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In 2015, the Centers for Medicare and Medicaid Services announced the Medicare Advantage (MA) Value-Based Insurance Design (VBID) model test, which allows MA insurers to use flexible benefit design strategies, such as reduced cost-sharing, to encourage beneficiaries with chronic disease to use high-value care. During the first year of implementation (2017), nine MA insurers offered VBID in 45 health plans to a total of 96 053 eligible beneficiaries. We used MA encounter data to estimate the impact of VBID on health services utilization in 2017 using a difference-in-differences research design. We found that VBID increased use of 10 out of 18 targeted services, and led to general increases in primary care visits, specialty care visits, and drug fills across eligible beneficiaries. The model was also associated with increases in ambulatory care sensitive inpatient and emergency department visits, an unanticipated effect that may be temporary. Overall, our findings suggest that VBID successfully increased the use of high-value services among eligible MA beneficiaries, an important first step along the pathway to better chronic disease management, lower spending, and improved beneficiary health.

Cover -- Title Page -- Copyright -- Contents -- Preface -- Figures -- Tables -- Summary -- Acknowledgments -- Abbreviations -- CHAPTER ONE Introduction -- CHAPTER TWO Approach to Estimating Risk at Installations and Major Commands -- RAND Military Workplace Study and Data -- Characterizing Organizational Units in Each Service Branch -- Statistical Methods -- CHAPTER THREE The Distribution of Sexual Assault Risk -- Total Installation Risk -- Estimated Number of Personnel Sexually Assaulted in One Year -- Installation-Specific Risk -- Large Command Sexual Assault Risk -- CHAPTER FOUR The Distribution of Sexual Harassment Risk -- Large Command Sexual Harassment Risk -- CHAPTER FIVE Conclusions and Recommendations -- Patterns in Sexual Assault Risk Suggest Consistent Sources of Risk -- The Distribution of Risk Is Uneven Across Installations and Commands -- Installation-and Command-Specific Risk Account for Many Sexual Assaults -- Sexual Assault and Sexual Harassment Risk Are Highly Correlated -- Different Aggregations of Risk Could Be Useful -- Caveats and Limitations -- Recommendations -- APPENDIX Marine Corps Command-Specific Risk -- References.

To better understand sexual harassment and gender discrimination in the Army, RAND Arroyo Center researchers created profiles of active-component soldiers' most serious sexual harassment and gender discrimination experiences. This report describes the most common types of behaviors that occur, characteristics of (alleged) perpetrators, most common times and places in which sexual harassment and gender discrimination occur, and differences between high-risk and non-high-risk installations. Women's and men's experiences of sexual harassment and gender discrimination look broadly the same at high-risk installations compared with non-high-risk installations, and they do not appear to differ across high-risk installations. However, men's and women's experiences of sexual harassment and gender discrimination in the active-component Army are very different. Women are more likely than men to experience gender discrimination, repeated attempts to establish an unwanted romantic or sexual relationship, and sexual comments about their appearance, whereas men are more likely than women to be told that they do not act like a man is supposed to act. Soldiers often experience multiple forms of sexual harassment and gender discrimination; women experience more types of behaviors, on average, than men do. What women's and men's experiences have in common is that they frequently take place at work during the workday and involve exposure to offensive or persistent discussion of and jokes about sex

Sexual assault and sexual harassment have a variety of consequences harmful to those who are targeted, including psychological and physical health effects. In addition, sexual assault and harassment may have deleterious and costly consequences for employers if the abuse results in higher turnover or low morale and productivity. This report describes data analyses designed to assess the effects of sexual assault and sexual harassment on service members' decisions to separate from the military. The researchers found that exposure to sexual assault (as determined by survey responses) doubled the odds that a member would separate from the military in the ensuing 28 months. Over this period, an estimated 2,000 more separations occurred than would be expected had members not been sexually assaulted, and 8,000 separations (or roughly 8 percent of all separations) were similarly associated with sexual harassment. Secondary analyses demonstrated that separations associated with sexual assault and harassment were disproportionately voluntary-that is, the service members were not discharged for problem behaviors or other failures to adhere to standards or expectations in the military. These findings suggest that sexual assault and harassment are costly for both the affected service members and the services and that they harm military readiness. The report concludes with recommendations for how the Department of Defense could use this study's findings to reduce sexual assault, sexual harassment, and the separations associated with these experiences. Data for these analyses are drawn from the 2014 RAND Military Workplace Study, which invited close to 560,000 U.S. service members to share their experiences

RAND researchers review survey methods, sample demographics, key findings, and policy implications from the 2015 Health Related Behaviors Survey of active-duty service members.

The Veterans Access, Choice, and Accountability Act of 2014 addressed the need for access to timely, high-quality health care for veterans. Section 201 of the legislation called for an independent assessment of various aspects of veterans' health care. The RAND Corporation was tasked with an assessment of the current and projected demographics and health care needs of patients served by the Department of Veterans Affairs (VA). The number of U.S. veterans will continue to decline over the next decade, and the demographic mix and geographic locations of these veterans will change. While the number of veterans using VA health care has increased over time, demand will level off in the coming years. Veterans have more favorable economic circumstances than non-veterans, but they are also older and more likely to be diagnosed with many health conditions. Not all veterans are eligible for or use VA health care. Whether and to what extent an eligible veteran uses VA health care depends on a number of factors, including access to other sources of health care. Veterans who rely on VA health care are older and less healthy than veterans who do not, and the prevalence of costly conditions in this population is projected to increase. Potential changes to VA policy and the context for VA health care, including effects of the Affordable Care Act, could affect demand. Analysis of a range of data sources provided insight into how the veteran population is likely to change in the next decade.