Benefit Gains Have Turned TRICARE Reformers Toward Smoother Service
February 8, 2001Military leaders and defense health officials locked arms two years ago to rescue a mismanaged and chronically under-funded military health care system, which was hurting morale and perhaps readiness.
The alliance between the Joint Chiefs and TRICARE officials has resulted in successes. For example, it was at least partially responsible for Congress approving last fall the biggest increase in military medical benefits in more than 30 years. The partnership had a bigger role in a recent sharp drop in complaints, from both patients and health care providers, over access to care and claim processing delays.
That alliance, senior defense officials said, is turning its attention now to a $1.4 billion health budget shortfall for the current year, and to reorganizing TRICARE networks and support contracts to reduce hassles for patients and improve efficiency.
Defense officials credit Army Gen. Henry ``Hugh'' Shelton, chairman of the Joint Chiefs, for keeping high-level attention on health care. He shifted the focus there in 1999 after helping to secure impressive military pay and retirement gains from the administration and Congress.
Shelton soon had plenty of company, not only four-star colleagues but military associations, which led the charge for health care reform for years, and a groundswell of individual retirees, angry over broken health care promises.
When Shelton's public and private advocacy for health benefit reform failed to win the support he wanted from the Clinton White House, particularly for disenfranchised elderly retirees, spouses and survivors, Congress took up the cause. Military leaders and TRICARE officials still sound surprised by the richness of benefit gains passed in 2000.
For active duty families, they include an end to co-payments, of $6 and $12 per doctor visit when enrolled in TRICARE Prime, the managed care program. This change will take effect April 28 but, in some regions, co-payments will continue to be collected for additional months. These patients later will be reimbursed for paying the co-pays.
On Oct. 1, TRICARE Prime remote benefits will be extended to the families of 80,000 service members assigned 50 miles or more from the nearest military base. Only service members themselves in remote areas have the fuller health benefit now.
About 1.4 million elderly beneficiaries will become eligible April 1 for the same of pharmacy drug options as younger retirees. On Oct. 1, when TRICARE for Life begins, military beneficiaries enrolled in Medicare Part B, will be able to use TRICARE as a second payer to Medicare. Many elderly will be able, in time, to drop medigap insurance plans.
Given the richness of the new benefits, defense officials sound satisfied that health promises to older retirees are being kept. ``Go out and look at benefits around the world and, I'll tell you what…this is a first-class benefit,'' said a senior official.
For almost two years, Defense health officials and representatives of the Joint Staff have worked together on easing irritants under TRICARE for patients and providers through better business practices. Officials announced, at the annual TRICARE conference last month, that the number of TRICARE claims delayed more than 60 days fell sharply, from more than 30,000 in December 1999 to less than 1000 a year later. The number of claims over that are more than 120 days old fell from 1493 in December 1999 to 18 a year later.
The Defense Department this year is required to conduct its second Quadrennial Defense Review, an intense effort to review strategy, determine proper force structure, and argue that enough dollars be earmarked in future budgets. One Defense official said Shelton sparked a kind of ``mini-QDR,'' but for military medicine two years ago. And it continues.
Besides adopting better business practices, Defense officials are moving to fully fund health care budgets, which were chronically under-funded during the Clinton years. The Defense Medical Oversight Committee has the lead.
DMOC was formed in the wake of complaints from the Joint Chiefs about TRICARE. Rudy de Leon, then under secretary of defense for personnel and readiness, believed military leaders needed to understand the true costs of health care while pressing for change. As a result, the service vice chiefs and under secretaries of each service are full participants in DMOC, with one of the vice chiefs serving as co-chair on a rotating basis.
DMOC currently is studying the structure of TRICARE and its regions, weighing organizational alternatives including whether a single contractors should handle all claims processing or all pharmacy networks across regions, so that users see more of a consistency of service and benefits no matter where assigned.
Another big concern is closing a $1.4 billion gap in the medical budget for this fiscal year. DMOC, said one senior official, ``has brought the medical funding issue to life like it's never been before.'' So when debating budgets, the service vice chiefs ``have already got the medical piece locked and cocked in their minds.''
For the DMOC, the Army vice chief is heading up a study on TRICARE organization, the Marine Corps is studying procurement strategy for the system, and the Air Force vice is looking at the strategic business plan.
``Are the contracts set up right within a region. Should we have one contract? Should we have 100,'' asked a Defense official. ``If they were in civilian health care delivery, how would they structure this system…We tried to structure it militarily, in the past. That may be totally wrong.''
``About the end of March,'' he added, ``the DMOC is supposed to have some plan for the road ahead.''
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PRESS RELEASE
January 28, 2002
Congressman Shows Announces "Tricare Town Meetings"
Military Retirees can question officials about military health care
(Washington) - Congressman Ronnie Shows (MS-04) announced today that he will participate in three "Tricare Town Meetings" on February 18th and 19th in Ellisville, Jackson and Summit, MS. These meetings are open to the public, and free of charge. They will allow people with questions or complaints about military health care to get answers from Defense Department Agency officials who are in charge of military health care.
These forums have been initiated by the Tricare Management Activity (TMA) office of the Department of Defense. Congressman Shows and officials from the Defense Department, the TMA and Humana will participate in these question-and-answer sessions.
On Monday, February 18, there will be "Tricare Town Meetings" at Jones County Junior College in Ellisville from 10:00 to 11:30 a.m., and at the Jackson Medical Mall Auditorium from 3:00 to 4:30 p.m. On Tuesday, February 19, an additional meeting will be held in the Fine Arts Auditorium at Southwest Mississippi Community College in Summit from 1:00 to 2:30 p.m.
"All military retirees should get the health care they were promised, but Tricare just isn't working for many retirees, especially those who live in rural areas like Mississippi," said Congressman Shows. "One of my top priorities is making sure that military retirees receive the high standard of health care they were promised when they entered the service.
"In March 1999 I attended a Military Retiree Summit in Laurel organized by Laurel resident, Jim Whittington, and Floyd Sears of Ocean Springs. After hearing about this problem from over 400 military retirees at that meeting, I introduced a bill to fix the military retiree health care mess, " said Congressman Shows.
"My bill - The Keep Our Promise to America's Military Retirees Act - led to the implementation of Tricare-for-Life. From now on, Tricare will act as a second payer for military retirees who qualify for Medicare, and those retirees now qualify for the generous Tricare pharmacy benefit."
"Unfortunately," said Congressman Shows, "I have heard from many military retirees who do not yet qualify for Medicare, and they are still having problems with Tricare. Some have difficulty getting medical appointments at military bases. Many who don't live near bases have trouble finding a doctor that will accept Tricare. Others have had difficulty with their claim filing, processing, or reimbursements.
"Needless to say, this is wrong," continued Congressman Shows. "To fix this problem I have introduced a bill that would allow any military retiree to elect coverage by the Federal Employee Health Benefit Plan (FEHBP), the same plan offered to federal retirees and Members of Congress. If Tricare isn't serving them, they need more choices, such as FEHBP.
"I am happy to take part in these 'Tricare Town Meetings.' I want military retirees to go to the top with their concerns, and tell the folks from Tricare. If they can fix the system, then everybody wins. That is what I want," said Congressman Shows. "And this what Jim Whittington and Floyd Sears want, too. I am pleased that we will be at these meetings to make sure that the folks from Tricare answer each of the retiree's questions."
Ronnie Shows represents the 4th Congressional District of Mississippi in the United States Congress. He may be contacted by writing to: 1408 Longworth House Office Building, Washington, DC 20515, or by calling his Jackson Office at 601-352-1355 or Washington Office at 202-225-5865. Congressman Shows can also be contacted on the World Wide Web at:
http://www.house.gov/shows