Chronic Care Management (CCM): How to Care for Veterans

About 19 million of the United States population consists of veterans ⁽¹⁾ and 14 percent of Americans are covered by Medicare ⁽²⁾. Compared to the general population, veterans served by the Veterans Health Administration suffer from three additional non-mental health diagnoses and one additional mental health diagnosis ⁽³⁾. Chronic Care Management coordinators should have experience in providing care and assistance to veterans. Chronic Care Management should provide essential care to veterans through diagnosis-related education, access to individual resources, and assistance with mental health services.

Providing Diagnosis-Related Education to Veterans

Competent coordinators focus on helping their veteran patients better recognize and respond to self-management methods which positively impact their chronic conditions. In a study based upon post-traumatic stress disorder (PTSD) and medication adherence, a greater proportion of participants with likely PTSD were non-adherent to medications than other participants (67% versus 35%) (4). Chronic Care Management team members should be efficient in performing medication reconciliation and implementing medication management systems for veterans. CCM coordinators should utilize opportunities to educate veteran patients regarding the following:

• Comprehension of chronic conditions
• Compliance of provider instructions
• Course of action for self-management of diagnoses

As a result of information provided by coordinators, veterans of Chronic Care Management should experience healthy and independent lifestyles.

Mental Health Assistance for Veterans

Veterans benefit from Chronic Care Management by receiving access to assistance with mental health concerns. Of the 1.7 million veterans who served in Iraq and Afghanistan, 300,000 (20 percent) suffer from post-traumatic stress disorder or major depression ⁽⁵⁾. According to the Army, only 40 percent of veterans who screen positive for serious emotional problems seek help from a mental health professional ⁽⁵⁾. Coordinators are required to be available 24/7 to all Chronic Care Management patients, and veterans should be informed of this essential part of Chronic Care Management. Open communication between veteran patients and coordinators should build trusting relationships which allow expressions of daily stress or mental instability. Coordinators should assist with locating counselors, therapists, or social/case workers for veteran patients to improve their mental health. Support of mental health assistance from Chronic Care Management should show boosts in veteran patient morale.

Access to Individual Resources for Veterans

Data released by the Bureau of Labor Statistics concluded that veterans who left military service have an unemployment rate of 11.7 percent, well above the overall jobless rate of 9.1 percent ⁽⁵⁾. Financial strains and food supplements should be areas of focus for coordinators assisting veteran CCM patients. During communication with a Chronic Care Management coordinator, veterans may share concerns regarding the following:

• Medication costs
• Utility/Home expenses
• Insurance benefits
• Assistive device prices
• Transportation needs
• Food supplements
• Living arrangements

Coordinators for Chronic Care Management should alleviate barriers expressed by veteran patients. The United States Department of Housing and Urban Development estimated that veterans represent 12% of the homeless population ⁽⁶⁾. A Department of Defense task force found that a significant number of veterans face constrained access to care when they return to their communities ⁽⁵⁾. CCM services should promote individual and transitional care for veteran patients. Hence, veteran enrollees of Chronic Care Management should experience improvements in various aspects of their lives from increased chronic condition information, mental health assistance, and resource accessibility.

References

1. InfoPlease. [Online] Sandbox Networks, Inc., 200-2016 . [Cited: September 12, 2016.] http://www.infoplease.com/spot/veteranscensus1.html.
2. Center Forward Health Basics. [Online] 2011. [Cited: September 16, 2016.] http://www.center-forward.org/wp-content/uploads/2012/04/Medicare-Medicaid-and-the-Military-04-12-update-2.pdf.
3. Madhulika Agarwal, M.D., M.P.H., Chief Patient Care Services Officer. Meeting the Challenges of Veterans with Chronic Illnesses. 2005. URL: http://www.hsrd.research.va.gov/publications/internal/forum11_05.pdf.
4. Ian M Kronish, MD, MPH,1 Donald Edmondson, PHD,1 Judith Z Goldfinger, MD,2 Kezhen Fei, MS,3 and Carol R Horowitz, MD, MPH2. Post-Traumatic Stress Disorder and Adherence to Medications in Survivors of Strokes and Transient Ischemic Attacks. 2012, URL: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3404197/.
5. American Psychological Association. [Online] 2016 American Psychological Association. [Cited: September 12, 2016.] http://www.apa.org/about/gr/issues/military/critical-need.aspx.
6. Henry, Meghan, Cortes, Dr. Alvaro and Morris, Sean. The U.S. Department of Housing and Urban Development. [Online] 2013. [Cited: September 13, 2016.] https://www.hudexchange.info/resources/documents/ahar-2013-part1.pdf.