Research for MTF
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.
Read More
| Download Report
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).
Read More
| Download Report
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.
Read More
| Download Report
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.
Read More
| Download Report
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.
Read More
| Download Report
January 1, 1998
This CNA annotated briefing (CAB) summarizes findings and recommendations for medical play in KERNEL BLITZ '97, an amphibious exercise held in June-July 1997. The project was sponsored by the CINCPACFLT Surgeon.
Read More
| Download Report
October 1, 1996
In the future, medical support for Naval Expeditionary Forces will face different and perhaps more difficult challenges. Under traditional doctrine, medical support relies heavily on placing its assets on the beach, after an initial buildup of forces clears the area of enemy threats. In future operations, however, under the Operational Maneuver From the Sea Concept, there will often be no buildup of forces at a beach landing site. The warfighters will operate with great force and at a pace that allows them to dictate the terms of the conflict. They will act decisively, at multiple locations if called for, over large distances, keeping the enemy reactive and ineffective by applying strengths to enemy weaknesses. Small units will move independently, exploiting weaknesses that could not have been predicted before battle. This research memorandum addresses two questions: What are Navy medicine's alternatives for handling the greater need for information and communication in the new battle environment? And What are Navy medicine's minimum information and communication requirements for doing its job in such taxing conditions?
Read More
| Download Report
March 1, 1996
As medical care in the civilian sector is moving toward managed care, so it is in the military. The Office of the Secretary of Defense (Health Affairs) has sponsored a series of demonstration projects - limited implementations of health care management programs. One such program is TriCare, in the Tidewater area of Virginia. The project, which began in late 1992, was to have two major changes in the financing and delivery of health care. The program included three options for beneficiaries: Prime (an HMO), Extra (a preferred provider organization) and Standard (the standard CHAMPUS) option. The purpose of this research memorandum is to present the findings from our analysis of changes in the levels of access and satisfaction with military-sponsored medical care. The analysis is based on data we collected for an evaluation of the TriCare demonstrations project in Tidewater, Virginia.
Read More
| Download Report
January 1, 1996
There are basically two different approaches to determining requirements of staffing a primary-care-based system. Both approaches have their strengths and weaknesses, but we found that the optimization model, although technically feasible from a modeling point of view, wasn't an approach we could follow and complete. The primary disadvantages concern the need for certain kinds of data. To determine who should staff a primary care system and how generalists and specialists substitute for each other, you need to carefully define who can do what. We used HMO staffing ratios for a large number of medical subspecialities. After applying these ratios to Navy beneficiary populations at 22 U.S. naval hospitals and nine overseas naval hospitals, we derived the kinds of staffing that would be observed had the HMO provided care for these beneficiaries.
Read More
| Download Report
October 1, 1995
The military and civilian health care systems, while distinctly different, share some concerns. These common concerns include the overutilization of inpatient care and the rising cost of medical care. Overutilization is of concern in the private sector for a number of reasons. First, insurance reduces the sensitivity of individuals to health care costs. As a result, people may use too much medical care. Cost sharing and cost containment programs tend to reduce this problem. Second, doctors may increase the use of medical services to increase their own profits and to shelter themselves from malpractice suits (i.e., defensive medicine). Cost containment programs - like concurrent review - help to reduce this incentive. Overutilization is also a concern in the military sector. Like the civilian sector, beneficiaries may use too much health care because insurance reduces the cost of care. In addition, the Department of Defense historically allocated resources to hospitals on the basis of past need. As a result, hospital commander had no financial incentive to curtain hospitalizations. This paper, which is part of a CNA self-initiated study, compares the inpatient use of nine military catchment areas to the civilian sector. The variables we study include: gender- and age-adjusted inpatient admission rate, and case-mix-adjusted length of inpatient hospital stay. Length of stay measures the intensity of treatment once a patient enters the hospital. The inpatient admission rate measures the likelihood of entering the h
Read More
| Download Report
Follow CNA on
© 2013 CNA. All Rights Reserved.
4825 Mark Center Drive, Alexandria, VA 22311 | 703.824.2000 | Directions | Site Map