• Caroline Sloan, Karen M Stechuchak, Maren K Olsen, Eugene Z Oddone, Laura J Damschroder, and Matthew L Maciejewski.
• Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), , Durham Veterans Affairs Health Care System, Durham, NC, USA.
• J Gen Intern Med. 2020 May 1; 35 (5): 1452-1457.

BackgroundShort-term health care costs following completion of health risk assessments and coaching programs in the VA have not been assessed.ObjectiveTo compare VA health care expenditures among veterans who participated in a behavioral intervention trial that randomized patients to complete a HRA followed by health coaching (HRA + coaching) or to complete the HRA without coaching (HRA-alone).DesignFour-hundred seventeen veterans at three Veterans Affairs (VA) Medical Centers or Clinics were randomized to HRA + coaching or HRA-alone. Veterans randomized to HRA-alone (n = 209) were encouraged to discuss HRA results with their primary care team, while veterans randomized to HRA + coaching (n = 208) received two brief telephone-delivered health coaching calls.ParticipantsWe included 411 veterans with available cost data.Main MeasuresTotal VA health expenditures 6 months following trial enrollment were estimated using a generalized linear model with a gamma distribution and log link function. In exploratory analysis, model-based recursive partitioning was used to determine whether the intervention effect on short-term costs differed among any patient subgroups.Key ResultsMost participants were male (85%); mean age was 56, and mean body mass index was 34. From the generalized linear model, 6-month estimated mean total VA expenditures were similar ($8665 for HRA + coaching vs $9900 for HRA-alone, p = 0.25). In exploratory subgroup analysis, among unemployed veterans with good sleep and fair or poor perceived health, mean observed expenditures in the HRA + coaching group were higher than in the HRA-alone group ($12,814 vs $7971). Among unemployed veterans with good sleep and good general health, mean observed expenditures in the HRA + coaching group were lower than in the HRA-alone group ($5082 vs $11,612).ConclusionsCompared to completing and receiving HRA results, working with health coaches to set actionable health behavior change goals following HRA completion did not reduce short-term health expenditures.Trial RegistrationClinicaltrials.gov identifier: NCT01828567.

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