Research for Medical Services

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The MHS Optimization Project: Estimating the Potential for Recapturing CHAMPUS Workload in the MHS
September 1, 2001
This annotated briefing reports the results of a study for the Office of the Assistant Secretary of Defense for Health Affairs (OASD/HA) and the TRICARE Management Activity (TMA) on the Optimization Plan of the Military Health System (MHS). The plan is designed to make the MHS more efficient as well as to increase the overall health of DOD beneficiaries. Our main goal is to determine the link between optimization and several measures of system efficiency. We explore how greater efficiency can increase system capacity so that current workload that is going to the managed care support contractors (MCSCs) can come back into the MTFs). This "recapture" of CHAMPUS workload is the main focus of this study. We examine recapture in several ways: by the military's medical treatment facilities (MTFs) providing more of the inpatient (IP) workload (the overnight stays that go "downtown") and more of the outpatient (OP) visits that today might go to civilian providers. Some of the workload may be part of the Prime network of civilian providers that the MCSCs have set up for DOD beneficiaries, but the majority is for non-network services for which DOD ultimately pays. For both IP and OP workload, we examine whether MTF physicians can provide more of these services and compare the "complexity" of the work with that provided by civilian providers. Lastly, we examine the demand for services, by measuring the demand rates of DOD beneficiaries and how well that demand is managed by local MTFs.
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Provision and Use of Navy Medicine Primary Care: Empirical Background for Optimization
August 1, 2001
The purpose of this research memorandum is to report and comment on the findings of an analysis of Navy Medicine Primary Care (NMPC) to members of the Primary Care Product Line (PCPL) Advisory Board (the Board) and to the Bureau of Medicine and Surgery (BUMED). This report is part of the support that CNA is providing to the product line. It analyzes Ambulatory Data System (ADS) records of visits made to Navy Medical Treatment Facilities (MTFs) during FY 2000, as well as data from two Department of Defense (DOD) surveys that provide information on the satisfaction of users of NMPC. Its intent is to provide empirical information as background to the Board's and BUMED's optimization activities. In this report, we describe what NMPC is, based on what primary care providers (PCPs) do in Navy MTF primary care (PC) settings, and identify how and to what extent the content and nature of NMPC varies by provider and setting. This approaches NMPC from the supply side - what care is provided by whom, and where. Its focus is not on how much care is provided (e.g., number of visits) but rather on the nature and distribution of that care (e.g., percentage of visits by clinical content and provider type).
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Patterns of Ambulatory Mental Health Care in Navy Clinics
June 1, 2001
The purpose of this paper is to describe ambulatory mental health care in Navy clinics We examined outpatient mental health visits in terms of absolute numbers, focusing on patient characteristics, clinic characteristics, and visit characteristics. We use absolute numbers instead of rates because Navy Medicine does not know definitively for how many beneficiaries it is responsible for providing care. This research provides the membership of Navy Medicine's Mental Health Executive Board with a picture of recent military beneficiary use of mental health services at Navy clinics. This analysis is for use by the Mental Health Executive Board to inform its decisions regarding the Navy's provision of mental and behavioral health services.
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Evaluation of Access and Quality of Health Care Under the TRICARE Program (FY 2000 Report to Congress)
May 1, 2001
CRM D0003492.A1/Final The FY 2000 Evaluation of the TRICARE Program was performed jointly by the CNA Corporation and the Institute for Defense Analyses (IDA) for the Office of the Assistant Secretary of Defense (Health Affairs). The objectives of the evaluation were to assess (1) the effectiveness of the TRICARE program in improving beneficiaries' access to health care, (2) the impact of TRICARE on the quality of health care received by Military Health System (MHS) beneficiaries, and (3) the effect of TRICARE on health care costs to both the government and MHS beneficiaries. This documents represents the Center for Naval Analyses' contribution of the Evaluation of the TRICARE Program, FY 2000 Report to Congress. The full report also included IDA's evaluation of the costs to the government and beneficiaries. The TRICARE evaluation project is an ongoing effort that provides an annual report to the Congress as the program matures.
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Tricare and Mental Health: Providing the Benefit
September 1, 2000
Navy medicine has identified mental health as one of the major product areas in which it wants to develop a business strategy that supports the effective and efficient provision of these services to the military health system's beneficiaries. To develop this strategy, the Navy Bureau of Medicine has established a mental health product line executive panel. It's members include both medical and non-medical Navy and Marine Corps personnel, reflecting the Navy's diverse mental/behavioral health resources. Among the many tasks facing the panel is establishing a comprehensive baseline understanding of mental/behavioral health care services as they currently exist in the Navy and Marine Corps communities. Our purpose in this document is to provide an overview of the regional TRICARE mental health care delivery systems and to identify issues requiring further investigation, thought, and analysis during the course of the executive panel's proceedings. This annotated briefing represents the first in a series of research documents that we will be preparing for the working group during the next several months.
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The Implications of Universal Enrollment for the DOD Health Care System
June 1, 2000
The TRICARE program is designed to provide for the health care needs of those on active duty, their family members, and retirees and their family members. TRICARE is a complicated health care system with several different parts. One key component is Prime, the managed care portion of the Defense Health Plan (DHP). One must enroll in Prime in order to receive care under it; however, other options for receiving care do not require enrollment. This study responds to tasking from the Under Secretary of Defense (USD) for Personnel and Readiness concerning the feasibility of an enrollment system for the DHP. Under Prime, enrollment is a requirement for receiving care. In a limited sense, enrollment is not only possible but currently under way. We believe, however, that the more important question and one posed under the tasking is whether universal enrollment is feasible. As we'll show, Prime pertains to a relatively important and growing part of the beneficiary population that relies on military treatment facilities (MTF)-military clinics and hospitals-for health care. The other user of the MTFs rely on space-available care. These people don't have to enroll to use military healthcare providers or facilities; they use the NTFs for care when there is sufficient capacity.
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Medicare Risk HMO Withdrawals: Implications for Medicare Subvention
May 1, 2000
The Department of Defense (DOD) is working with the Department of Health and Human Services (DHHS) to develop for its Medicare-eligible beneficiaries a cost-effective alternative for delivering access to quality care. This alternative, commonly called TRICARE Senior Prime, will give Medicare-eligible beneficiaries the opportunity to enroll in Prime with primary care managers (PCMs) at military treatment facilities (MTFs). TRICARE Senior Prime enrollees will have the same priority access to MTF as military retirees and retiree family members currently enrolled in Prime. At present, this program is in the demonstration phase. DOD should be concerned that many managed care plans have either withdrawn from the Medicare-Choice program entirely or reduced their service areas in the last several years as the Medicare-Choice plan has been phased in. The purpose of this report is to determine what factors have played a part in these withdrawals and how this could affect the viability of the TRICARE Senior Prime program.
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The DOD Health Care Benefit: How Does it Compare to FEHBP and Other Plans?
May 1, 2000
CNA was tasked by the Under Secretary of Defense for Personnel and Readiness to examine the DOD health care benefit. The basic idea is to examine what exactly the benefit provides and compare it to what other employers provide-especially the federal government through its health care plan and private employers through their plans. Our approach was to compare the benefits offered under the Defense Health Plan (DHP) to the Federal Employees Health Benefits Program (FEHBP) both from the point of view of the employer, who cares what it will cost and how attractive it will be relative to what other employers provide, and to the employee, who then places a "value" on the benefits provided. The cost of the program to DOD is examined with some simple comparisons of total cost and cost per user. The main focus, however, was to compare not only the health care benefit provided to active duty personnel, but all of the benefits provided with what the federal government and private employers provide to their workers. It's not just the absolute level of one specific benefit that matters, but how the total compensation that includes all benefits compare with what's offered elsewhere.
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Pharmacy Options For DOD Medicare-Eligible Retirees
February 1, 2000
The Navy's Bureau of Medicine and Surgery asked CNA to examine several alternative pharmacy plans that would extend prescription coverage to the DOD 65+ Medicare-eligible population. The specific pharmacy plans examined fall under three general categories. After paying an enrollment fee, beneficiaries may receive prescriptions (1) through mail order, (2) at the military treatment facility (MTF) or mail order, or (3) at retail pharmacies or through mail order. This research memorandum describes these options and the costs to DOD for each.
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Are the DHP Savings From Utilization Management Achievable ?
March 1, 1999
This annotated briefing examines if Defense Health Program (DHP) savings from Utilization Management (UM) are achievable. We examined the effects of reductitions in the DHP budget associated with efficiencies arising from practicing UM at military medical facilities and clinics. We looked at key measures of efficiency and cost between DHP and the civilian health care market. We also determined how the system would respond to cuts in the budget due to UM efficiencies. Finally, we created a mathematical model that captured the way that money could be saved by practicing UM within DHP. We found that the mandated UM savings are achievable; however, the DHP faces several potentially difficult problems that will make it hard to achieve the intended savings.
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