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TRICARE Sizzles at Desert Fort

By Douglas J. Gillert
American Forces Press Service

FORT IRWIN, Calif., July 21, 1999 – Hot. Dry. Dusty. Remote. "Halfway between Hollywood and Hell," a soldier sitting on a curb outside the visitors quarters muttered as she took a swig from a sweating cola can in the meager shade of a scraggly tree.

If the Army's National Training Center comprises mostly hundreds of square miles of desert and mountains with not much vegetation, the main post is a green and inviting oasis of neat buildings and well-manicured lawns. It's here the soldiers return from field training, where they shop, eat and get their medical care. Housing is limited and many married soldiers find homes off post -- quite a distance off post, considering it's at least 40 miles by car to the nearest community.

Health care used to be one of the most contentious things about desert life for these soldiers and their families. Before TRICARE, the DoD managed health care plan, arrived four years ago, emergency and specialty care often involved extended travel and time away from home and work. It meant spending money for baby sitters, hotels, gas and other necessities some of the younger families couldn't really afford but had to, anyway.

But TRICARE came, and things changed. They got -- and keep getting -- better. So much better that a 1998 patient survey revealed a 97 percent satisfaction rate with health care, 20 points higher than the year before.

Today, a network of civilian primary and specialty health care complements the care given at the Weed Army Community Hospital, here. Instead of having to send people as far away as Walter Reed Army Medical Center in Washington, the hospital supplements its in-house care with civilian medical services available in Southern California. That means less time away from jobs and homes, a plus for families and commanders.

"Our current plan of health care at Fort Irwin and in the surrounding community has enhanced the readiness of soldiers," said Brig. Gen. William G. Webster Jr., National Training Center commander. "Our soldiers and their families know that if something goes wrong, they will be taken care of."

In October 1996, things went terribly wrong for Dian Bower. Doctors found cancer in her brain and scheduled her for surgery. She survived the surgery, but cancerous cells remained, and her Army doctors referred her to a neurology clinic in Los Angeles. There, while she got the health care that would eventually free her of the murderous cancer cells, the TRICARE Service Center took care of her bills and helped her get around the congested city.

Bower wonders whether she'd be alive today without the benefits of TRICARE. She knows she would have gotten expert care back East at Walter Reed, but she's grateful she could remain near home, family and friends.

"I firmly believe that I would not be here today if it were not for the quick and correct response my primary care manager gave me and the assistance TRICARE provided," said Bower, who recently moved to Oklahoma. "I'm thankful they took such good care of me."

Meeting patient needs is Army Dr. (Col.) Michael McCaffrey's highest priority as commander of the Fort Irwin hospital. McCaffrey brought to the job a philosophy developed after years of private practice. "If the customer doesn't come through the door, you don't make any money," he said.

Although the Army hospital isn't in the health care business to make money, McCaffrey saw that a large portion of his patient population -- family members and retirees -- had health care choices. They didn't have to enroll in TRICARE. But hospital capabilities, including equipment and staffing, are based on the number of patients they treat. So, to bring in as many family member and retiree patients as he can, McCaffrey gave them appointments on the same day they call (or when it's convenient for them) and made sure they see the same providers as much as possible.

McCaffrey also responded to military readiness needs, reducing the time soldiers spend at sick call from a half-day or longer to no more than an hour or two. Weed doesn't really have sick call anymore; soldiers are enrolled with a primary care manager and receive short-notice appointments when they're feeling ill.

TRICARE also has brought more preventive medicine programs to the fort, a move Webster said has made his troops healthier than ever. The center commander said soldiers score an average of 250 out of a possible score of 300 on the annual Army physical fitness test, and there appears to be less smoking and drinking than in the general population.

"Preventive maintenance in the medical area is paying great dividends," Webster said.

In her role as "mayor" of family housing, Carol Reynolds also hears good things about medical care at Fort Irwin. She said McCaffrey and his staff want to know about problems that surface and are quick to remedy them.

But Reynolds' experience with Weed is also personal. The wife of an active-duty officer and mother of two children, she and her son, Robert, suffer from asthma and environmental allergies. Most important to her is seeing the same doctor -- they do -- and not being treated as a number. They aren't.

"This has been a very favorable experience," she said of the health care at Fort Irwin. "The doctors don't mind talking with me, giving me literature. They want me to be informed, so I can take an active role in my son's care."

She likes being able to use the health care hot line here to get advice any time of the day or night. "It doesn't matter whether it's a cold or an emergency," she said. "The [on-call primary care manager] will call you back quickly."

Well-traveled as an Army wife, Reynolds has seen TRICARE's impact here and at other bases. She likes recent changes to the system that allow members of TRICARE Prime, the plan's health maintenance option, to transfer from one region to another without having to dis-enroll at the old location and re-enroll at the new one. And she likes the improved relationships between patients and their physicians.

"Doctors in the Army have become more aware of their patients," she said.

"The primary care managers get to know their patients," Webster affirmed. "Our soldiers spend 14 days of every month in the field. They know their doctors and know that their families will be taken care of."

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Click photo for screen-resolution imageEfficient and often same-day appointments at the Weed Army Community Hospital, Fort Irwin, Calif., have improved patient satisfaction among active duty soldiers from 77 percent in 1997 to 97 percent last year. Photo by Douglas J. Gillert.  
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Click photo for screen-resolution imageCommander of the Army's National Training Center, Fort Irwin, Calif., Brig. Gen. William G. Webster Jr., said medical care under DoD's TRICARE health plan is improving the way military health beneficiaries are taken care of. Photo by Lt. Richard Haupt, USN.  
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