Projects on Improving Health Systems and Interventions
Plan for a Servicemember Integrated Health Program
RAND is providing a long-range plan for establishing an integrated employee health program within DoD. This study involves first outlining the conceptual framework for an integrated program as well as identifying potential obstacles and barriers to implementing such a program.
Systematic Treatment Engagement for Posttraumatic Stress Disorder Using Primary Care (STEP-UP)
In partnership with the Uniformed Services University of Health Services and RTI, RAND is evaluating the effectiveness of stepped care for war-related PTSD and depression among soldiers returning from OEF and OIF. The stepped-care approach will be implemented in six military treatment facilities around the country. RAND will lead the qualitative evaluation of the intervention and the analyses of cost-effectiveness.
Assessing Chiropractic Treatment for Low Back Pain, Military Readiness, and Smoking Cessation
In this multi-site trial, RAND is examining the effect of chiropractic clinical treatment on health concerns relevant to servicemembers. This study involves collaboration with the Samueli Institute and Palmer College of Chiropractic.
New Capabilities for Assessing Injuries Caused by Under-Body Blast
RAND is helping the U.S. Army Medical Research and Materiel Command (USAMRMC) improve DoD and Army capabilities to analyze and predict vehicle occupant injuries from under-body blast events.
Information Technology and Health Informatics
RAND researchers are supporting the initial planning stage leading to development of a roadmap for a research initiative on health information technology (IT). The roadmap seeks to address needs identified by the Military Health System to better coordinate its health IT research, address IT capability gaps through well-focused research initiatives, and reduce programmatic risk for enterprise projects. RAND researchers are considering how issues related to military health policy are incorporated in the roadmap, including policy related to how health care services might be influenced by IT initiatives and where IT initiatives will be influenced by existing or anticipated healthcare policy.
Military Medical Leadership Development
The Military Health System (MHS) faces several challenges: exploding health care costs, an increased emphasis on performance management, combat operations that have placed unparalleled pressure on the health care system both at home and abroad, and a need to integrate the medical force into joint operations. Leadership will play a central role in responding to these challenges. RAND examined how leaders in the health care field are prepared and supported in the civilian and military sectors and recommended improvements to the ways in which the MHS identifies and develops potential leaders.
Reviewing DoD Suicide Prevention Programs
Suicide is a growing concern in the military. Estimates indicate that the rate of suicides among Army soldiers on active duty is the highest that it has been in the past decade, and there is concern about whether such trends are evident in the other services. RAND evaluated suicide prevention programs across the services, individually, and as a whole.
Health Care for Dual-Eligible TRICARE Beneficiaries
Under current policies, the Centers for Medicare & Medicaid Services, DoD, and the VA each view TRICARE for Life (TFL) beneficiaries independently. At issue is how to restructure federal funding policies in a way that will foster viewing these dual-eligible beneficiaries as a joint responsibility and will provide them with the highest-quality care at the lowest cost to the federal government. To inform this policy issue, RAND estimated the costs of care provided to TFL beneficiaries across civilian care, MTFs, and VA facilities and developed models for sharing costs between the programs that would provide incentives for coordinated, cost-effective care.
Review of Military Health Benefit Design
DoD health care benefits provided to retired and Reserve personnel have expanded, while beneficiary cost-sharing arrangements for non-active duty personnel and dependents have decreased. To control escalating health care costs associated with this increased demand, DoD has considered restructuring the health care benefits provided to active duty dependents and military retirees and their dependents. RAND designed a simulation model to assess the implications, for government and beneficiary cost, of potential changes in the military health benefit and is using the model to evaluate a health savings account option. A paper describing this work is forthcoming.
Longitudinal Study of PTSD, TBI, and Functional Impairment Among OEF/OIF Veterans
RAND is conducting further analyses on the existing data set from the RAND Invisible Wounds of War study to address remaining clinical and scientific research questions regarding the mental health issues facing servicemembers returning from Iraq and Afghanistan. All study publications are available at http://veterans.rand.org.
Reviewing DoD’s Occupational Health Program
Today’s DoD workforce is highly skilled, works under high pressure, and often takes risks to accomplish its national security mission. Despite the workforce’s changing jobs and performance tasks, DoD still maintains a decades-old industrial-based approach to military accession, occupational health, and disability evaluation. RAND conducted a comprehensive review of existing DoD occupational health and wellness programs in order to inform the design of an integrated and comprehensive employee health program for DoD’s active duty workforce.
Evaluating the VA Enrollee Health Care Projection Model
The Department of Veterans Affairs relies on the Enrollee Health Care Projection Model to project veteran enrollment, their use of health care services, and the cost of providing those services. These data are used to set the VA medical care budget. RAND reviewed and assessed the VA Enrollee Health Care Projection Model to determine if its methodology is likely to yield reasonable predictions and to identify potential future modifications to the model.
Using the Military’s New Electronic Medical Records to Monitor System Performance
Electronic medical record systems have the potential to improve health care in many areas, from reducing duplicative testing to increasing adherence to evidence-based practice. RAND developed a framework and defined specific measures to be used to judge and report the efficiency, safety, and health benefits of the military’s health system, drawing on data from the Armed Forces Health Longitudinal Technology Application (AHLTA), a new electronic medical record system.
Transforming the Army Medical Department
The Army has been transforming itself into what it calls the Future Force, which relies on a combination of rapid operations, dispersed forces, and superior information. These new concepts pose considerable challenges for medical forces, which must find, stabilize, and evacuate casualties who are spread across a dispersed battlefield. RAND designed and facilitated a series of workshops to determine what the new concepts mean for providing medical support to the fighting units and synthesized the results to identify challenges for the structure of the medical force.
Reforming the Military Health System Pharmacy Benefit
As in the private sector, the military health care system has experienced a rapid growth in expenditures, including double-digit growth for prescription drugs. RAND assessed the factors contributing to the rising costs of prescription medications for military retirees and their families and proposed measures that might curb costs without sacrificing patient safety or the quality of care.
Expanding Mental Health Provider Options
Military health insurance under TRICARE provides coverage for most medically necessary mental health care delivered by qualified providers. RAND evaluated the DoD’s demonstration project to expand beneficiaries’ access under TRICARE to licensed or certified mental health counselors.
Improving VA Resource Allocation
The Veterans Equitable Resource Allocation (VERA) system was adopted in 1997 to improve the nationwide distribution of the VA medical budget. RAND assessed whether VERA shortchanged some areas of the country and some veterans with special health care needs, leading to implementation of a more-refined VA patient classification system.
Assessing the Health Benefits of Medicare-Eligible Military Retirees
Medicare-eligible military retirees are entitled to benefits under both Medicare and the military’s comprehensive TRICARE for Life (TFL) plan. RAND examined the TFL benefit design and its potential benefits and costs for DoD, Medicare, beneficiaries, and taxpayers, with the goal of identifying efficient strategies for the design and administration of TFL benefits.
Reorganizing the Military Health System
Since the end of World War II, the question of whether to create a unified military health system—instead of one with separate Army, Navy, and Air Force medical departments—has arisen repeatedly. RAND examined organizational alternatives to see if a unified system could lead to reduced costs, better health care delivery, a more efficient administrative process, and improved readiness.
Standardizing Army Health Care
DoD and the VA have sought to standardize care for both health systems to achieve greater consistency, quality, and cost-effectiveness. RAND partnered with the Army Medical Department to implement DoD/VA clinical practice guidelines proactively across the Army health system for selected conditions (asthma, low back pain, diabetes, and post-deployment health concerns).