Research for Tricare

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.

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.

The Assistant Chief for Health Care Operations (BUMED 03) asked CNA to develop a method that Navy medicine can use to determine whether it is meeting Tricare access standards, especially for scheduling appointments. The report found that the Composite Health Care System (CHCS) currently gives local military medicine providers the ability to track patient access to care, but that many providers are grappling with the same concerns and issues. To reduce redundancy, the report recommends that Navy medicine adopt standard guidelines for appointing and tracking access based on the experience of the facilities pioneering Tricare. It specifically recommends that Navy medicine develop system-wide appointing guidelines that increase the use of central appointing, standardize appointment types, make specialty referrals electronic, and develop specialty referral guidelines.

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.