Assessment A (Demographics)

1 2015 RAND Corporation. All rights reserved. Prepared by: RAND Corporation A Product of the CMS Alliance to Modernize Healthcare Federally Funded Research and Development Center Centers for Medicare & Medicaid Services (CMS) Prepared For: Department of Veterans Affairs At the Request of: Veterans Access, Choice, and Accountability Act of 2014 Section 201: Independent Assessment of the Health Care Delivery Systems and Management Processes of the Department of Veterans Affairs Assessment A (Demographics) September 1, 2015 Prepared for CAMH under: Prime Contract No.

2 HHS-M500-2012-00008I Prime Task Order No. VA118A14F0373 This document was prepared for authorized distribution only. It has not been approved for public release. Assessment A (Demographics) This page intentionally left blank. The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision. ii Assessment A (Demographics) Assessment A Authorship Credits Assessment A Study Directors RAND Project Director Christine Eibner Carrie Farmer Heather Krull Communications Analyst RAND Project Co-Director David Adamson Section 1: Introduction David Adamson Christine Eibner Heather Krull Section 4.

3 Enrollment and Reliance Matthew Cefalu* Andrew Mulcahy* Kristine Brown Jaime Hastings Amii Kress Carolyn Rutter David Adamson Robin Weinick * Denotes team lead Section 2: Conceptual Framework Christine Eibner Amii Kress Andrew Mulcahy Jaime Hastings Kristine Brown Matthew Cefalu Michael Pollard Heather Krull Section 5: Health Care Needs Projections Kristine Brown* Kanaka Shetty* Trinidad Beleche Matthew Cefalu Kandice Kapinos Carolyn Rutter Amii Kress Rachel Ross Section 7: Conclusions Heather Krull Kristine Brown Amii Kress Andrew Mulcahy Michael Pollard Christine Eibner Susan Hosek Section 2: demographic Projections Michael Pollard* Ernesto Amaral Joshua Mendelsohn Matthew Cefalu Amii Kress Rachel Ross Section 6: Scenarios Andrew Mulcahy* Philip Armour Joshua Mendelsohn Dulani Woods Olena Bogdan The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision.

4 Iii Assessment A (Demographics) This page intentionally left blank. The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision. iv Assessment A (Demographics) Acknowledgments We gratefully acknowledge the support of Alfonso Rivera Illingworth, who provided superb project coordination; Jill Gurvey, Andrew Madler, Craig Martin, Teague Ruder, and Mark Totten, who provided research programming support; and Christian Lopez, Marc PunKay, and Rachel Ross for research assistance.

5 We are grateful for the support and guidance from the project s management team, including Robin Weinick and Terri Tanielian, and the strong organizational support from Clare Stevens. We appreciate the comments provided by our reviewers, Beth Asch, Daniel Ginsberg, Carole Gresenz, Katherine Kahn, Kenneth Kizer, Paul Koegel, and Allison Percy. We addressed their constructive critiques, as part of RAND s rigorous quality assurance process, to improve the quality of this report. We are grateful to Meg Harrell for coordinating the quality assurance process for this project.

6 We thank Stacy Fitzsimmons and Anna Hansberry for excellent administrative assistance, and Allison Kerns for careful edits in the preparation of this report. We also acknowledge the support of our MITRE colleague, Sandy Sinay, along with her team. We are grateful to the subject-matter experts of Veterans Affairs projection models, who helped us develop our understanding of existing and ongoing research efforts. The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision.

7 V Assessment A (Demographics) This page intentionally left blank. The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision. vi Assessment A (Demographics) Preface Congress enacted and President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (Public Law 113-146) ( Veterans hoice Act ), as amended by the Department of Veterans Affairs (VA)

8 Expiring Authorities Act of 2014 (Public Law 113-175), to improve access to timely, high-quality health care for Veterans/ Under Title II Health Care Administrative Matters, Section 201 calls for an Independent Assessment of 12 areas of VA s health care delivery systems and management processes. VA engaged the Institute of Medicine of the National Academies to prepare an Assessment of access standards and engaged the Centers for Medicare & Medicaid Services (CMS) Alliance to Modernize Healthcare (CAMH)1 to serve as the program integrator and as primary developer of the remaining 11 Veterans Choice Act independent assessments.

9 CAMH subcontracted with Grant Thornton, McKinsey & Company, and the RAND Corporation to conduct 10 independent assessments as specified in Section 201, with MITRE conducting the 11th Assessment . Drawing on the results of the 12 assessments, CAMH also produced the Integrated Report in this volume, which contains key findings and recommendations. CAMH is furnishing the complete set of reports to the Secretary of Veterans Affairs, the Committee on Veterans Affairs of the Senate, the ommittee on Veterans Affairs of the House of Representatives, and the Commission on Care.

10 The research addressed in this report was conducted by the RAND Corporation, under a subcontract with The MITRE Corporation. 1 The CMS Alliance to Modernize Healthcare (CAMH), sponsored by the Centers for Medicare & Medicaid Services (CMS), is a federally funded research and development center (FFRDC) operated by The MITRE Corporation, a not-for-profit company chartered to work in the public interest. For additional information, see the CMS Alliance to Modernize Healthcare (CAMH) website ( healthcare/who-we-are/the-camh-differenc e). The views, opinions, and/or findings contained in this report are those of RAND Corporation and should not be construed as an official government position, policy, or decision.