TRICARE Gets a Grade

February 26, 2016

This has been a busy week for the Military Health System (MHS) on Capitol Hill. It isn't a secret Congress is intently focused on reforming the MHS, including the TRICARE program, and held several hearings this week on that topic. 

MOAA and The Military Coalition submitted written testimony for these hearings, stressing the need for system improvements, and not just fee increases for beneficiaries. Particular areas of concern include:

  • Unresponsive TRICARE Prime appointment and referral systems
  • Lower patient loads of military vs. civilian providers
  • Outdated payment systems for pediatric care
  • Wellness and case management program shortfalls
  • Inconsistent/inadequate coverage for Reserve Component beneficiaries

At a Senate Armed Services Personnel Subcommittee hearing Tuesday, Chairman Lindsey Graham (R-S.C.) said, “…we need to learn how we can redesign an outdated 20th Century health care system that's become unsustainable and does not work as well as it should for service men and women and their families.”

Just how outdated is the system? That was addressed by a panel of witnesses from the civilian health care industry, and was followed by a panel of MHS leadership, including the service Surgeons General.

The first panel focused on positive trends within civilian health care, which the witnesses said is becoming much more consumer-driven.

Provider performance has become more transparent to a more discerning consumer, with access becoming a key measure of system performance. Access to care was highlighted as what sets a first-class system apart from the rest.

Civilian health care industry leaders also discussed how payments to providers are changing - rapidly. More civilian health organizations are basing their payments to doctors, hospitals, and other providers on value and quality outcomes, rather than simply paying a set fee for each patient visit. In other words, civilian payment systems are focused more and more on rewarding superior system performance and penalizing underperforming providers - doctors whose patients don't recover as well, or hospitals with higher-than-normal readmission or infection rates, for example.

The second panel of defense and service medical leaders discussed the current state of the MHS. While described as providing excellent operational and superior survival rates for battlefield injuries, the MHS struggles with providing consistent peacetime beneficiary care.

They acknowledged their own internal surveys show the MHS is fragmented, administratively cumbersome, and plagued by difficulties in accessing care.

From access to military hospitals to the design of the TRICARE network contracts, the system has not kept up with modern practices. The surgeons general acknowledged these issues and vowed to make changes. Success depends on improving access to care, as well as better aligning the readiness mission with beneficiary care.

“I think TRICARE as its design is really antiquated. I wouldn't give it a B,” said Sen. Graham. “…we're going to look at TRICARE and turn it upside down and make it more transparent and make it more accountable...”

MOAA will work with Congress in the coming months in our ongoing efforts to improve access and other problem areas while doing our best to protect against imposing disproportionate fee increases.

“We're pleased Congress seems serious about improving care delivery and healthy outcomes for military beneficiaries, and is digging deeper than just fee hikes,” said MOAA Deputy Director of Government Relations, Capt. Kathy Beasley, USN (Ret).



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