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TRICARE Delivers Improved Health Care, Director Says

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, Sept. 11, 1998 – Access. Quality. Cost. These are the three guiding principles of TRICARE as Dr. H. James Sears, a former Navy psychiatrist and retired rear admiral, steers the DoD health plan through the rough waters of often- negative opinion.

Like the faithful captain of a new ship, Sears believes the voyage will succeed -- must succeed. Despite challenging swells from critics, his order is "full speed ahead."

"I feel a tremendous urgency to get things done," Sears said. As executive director of the TRICARE Management Activity, he oversees the worldwide DoD program responsible for the health care of some 8 million beneficiaries. Many of these people -- particularly retirees -- see TRICARE's annual costs and per-visit fees as proof of a broken promise of free lifetime health care. Some critics want to scrap the military system in favor of alternative federal or commercial health plans.

Well acquainted with military health care in the past, Sears left a private consulting service in San Diego for TRICARE because of "the assault on military medicine."

"Why do we need this direct health care system [health care provided by military medical staffs in military medical facilities]? Why don't we just contract it out? Why do we need a medical school and graduate education? You hear these questions being raised very prominently," Sears said. "But if we lose the direct care system, we lose the underpinnings we need to sustain a ready force.

"TRICARE is readiness. It is responsible for the fitness of the force. It's also responsible for providing family health care so that when service members deploy, they know their families are going to be well taken care of."

Finally, TRICARE ensures military medics are properly trained, Sears said. "If we don't have a direct care system that trains military medical staffs, we're not going to be able to care for our folks when we go to war or deploy on a humanitarian mission," he said.

Sears' goal is to make military medicine more efficient and, hence, accessible to more people. One of his first priorities is to develop uniform business practices for the day-to-day operation of military treatment facilities. "We can increase the capacity of our facilities and thereby increase access to direct care," he said.

An independent study of TRICARE Region 11 (Washington, Oregon and Northern Idaho) reveals that TRICARE has, indeed, answered the questions concerning access, quality and cost, Sears said. The Center for Naval Analysis and Institute of Defense Analysis chose Region 11 for the study because it has been operating long enough to get a before- and-after picture.

"The study reveals a dramatic, statistically significant increase in access to the system," Sears said. "Maintaining quality was never an issue, but controlling costs certainly was -- and is -- and the study actually shows a slight decrease in costs to the government.

"If those indicators continue throughout the system, we're doing what every health plan would die to do -- improve access, maintain high quality and not increase costs. You can't do better than that."

As other TRICARE regions mature, they, too, will come under the same scrutiny. Meanwhile, customer satisfaction surveys across the system reveal incremental improvements in nearly every area of military health care over the past three years, Sears said. Such satisfaction, he said, is vital to TRICARE's success.

"For our active duty force, where retention and deployments are major issues, they've got to be very satisfied with their health care or they're not going to stay in the service," he said.

The difficulty lies in convincing people TRICARE is a good deal, Sears said. "We've suffered the public backlash against health maintenance organizations, but when you look at the benefit closely, we've made tremendous improvements in military health care."

Sears recalls how difficult it used to be to get an appointment. "We now get complaints if the phone doesn't answer in two minutes," he said. "I remember when nobody answered or when the phone was always busy. Or when, if you needed a specialty appointment and didn't call on the first day of the month, you had to wait until the next month. That doesn't happen anymore."

Even patient costs are lower when they do have to get care from a civilian provider, he said. "Under CHAMPUS, they had to pay a deductible, and co-payments were higher than under TRICARE Prime. Retirees used to have to pay the first $150 of health care under CHAMPUS. Now, they pay $230 a year with no deductible. And instead of paying 25 percent of costs per visit, they pay a flat rate of $12 a visit."

Supplementing direct care with a civilian network also enhances military care, he said. "In the old days, you either went to the military treatment facility or you went into town, and there was no connection. The folks in the military facility often didn't even know the docs in town. Today, there is greater and greater familiarity, and the systems mesh more and more.

"What that does is give the patients a more comprehensive health care system. They now have an automatic flow to a qualified, credentialed specialist. They don't have to go back home, look in a telephone book and figure out who to go to.

"TRICARE is maturing. We need to stabilize it, but if you look across the country, it's working well. It may not be working as smoothly as we'd like, but it's dramatically better. The changes we are trying to make in the system will do nothing but increase our ability to deliver quality health care."

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