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TRICARE Report Card: High Marks, Room for Improvement

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, April 10, 1996 – Thousands more than expected have signed up for TRICARE Prime, the top option under DoD's new managed health care program. This comes under the "good news, bad news" category for DoD officials. It was good so many wanted to participate, but it slowed processing procedures.

In the first few months of enrollment in the Pacific Northwest's Region 11, the first of 12 TRICARE regions to begin operations, enrollment surpassed what was expected the first year.

"That caused some administrative delays that frustrated some enrollees," said Dr. Stephen Joseph, assistant secretary of defense for health affairs. "Then the same thing occurred in Region 6 [Arkansas, Louisiana, Oklahoma and Texas].

"These were growing pains," Joseph said. "Once we realized the popularity of TRICARE Prime, we were able to adjust. On a scale of 10, I give TRICARE an 8."

Of course, Joseph wants, and anticipates, higher scores as the program develops and expands to all regions, including Europe -- where a modified version of TRICARE aided the Bosnia deployment -- and the Pacific.

DoD began TRICARE to counteract rising health care costs and the impact of base closures and fewer military hospitals. Active duty members and their families, non-Medicare eligible retirees and their families, and survivors qualify.

TRICARE is a managed care health plan formed through a partnership of military medics with civilian contractors. Besides cutting costs, it was designed to improve access to care, quality of care and medical readiness.

Three levels of care are available as enrollment options:

o Prime -- Similar to a civilian health maintenance organization that serves as a central source for all health needs. All active duty service members will be enrolled in Prime and receive most of their health care from military medics. Active duty personnel and their families enroll at no charge; retirees pay an annual fee of $230 or $460 per family.

o Extra -- No enrollment. People using this option can choose any health-care provider. If they use an authorized network provider, they receive a 5 percent discount from TRICARE Standard cost shares after paying the annual CHAMPUS deductible.

o Standard -- New name for standard CHAMPUS. Users pay CHAMPUS deductibles and cost shares and abide by CHAMPUS rules.

Joseph said he hopes everyone will see the benefit of selecting the Prime option.

"In my mind, the greatest reason for enrolling in Prime is the $11-per-day cost for hospitalization," he said. He compared that to $25 or more a day for active duty members and their families admitted to civilian hospitals, and up to $330 retirees have to pay under TRICARE Standard and CHAMPUS rules.

Joseph said he's frustrated, however, by Congress' inaction on allowing Medicare-eligible beneficiaries over the age of 65 to enroll. Under current law, the military cannot be reimbursed by Medicare for care provided the over-65 population.

"We've been fighting this battle a long time, and I respect the patience of that group of people in waiting for congressional action on this. Not allowing them into TRICARE is a big frustration and credibility buster," Joseph said.

Both houses currently are considering changing the law, Joseph said. "Until they change the law, we will continue to treat our over-65 segment on a space-available basis."

Unfortunately, space in military medical facilities could become even scarcer. Some members of Congress have assailed military peacetime health care, saying costs could be cut in half if the services treated active duty members only. But Joseph said there's an undeniable link between treating patients of all ages and health conditions, and meeting the health needs of war fighters.

"American people demand a very high standard of wartime health care," he said. "They expect us to be there right away -- and that's the right expectation. But this requires a highly skilled and practiced medical force.

"We can't recruit and retain good doctors unless we provide them a good practice, and the research and training opportunities available to them in our major regional medical centers.

"We need a broad, robust patient population and health care system that keeps our medics ready for any contingency."

TRICARE also ensures availability of health care even when large numbers of service medics deploy. Joseph cited Operation Joint Endeavor as an example.

"The majority of American service members in Bosnia deployed from units in Europe," he said. "Two years ago, that would have been a disaster, because we had no system in place to provide health care to family members and service members not deployed.

"Because of our success in establishing resource-sharing agreements under European TRICARE, the deployment and backup health care have been seamless," he said.

Resource-sharing impacts stateside TRICARE, as well, Joseph said. For example, he cited an obstetrics shortage at Fairchild Air Force Base in eastern Washington filled by an Army physician from the western part of the state. Regionalizing military health care greatly enhances availability and accessibility for all eligible beneficiaries, he said, and expands the practices of military physicians.

"To survive in the current environment and meet the challenges of future environments," Joseph said, "we must be flexible. TRICARE was designed to meet current needs and what we think future needs will be. As we progress, those needs -- and the needs of our patients -- are going to change."

TRICARE, with its inherent cost-savings and expanded provider base, the assistant secretary said, provides that flexible response.

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