TRICARE Opens Doors to Health Care
By Douglas J. Gillert
American Forces Press Service
TACOMA, Wash., April 25, 1996 "I'm sorry, ma'am, all pediatrics appointments for the month have been filled. Please call back on the first Tuesday of next month, between 7:30 and 10 a.m. ..."
Frustrating messages like this should disappear under TRICARE, DoD's managed health care plan. TRICARE, said officials, will dramatically increase patients' access to health care.
How access will improve is being demonstrated in the northwestern United States, where TRICARE Region 11 began operating last spring. Here, a combination of military treatment facilities and a civilian managed care organization provide health care to 400,000 service members and retirees and their families.
By summer 1997, the schedule calls for 12 regions to be directing military health care nationwide. Managed care programs also are slated for U.S. service members and their families overseas.
"TRICARE has allowed us to fill the gaps and inconsistencies in our health care delivery system and standardize the benefit throughout the region," said Army Dr. (Brig. Gen.) George J. Brown, who commands Madigan Army Medical Center here and oversees Region 11 TRICARE. TRICARE support contracts will vary from region to region, but the basic services won't change, said Brown, and Region 11 patients are learning TRICARE provides fast appointments, indepth health care information and a wide choice of services.
Full benefit from these services comes only with enrollment in Prime, the TRICARE health maintenance organization option.
All active duty members are enrolled in TRICARE Prime; families of active duty members who choose to enroll in TRICARE Prime pay no enrollment fees. Military retirees under age 65 who enroll pay an annual fee. All Medicareeligible DoD beneficiaries and CHAMPUSeligible beneficiaries who elect not to enroll in TRICARE Prime remain eligible for care in military medical facilities on a spaceavailable basis.
Every region will offer similar access standards, said Dr. (Col.) Paul Evans, family practice director at Madigan: within 24 hours for urgent (nonemergency) care, within seven days for routine care and within 30 days for wellness care (health maintenance appointments). And while some procedures may differ, he said, Region 11 offers a good overview of how TRICARE will operate everywhere.
Health professionals and benefits counselors at eight service centers provide information and enrollment assistance in the region. These staff help CHAMPUSeligible patients with their health care needs, answer any questions about TRICARE, enroll new Prime members and assist persons transferring from other regions.
"Many people don't realize they have to disenroll from one region before they can enroll in another," said Alice Acker, field coordination manager of the TRICARE service center in Silverdale, Wash. "Because of the difference in contracts, the procedures may be different, so it's a good idea they come by here before they seek health care services."
To help people determine the level of care they need, the region offers free phonein health care advice. "We're running about 4,000 calls a month," said Larry Naehr, director of Foundation Health Federal Services, which operates the Region 11 managed care support contract.
Callers can talk to personal health advisers registered nurses who help them decide if they need to see doctors right away or if they can take care of the problem. At the same number, an audio library provides information on hundreds of health topics.
"My wife uses the nurse advisory line regularly," said Air Force Master Sgt. Randy Parkin, first sergeant of the 62nd Civil Engineering Squadron at McChord Air Force Base. "The service is prompt and courteous. One of the advisers even called back to see how she was doing."
Another phonein service connects callers with a health care finder. Usually registered nurses, finders work out of TRICARE service centers. They are Foundation Health employees.
"We help people find the care they need, any time of the day or night," said Judy Bunce, who works at the Madigan service center. At least one finder in the region is always oncall after normal duty hours and takes calls at home.
Health care finders help callers obtain specialty care referrals, nonavailability statements for TRICARE Standard care and emergency access to health care for persons traveling outside their home TRICARE region. "In addition," Bunce said, "we often just offer them reassurance.
"Some callers are really distraught," she said, "so we calm them down. Once they understand they're talking to a trained health care professional, they begin to relax and know they're going to get the help they need, and we can point them in the right direction. They're especially pleased when we call them back in a few days to see how they're doing."
Yet another phone call connects people to the region "nerve center" the TRICARE Regional Appointment Center in downtown Tacoma. Here, 50 operators answer nearly 60,000 calls a month from people seeking access to the health care system.
The center's tollfree number is printed on plastic cards TRICARE Prime enrollees receive. In addition, direct access telephones clearly labeled "TRICARE Appointments" are located in central areas of military treatment facilities.
"We book appointments for the six military facilities in the western Puget Sound area," said Ann Saunders, center director. This includes Madigan, Bremerton Naval Medical Center, McChord and three other naval facilities at Oak Harbor, Everett and Bangor, Wash.
The center operates 11 hours daily and books appointments for anyone with access to a military facility. An automated call distribution system commonly used by large customerservice organizations to route calls enables them to handle the daily traffic.
Since the center is connected to DoD's Composite Health Care System a central data base of worldwide patient information operators can update callers' personal data such as home addresses and telephone numbers. The defense eligibility enrollment reporting system data base shows eligibility for military health care, and a Foundation Health data base indicates TRICARE status.
After confirming the caller's TRICARE enrollment, Saunders said, the operator can book the appointment. If necessary, she can put the caller on hold and use another line to contact the clinic for appointment options before finalizing the transaction.
"The average length of a call from connection to confirmed appointment is three minutes," Saunders said.
"That's a little longer than I'd like it to take," said Spc. Mark Cleveland, "but it sure beats not getting an appointment at all. With TRICARE, I know my family and I can get in to see a doctor when we need to."
Foundation Health's Naehr said other regions have taken note of Region 11's processes. "As the first region up, we've pioneered TRICARE, so naturally, there's an interest in how we work," he said. At least one Region 12 in Hawaii asked how to put together a similar central appointment center, Naehr said. And Regions 1 (Northeast), 2 (Virginia and North Carolina) and 5 (East Central) expressed interest.
"The lessons we've learned can and will impact other regional contracts," Naehr said. "TRICARE is a young program that will go through many adjustments and refinements as it expands across the nation."