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Stakeholders' Report Points to TRICARE Progress

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 13, 1999 – TRICARE systematically tracked patient concerns in 1999, streamlining enrollment, improving claims processing and steadily improving patients' number one bug-a-boo, access.

These and other achievements and ongoing concerns are detailed in the 1999 TRICARE Stakeholders' Report published by the TRICARE Management Activity, here.

The report describes TRICARE performance in three critical areas: access, quality and cost. Combined, these areas are key to customer satisfaction, according to TRICARE officials. Sources for the report included the Annual Health Care Survey of DoD Beneficiaries; results of an independent study by the Center for Naval Analyses and Institute of Defense Analysis; and patient feedback.

TRICARE access standards are now universally in place, the report states. These standards are:

  • Urgent care: one day or less
  • Waiting room time at doctor's office: 30 minutes or less
  • Minor illness care: within one week
  • Travel time to doctor's office: 30 minutes or less

Emphasizing the president's Patient Bill of Rights, TRICARE targeted wider use of medical specialists as primary care managers and ensured providers disclosed all health care information to their patients. The report emphasized the availability of preventive services, including eye exams, immunizations, hearing tests, mammograms, pap tests and prostate exams. The report shows higher patient satisfaction in such areas as thoroughness of exams and treatment, accurate diagnoses, provider skill and outcome of care.

TRICARE soon will begin delivering Prime care to active duty service members serving in remote locations; established a demonstration project to deliver health care to beneficiaries over the age of 65; and reduced out-of-pocket costs for patients getting care at non-military facilities. Enrollment costs for retirees didn't change nor are they expected to.

TRICARE has been able to maintain stable enrollment fees for retired participants since the plan's inception in 1995. Even though the average cost of enrolling in health maintenance organizations nationwide is expected to rise 7 to 11 percent in 2000, TRICARE has maintained its annual fee of $230 for individuals and $460 for retiree families.

The report does list some areas of concern voiced by the largest patient population under TRICARE, active duty enlistees. Soldiers, sailors, airmen and Marines asked medical enlisted advisers to:

  • Make sure access standards are met system-wide. Patients are less satisfied with their access to health care in newer TRICARE regions, the Northeast, for example. And access standards aren't always met at remote locations and where bases have closed. The report doesn't delineate what's being done to fix these issues, but TRICARE officials said they are working on them and that start-up problems have been similar across the country but have been worked out as regions matured.
  • Make health care information easier to understand. The report sites several initiatives TRICARE and the individual services have taken to simplify health care information. These include "TRICARE Made Simple," a booklet printed in English and Spanish that was widely circulated this year; "Navigating TRICARE," a new Navy and Marine Corps pamphlet; and new videotapes on TRICARE Europe and the National Mail Order Pharmacy Program.
  • Drop annual re-enrollment requirements. Annual re- enrollment became automatic this year. Beneficiaries now receive a notice in the mail that they've been automatically re- enrolled. They are then given the option to cancel their membership.
  • Add doctors to the TRICARE network. According to the stakeholders' report, TRICARE beneficiaries represent 3 percent of the U.S. patient population, but the provider network includes nearly 20 percent of U.S. physicians and 40 percent of U.S. hospitals. TRICARE's task, the report indicates, is to continue making sure networks are large enough to meet beneficiary needs.
  • Speed claims processing and stop creditors from pursuing our people. The report doesn't say it, but TRICARE has scrambled to correct a host of problems with claims for reimbursement from network providers. It's a big task. TRICARE processes more than 27 million claims a year, the report states. Nationally, 92 percent of all TRICARE claims are processed in 30 days and 98 percent in 60 days, according to the report.

    Despite these irritants, satisfaction levels have risen across the gamut of TRICARE services, the report indicates. As a result, 92 percent of people enrolled in TRICARE said they would re-enroll if they were given the option.

    The report points out what military medicine used to be like, when it focused only on treating illness, with little emphasis on preventing it. Or, when you needed an appointment and had to call first thing in the morning or on the first morning of the month. And when there were no access standards; if the base hospital or clinic couldn't provide the care you needed, you were sent downtown to find health care on your own.

    Officials aren't smug about TRICARE's progress however, stating at the end of the report, "We still have a lot to do."

    The entire report can be found in PDF format on the Internet at www.tricare.osd.mil. To read it on line, you'll need the free Adobe Acrobat document reader, available at http://www.adobe.com/prodindex/acrobat/readstep.html.

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