Survey Changes

Proposed 2019 Changes to the VA Survey of Veteran Enrollees’ Health and Use of Health Care (Survey of Enrollees)

The following is a summary of recommended changes, additions, and deletions to the Survey of Enrollees. In general, changes reflect updated language or new questions based on changing health care delivery landscape or emerging initiatives related to VA Priorities of Greater Choice, Modernizing Systems, Efficiency, Improving Timeliness, and Suicide Prevention.

In order to accommodate new questions, two strategies have been adopted. First, questions that have been identified as no longer relevant have been dropped. Second, data that is not required on an annual basis is rotated, so that some questions are scheduled to be asked in 2019 and other questions are scheduled to be asked in 2020. Major additions or deletions are summarized in the next few paragraphs. This is followed by a section by section outline of all changes, including wording or answer options.

Three questions which together ask about experience using Community Care paid for by the VA are permanently added. These questions are multi-part and ask a total of 16 yes/no questions.

To accommodate these new questions, the survey permanently drops two yes/no questions about Medicare Part A and Part B. This data has only been used by the VHA actuarial contractors and they no longer require this data. In addition, two questions from the series of digital access questions will be dropped. These questions are multi-part and ask a total of 14 yes/no questions. The survey will continue to ask about internet access and willingness to use the internet for various health care related activities, but it will no longer ask about general reasons that an enrollee goes on line or the number of times a week an enrollee uses various devices.

A module for odd years beginning in 2019 adds:

• Expanded health status question that uses a series of seven questions developed by the 100 Million Healthier Lives effort that focus on the social determinants of well-being.

• Two questions to determine inpatient use and dependence on VA (we have included these in each clearance request, but have not used them in approximately 10 years).

• A series of five questions in support of VHA’s smoking cessation education program and to determine the extent of smokeless tobacco and e-cigarette use among enrolled Veterans.

• One question designed by VHA’s epidemiology program to monitor the magnitude of potential health issues among Veterans who served in the first Gulf War era.

To accommodate new questions designated for odd years, the survey will drop the following questions in odd years, but ask them in even years.

• One General Health Status Question

• A 17 part question that asks about various needs for assistance*

*Three questions that focus on cognitive needs for assistance will be maintained as this data as shown increasing need for assistance among the Veteran population.

In general, while the above questions are still relevant, we do not need to gather this information every year.

In odd years, the survey also adds three travel time and distance questions as they relate to access in exchange for a current question that asks respondents to rank eleven factors enrollees might look for when choosing a health care provider.

New Questions are preceded with the words (NEW) before the question number on the attached survey instrument. Questions targeted for odd years (beginning in 2019) are in red. Questions targeted for even years (beginning in 2020) are in blue. For the purposes of this review, questions are numbered sequentially, whether they are asked annually or not. The following section delineates all changes section by section.

Section 1: Introduction

• Question 3 – changed “I don’t remember enrolling” to “Not Sure”. Provides broader “opt out” for respondents.

• Deleted “What is the primary reason you enrolled?”. This question was developed in anticipation of ACA. It was unsuccessful in producing usable data and has not been asked since 2015.

Section 2: Health Benefits

• Deleted questions asking about Medicare Part A and Part B. The survey will continue to ask about Medicare and, if the respondent says yes, will ask if they have Medicare Advantage. Our actuary has indicated that they do not need to know if recipients have Part A or B. This data has not been used in any other capacity.

• At the suggestion of our actuary, survey now clarifies that Medicare Advantage plans can be offered by employers to their retirees and are known as “Employer Group Waiver Plans (EGWP).

• Deleted example of “Medicare + Choice” in Medicare Supplement Question; Medicare + Choice no longer exists.

• At request of actuary, added back in “who provides this coverage” if respondent says “yes” to question about private insurance; added an option to indicate if purchased on a Federal or State exchange.

• Deleted a question about whether or not private insurance is under an HMO. This question has not been asked since 2015 and actuary notes distinctions among health care plans are too blurred to make this question useful.

• Deleted “Medicare + Choice” and added Employer Group Waiver plans as plans to exclude from Private insurance. This was requested by actuary.

• Tweaked Long Term Care question to confirm we were asking about insurance and add Medicare in instructions to exclude.

Section 4: Views on Health Care and Reasons for Using or Not Using VA’s Health Care System

• Amended outpatient question to confirm that when considering VA paid visits, co-pays should be excluded, at request of actuary.

• Added two questions about inpatient utilization at actuary request. These questions are from the original survey and have been submitted for approval with each clearance renewal of the survey. They will asked on odd years only.

• Changed Likert scale in “satisfaction” questions to more traditional options of Very Satisfied, Satisfied, Neutral, Dissatisfied, Very Dissatisfied. Formerly, these options were Very Satisfied, Moderately Satisfied, Somewhat Satisfied, Not at all Satisfied and Does not apply.

• Added “You had a condition requiring immediate attention and could not get an appointment at VA”. This addition was suggested by a respondent; several letters received from respondents indicated problems with access when they felt they needed immediate attention.

• At recommendation from health economist review, created ranking question when asking about factors commonly considered when selecting a health care provider. Added additional concepts to this questions: prefer provider of same race/ethnicity and prefer provider of same gender.

• Added question from 2013 which focuses on travel time and distance as a barrier to access as an alternate to question asking about factors commonly considered when selecting a health care provider. Travel time and distance questions will be asked on even years.

Section 5: Current Health

• Deletes Caregiver Assistance from section title (assistance requirements will not be asked each year)

• Added alternate questions to basic “Health Status” Question to correlate with the 100 million healthier lives well-being questions.

• Added additional smoking questions to better understand enrollees’ awareness of Quit Smoking tools offered by VHA and their use of smokeless tobacco and e-cigarettes.

Section 5: Current Health

• Creates a distinction between “retired” and other reasons someone might be in the workforce (student, homemaker, on disability, etc.) when asking about employment status.