TRICARE 101 TRICARE Management Activity

1
TRICARE 101TRICARE Management Activity
S. Dian Lawhon, MHR, APR Director, Communications
Customer Service 8 May 2003
2
What is TRICARE?

• A Healthcare Program Using Military Healthcare as
  the Main Delivery System

• Augmented by a Civilian Network of Providers and
  Facilities
• Serving our Active Duty, Their Families, and
  Retired Military/Families World Wide

3
Why TRICARE?

• 1980s DoD faced with rising health costs
• 1990s Modernization vs. Infrastructure
• Flat DoD budget, decreasing active duty, medics
• Our beneficiaries still need access
• Makes good business sense
• TRICARE managed care strategy initiated
• Preserve readiness mission
• Increase choice, Improve access
• Control costs

4
TRICARE isthe same as before(CHAMPUS TRICARE
Standard)Plus More(TRICARE Prime, Extra,
TRICARE For Life and TRICARE Plus)TRICARE isa
Better Benefit
5
TRICARE Options

• TRIPLE OPTION
• TRICARE Prime HMO-type Option-Enhanced
  Preventative Benefits (Requires Enrollment and
  Copayments)
• TRICARE Extra PPO-type (Deductibles and Cost
  Shares)
• TRICARE Standard Fee For Service type
  (Deductibles and Cost Shares)

6
(No Transcript)
7
40 of U.S. HospitalsParticipate in the
TRICARE Network
Over 1 in 4 U.S. PhysiciansParticipate in
theTRICARE Network
40
30
Out of 5,000 U.S. Hospitals2,000 are in the
TRICARE Network
Out of 690,000 U.S. Physicians 207,000 are in the
TRICARE Network
40 of U.S. DentistsParticipate in the TRICARE
Network
40
Out of 130,000 U.S. Dentists 51,000 are in the
TRICARE Network
8
MHS Beneficiary Populationby Beneficiary Category
Source MHS Mart (M2), Population Summary File
for March 2002, extracted 15 May 2002.
9
(No Transcript)
10
TRICARE Goals

• Improve Medical Readiness
• Improve Access
• Maintain High Quality
• Contain Costs

11
TRICARE Prime Preventive Services

• Comprehensive Health Promotion and Disease
  Prevention Examinations
• Targeted Health Promotion and Disease Prevention
  Examinations
• Breast Cancer
• Cancer of the Female Reproductive Organs
• Testicular Cancer
• Prostate Cancer
• Colorectal Cancer
• Thyroid Cancer
• Infectious Diseases
• Cardiovascular Diseases
• Immunizations

12

TRICARE PrimeA Superb Health Benefit

• Prescription Drugs
• Mail Order Discount Plan
• Vision Benefits
• Mammography
• Mental Health
• Dental
• Skilled Nursing Facility
• Home Health Care

Superior to Most Civilian Health Plans
13
TRICARE Pharmacy Program

• Eligibility
• AD, Retirees and their families and RC members
  and their families when ordered to active duty
  for more than 30 consecutive days
• Four options for filling prescriptions
• Military treatment facility pharmacy
• National Mail Order Pharmacy
• Retail Network Pharmacy
• Retail Non-network Pharmacy

14
TRICARE Dental Coverage

• The TDP covers a wide range of diagnostic,
  preventive and restorative servicesdental
  X-rays, examinations, cleaning, fluoride
  applications, sealants, fillings, root canals,
  crowns, etc.
• Benefit package includes general anesthesia
  coverage when provided in connection with a
  covered benefit. Dentists or other professional
  providers must be licensed and approved to
  provide anesthesia in the state where the service
  is rendered.
• Maximum annual benefit coverage is 1,200 for all
  routine dental care. The maximum lifetime
  orthodontic benefit coverage is 1,500.
• Enlisted members in pay grades E-1 to E-4 have
  reduced cost-shares for certain procedures.

15
(No Transcript)
16
(No Transcript)
17
Patient Satisfaction Survey Results

• Based on data from a mail-out survey of 45,000
  DoD Beneficiaries during 2002
• Satisfaction with Health Plan
• No statistical difference between Active Duty Men
  and Women
• Satisfaction with Health Care
• No statistical difference between Active Duty Men
  and Women
• Satisfaction with Personal Doctor
• Rated Higher by Active Duty Women than by Active
  Duty Men

Results adjusted for factors including Service,
education, health status, race, age and others
that may independently influence ratings
18
Amazing Progressin Claims Processing
TRICARE Claims Over 60 days old
40,000
30,535
30,000
20,000
9,159
10,000
987
73
1,000
8
0
TRICARE Claims Over 120 days old
0
Apr-03
2,000
Dec-99
Jun-00
Dec-00
Jun-01
Dec-01
2,000
1,493
1,500
1,500
1,000
176
18
1,000
200
0
0
0
0
500
Apr-03
Dec-01
Dec-99
Jun-00
Dec-00
Jun-01
Primarily TFL aged claims, the result of
previously misplaced claims. The figure for Apr
03 was reported the week of April 17-23, 2003.
19
Health Costs Could Double by 2011

• By 2011, Americans are expected to spend
  9,216 per person on health care, about double
  what they spent in 2000.
• Health Costs are expected to grow at a rate
  of 7.3 annually between now and 2011.
• Health Care spending could reach 2.8
  trillion, or 17 of the nations gross domestic
  product, by 2011, up from 13.2 percent in 2000.
• Spending on prescription drugs, the fastest
  growing part of health spending, is expected
  to slow, dropping from 17.3 growth in 2000 to
  10.1 in 2011.

Source Washington Post, 3/11/2002
20
But not so with TRICARE
TRICARE Prime has maintained stable enrollment
fees since its inception.
Also ... TRICARE Standard (CHAMPUS) deductibles
have not increased since 1992
21
TRICARE Costs

• Active Duty Members
• No Cost for Care to Active Duty Members (except
  POS)
• Care Typically Provided in Military Facilities
• Supplemental and/or Emergency Care in Civilian
  Facilities Paid for 100
• Active Duty Covered by Prime Benefit

22
(No Transcript)
23
(No Transcript)
24
TRICARE Medical Costs for RC Family Members

• Fee For Service Options
• TRICARE Extra 15 cost share
• TRICARE Standard 20 cost share
• 50-100 deductible (E4 and below)
• 150-300 deductible (E5 and above)
• HMO Option - TRICARE Prime
• No cost shares or deductibles
• No enrollment fees

25
Uniform Formulary Pharmacy Copay Structure
26
TRICARE Dental Program Monthly Premiums (February
2003 January 2004)
27
TRICARE vs HMOs
Source Major Medical plan as quoted by Kaiser
Permanentes website www.kaiserpermanente.org/loca
tions/midatlantic/individualplan/services.html.
28
Kaiser Permanente Personal Advantage Plan
Source Major Medical plan as quoted by Kaiser
Permanentes website www.kaiserpermanente.org/loca
tions/midatlantic/individualplan/services.html.
29
Kaiser PermanenteQuality of Care
Source Data accessed from FEHB of Maryland
Quality Information located at this
url, www.opm.gov/insure/02/html/standards/states/m
d/quality_HMO_chart.html.
30
Not a Stagnant Benefit

• TRICARE Initiatives
• National Defense Authorization Act Improvements
• Strategic PlanningBest Business Practices
• Customer Service a priority BCACs/DCAOs
• T-NEX

31

TRICARE Initiatives

• 1996-Launched TRICARE Web Site
• 1998-Created TRICARE Management Activity to
  oversee TRICARE Program
• 1999-Launched TRICARE Prime Remote in Puerto Rico
• 2000-Beneficiary Counseling Assistance
  Coordinators (BCACs) and Debt Collection
  Assistance Officer (DCAOs) Programs
• 2001-Launched TRICARE Senior Pharmacy Program and
  TRICARE For LifeOur Promise Kept
• 2001-Deployed Pharmacy Data Transaction Service
  (PDTS)
• 2002-Launched DoD/Veterans Affairs Sharing
• First Step Military Treatment Facility Refill
  Mail Service

32
National Defense Authorization Act (NDAA) 01
Accomplishments

• Medal of Honor (MOH)
• Survivor Ext.
• Senior Pharm
• Active Duty Dependent (ADD)
• Copays
• TRICARE Prime Remote for Family Members
• (TPR-FM)-Waived Charges
• School Physicals
• Catastrophic Cap
• Travel Entitlement
• TPR-FM
• TRICARE For Life (TFL)

33
National Defense Authorization Act (NDAA) 02
Accomplishments

• Skilled Nursing Facility--Prospective Payment
  System (PPS)
• Benefit Aug 03
• Payment Aug 03
• Home Health Care-PPS
• Benefit with T-Nex
• Payment with T-Nex
• Custodial Care Definition Not at Risk (NAR)
  
• Custodial Care Definition At Risk (AR)
  Aug 03 and with T-Nex
• Extended Care Health System (ECHO)
• Modified Program For Persons
• with Disabilities (FPWD) with T-Nex
• Prosthetics, Hearing Aids,
• Augmentative Communication Devices with T-Nex
• Travel Expense Reimbursements
• Payment Rates for Institutions and Balance
  Billing
• Nonavailability Statement (NAS) TBD

34
National Defense Authorization Act (NDAA) 03
Accomplishments

• Transitional Assistance Management Program
• Demonstration NA per 03 language
• Enhanced Benefit

35
MHS Strategic Planning
Stakeholder Perspective Our stakeholders are the
American people, expressed through the will of
the President, Congress, and the Department of
Defense
External Customer Perspective Our customers are
the Armed Forces and all those entrusted to our
care
Financial Perspective Accomplish our mission in
a cost effective manner that is visible and fully
accountable
Readiness Theme Focus on activities to enhance
readiness of military forces and the medical
assets that support them
Quality Theme Ensure benchmark standards for
health and health care are met
Efficiency Theme Obtain maximum effectiveness
from the resources we are given
Internal Perspective
Learning and Growth Perspective (Internal
Customers) Our people and our support systems
are critical to giving us the capabilities to
execute on all we set out to achieve.
36

• Customer Service a Primary Focus

Beneficiary Counseling Assistance Coordinator
(BCAC) Debt Collection Assistance Officer
(DCAO) Programs
37
BCAC DCAO Roles Responsibilities Overview

• Responsible for casework and resolution for all
  cases presented
• Assist beneficiary in resolving issues
• Obtain Privacy Act Notice from beneficiary if
  necessary
• Assign case number and maintain tracking sheet
• Notify beneficiary of case resolution
• Adhere to reporting requirements of TMA as
  outlined

38
TRICARE Next Generation of Contracts (T-NEX)

• Current Regional Contracts Expiring
• 3 Regions versus 11
• 3 Contracts versus 7
• TMA to adopt industry best practices
• Will improve the TRICARE program while leaving
  the basic benefit structure (TRICARE Prime,
  Extra, Standard, and Plus) unchanged.

39
(No Transcript)
40
In Summary

• TRICARE Costs Successfully holding the line on
  both beneficiary and Government costs
• TRICARE Quality Outstanding
• TRICARE Access Good and getting better
• TRICARE Satisfaction Good and getting better
• TRICARE Benefit One of the most comprehensive
  health benefit plans in the US
• TRICARE Improvements Steady, accountable,
  proven track record of improvement

41
(No Transcript)
42
Health Care is a Readiness Issue
43
The TRICARE health plan is one of the best in
the world!
Finally
Thomas F. Carrato, RADM, USPHS Deputy Assistant
Secretary of Defense (Health Plan
Administration) 21 January 2003
44
(No Transcript)