate uptake and utilization of boceprevir and telaprevir in the Department of Veterans Affairs (VA). We evaluated whether therapies confirmed to response-guided protocols, whether they replaced standard interferon plus ribavirin therapy treatment, and whether IL-28B was used to guide therapy. This work can inform our understanding of how other new effective HCV therapies will be used, their diffusion, and the timing of their diffusion in actual clinical practice. We performed an administrative-data based analysis of all patients receiving pharmacologic treatment for HCV in VA from October 2009 to July 2013. Results There were 12,737 new HCV prescriptions in VA during this time, with 5,564 boceprevir or telaprevir prescriptions (44%) and 7,173 prescriptions (56%) written for standard dual therapy (interferon plus ribavirin treatment). Prescriptions for the new treatments heavily favored boceprevir versus telaprevir (83% versus 17%). Sixty two percent (62%) of boceprevir-treated patients completed their minimum-specified protocol, while 69.2% of telaprevir-patients completed their minimum-specified protocol. From October 2010 to July 2012, 4,090 patients had an IL-28B test; less than 16% of these tests guided subsequent HCV prescriptions. Uptake of boceprevir and telaprevir was rapid and the number of patients initiating treatment approximately doubled in the period after their introduction. While new prescriptions favor boceprevir or telaprevir over standard dual therapy, there appears to still be a strong role of interferon and ribavarin in treating HCV patients.

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