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# Special Disability Programs -- CARES-related Planning

**In *general*, the CARES planning model/process *uses*:**

1.  VA and National Census databases to project enrollment & market
    share at 2012 and 2022.

2.  Actuarial survival/mortality data & new active duty military
    separations

3.  Private sector databases to predict healthcare utilization, with
    adjustments for VA experience -- i.e., lack of co-pay, male
    predominance, higher co-morbidity, use of Medicare & private sector
    ("reliance" factors by priority), and management efficiency.

4.  Criteria for access (travel time), safety, and quality of care,
    impact on affiliations, research, and other missions (e.g., DoD
    contingency support & Homeland Security).

5.  Survey of space, beds, and clinical services in all VA facilities
    and VISNs.

**Caveats regarding the CARES model *vis-à-vis* the Special Disability
Programs (SDPs):**

1.  VA has unique programs for special disabilities for which no
    comparable private sector utilization benchmarks are available --
    i.e., *the **VA services** **are the benchmarks***. Hence,
    projections are based upon VA utilization data, not private sector
    utilization.

2.  Thus, some of the advantage of the Milliman forecasting model is
    lost, since the VA workload data may be subject to supply
    constraints.[^1]

3.  CARES models are not designed for service-level planning -- i.e.,
    they are currently configured for macro (large scale) planning for
    capital asset needs. Smaller numbers tend to show wider variation
    and less reliability.

4.  Furthermore, long-term planning is not an exact science (***note:*
    this applies the CARES model *in general* -- and is not specific to
    the SDPs**).

    a.  The CARES model is not perfect -- *but* it is constantly being
        re-examined and improved.

        i.  In order to assist its ***short-term*** budget planning and
            enrollment decision efforts, the VA has been using similar
            models for the past 5 years.

        ii. On-going improvements in the methods and the assumptions
            have been effected.

        iii. Moreover, with the CARES process, the model has been
             subjected to greater scrutiny than in the past.

        iv. The basic model appears to be actuarially sound.

    b.  Multiple unpredictable, ***external*** variables (e.g., medical
        technology advances, future military conflicts, and economic
        conditions) may affect the application of the model.

    c.  In addition, ***internal*** (i.e., VA-specific) factors (e.g.,
        public policy decisions and the "vision" of the administration
        at any one time) may affect the planning assumptions used in the
        model.

    d.  In early February, the CARES projections were updated based upon
        the revised enrollment projections, which incorporated policy
        changes for the President's FY 04 budget and Census 2000 changes
        in VetPop).

Process and Procedures for Special Disability Program (SDP) Planning
Initiative (PI) Development:

1.  The National CARES Program Office (NCPO) has engaged the clinical
    leaders of the SDPs as active participants in PI development.

2.  A separate team of SDP representatives constituted a PI Team, which
    met during the PI Selection Retreat (November 12-16, 2002).

3.  The SDP team reviewed available national data as projected using the
    CARES model from the existing Milliman categories:

    a.  Including Baseline (2001) and demand projections for 2012 and
        2022.

    b.  Whenever possible, PIs were identified for Blind Rehab (BR) and
        Spinal Cord Injuries and Disorders (SCI/D).

    c.  Mandated levels were observed.

    d.  Any utilization above the mandated levels has been included in
        the planning.

4.  For Mental Health and Traumatic Brain Injury, a number of
    consultations, discussions, and on-going investigation of the model
    has not lead to an alternative methodology for projections for those
    specific SDPs. Specific recommendations from Mental Health are being
    explored further.

5.  The NCPO and SDP leaders (BR & SCI/D) have developed alternative
    data analyses and forecasting methodologies to improve planning
    efforts for the SDPs.

    a.  Subject matter experts were paired with data management support
        personnel.

    b.  Revised projections were developed.[^2]

    c.  Planning initiatives were based upon the revised projections.

6.  Planning Initiatives pertaining to the SDPs will be incorporated
    into the VISN-level Market Plans by February 2003.[^3]

    a.  SCI/D and BR program representatives will work with the
        VISN-level CARES Steering Committees or Task Forces to resolve
        the proposed planning initiatives.

    b.  The SCI/D and BR PIs will be managed off-line (i.e., they cannot
        be entered onto the CARES-IBM template). Space issues will be
        resolved once planning template entries have been completed.

[^1]:
    > *Note*: private sector utilization is also constrained by the
    > benefits packages that third-party payers are willing to fund.

[^2]: See specific spreadsheets for detailed descriptions of the methods
    used.

[^3]: The alternative projections for BR and SCI/D were available by the
    end of January 2003 as targeted. However, the projections had to be
    updated for to incorporate the VetPop and enrollment projection
    changes. The policy and VetPop changes had minimal impact on the
    previously formulated planning initiative recommendations.