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Leaders Unfold Plan to Modify, Strengthen TRICARE

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Feb. 2, 1999 – Defense health officials unfolded bold new ideas for making sure TRICARE works as planned to deliver quality health care in peace and war. The result could mean more care in-house and less from contractors.

Addressing the 1999 TRICARE conference here, DoD health chief Dr. Sue Bailey and others laid out a plan to address shortcomings in the managed health care plan. In the past six months, a group of Army and Air Force colonels and Navy captains has put together a scheme to re-engineer TRICARE administration.

Navy Dr. (Capt.) Donald Arthur, assistant chief of health care operations for the Navy Bureau of Medicine in Bethesda, Md., and a member of the re-engineering team, said the effort represents a complete "change of culture." He presented the plan Feb. 1 to several hundred TRICARE providers and administrators gathered here from around the world to discuss ways to fine-tune the health plan.

The tri-service group's model ties staffing at military hospitals and clinics to their readiness mission. The facilities must have sufficient staffing to meet wartime requirements, he said, but they also must be augmented by available resources -- presumably a mix of civilian contract and military providers -- to meet peacetime requirements.

TRICARE was set up with the idea of complementing military resources with civilian contractors, so the plan doesn't seem like such a big change. But Bailey, assistant secretary of defense for health affairs, pointed out military resources are sometimes underused when DoD relies too much on contractors. She said that's going to change, beginning with the mostly contracted appointment system.

"I've initiated a review of the ratio of direct-care [in-house] phone awareness vs. contract," Bailey said. "I don't think we need to contract as much out." She said she plans to shifting functions back to the military is part of a larger effort to keep the promise and to restore members' trust in military medicine.

Bailey said the military has always provided quality health care to battlefields but hasn't been as faithful toward families. She there are inexorable links between wartime and peacetime medicine, including a well-trained medical team, a healthier, prevention-oriented beneficiary population and good information management.

"We are the HMO that goes to war," Bailey said. "We need our bills paid, our phones answered and our appointments made." She said TRICARE's success depends greatly on improving the overall health of beneficiaries, of tracking their health through better recordkeeping, and through responding to patient concerns and perceptions.

"Perception is reality. We need to simplify the message, make our system user-friendly and keep congressional leaders informed of the link between peacetime and wartime health care," she said. And one old perception of military medicine she doesn't want TRICARE to repeat is that it's "better than nothing."

"I want military medicine to be better than everything," Bailey said.

TRICARE Management Activity Director James Sears said the re- engineering plan will enable TRICARE to reach its full potential. He said the necessity for change is absolute.

"There are many threats to dismantle TRICARE," Sears said. He said TRICARE administrators must figure out how to move military medicine "from sick call to managed care to a healthy population." Sears challenged the medics to build a more effective organization.

"We have it in our grasp," he said, "to make TRICARE work."

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