DOD Health Care

Further Testing and Evaluation of Case-Managed Home Health Care Is Needed Gao ID: HRD-93-59 May 21, 1993

The Defense Department (DOD) has conducted two demonstration projects to see whether case-managed home care of military patients is a cost-effective way of providing health care for individuals with chronic or catastrophic medical problems. GAO found that neither project has yielded enough information to identify an effective structure for administering a permanent home health care benefit. Specifically, the projects have provided little insight into ways to identify potential home health care recipients, prevent program abuse, and determine when and how case management should be provided. Claimed savings under both projects are significantly overstated. DOD also needs to determine the extent to which the administration of the home care benefit can be integrated into the Coordinated Care program.

GAO found that: (1) neither of the demonstration projects provided sufficient case information for early identification of patients requiring home care and permanent high-cost benefits; (2) although CHAMPUS has not yet developed adequate internal controls to prevent program abuse and control access to home care services, the 1986 project's internal controls seemed reasonable; (3) CHAMPUS projects have not developed sufficient information to identify when case management is needed, the type of case management services required, and efficient and effective ways of delivering case management services; (4) although the two CHAMPUS projects have realized some savings, the claimed savings under both projects could be overstated by up to 31 percent because of inappropriate CHAMPUS cost accounting methods, flawed contractor accounting methods, and inaccurate project management cost accounting; and (5) DOD needs to determine the most cost-effective plan of delivering home care benefits and ways of integrating CHAMPUS into its new Coordinated Care Program to avoid potential overlap between the two programs.

Recommendations

Our recommendations from this work are listed below with a Contact for more information. Status will change from "In process" to "Open," "Closed - implemented," or "Closed - not implemented" based on our follow up work.

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