TRICARE 101 TRICARE Management Activity

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TRICARE 101TRICARE Management Activity
SGM Harry Robinson, Jr. Senior Enlisted Advisor
TMA 18 June 2002
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The Big Picture
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The Big Picture
The President
SERVICES
ARMY
SecDef
SG
ASD (HA)
AIR FORCE
TMA
SG
Chairman, JCS
NAVY
SG
USMC
The Joint Staff
JFCOM
PACOM
EUCOM
CENTCOM
SOUTHCOM
Functional CINCs
Geographic CINCs
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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

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

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TRICARE Goals

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

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• Beneficiary Counseling Assistance Coordinator
  (BCAC)
• Debt Collection Assistance Officer (DCAO)
• Program Update

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BCAC DCAO Roles Responsibilities Overview

• Responsible for casework and resolution for all
  cases presented
• Assist beneficiary in determining basis for debt
  collection
• Collect copies of all pertinent documentation
  i.e., provider bills and notices, TRICARE EOBs,
  letters from providers/credit reporting agencies,
  etc.
• Obtain Privacy Act Notice from beneficiary
• Assign case number and maintain tracking sheet
• Notify provider(s), collection or credit
  reporting agency that beneficiarys case is
  under review.
• Adhere to predetermined reporting requirements of
  TMA as outlined in the DCAO Training Guide

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BCACs DCAOs are here for YOU!

• Major Customer Service Initiative
• Legislative Mandate
• Expert Assistance -- Utilize Them!
• World-wide listing on web

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TRICARE Options

• TRIPLE OPTION
• TRICARE Prime HMO Option (Requires Enrollment
  and Cost Shares)
• TRICARE Extra PPO (Deductibles and Cost
  Shares)
• TRICARE Standard Standard CHAMPUS (Fee For
  Service)

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TRICARE PrimeA Superb Health Benefit

• Occupational Therapy
• Prescription Drugs
• Mail Order Discount Plan
• Vision Benefits
• Mammography
• Mental Health
• Dental

Superior to Most Civilian Health Plans
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TRICARE ProvidesReal Choice
Enrollment Fee Co-Pay Deductible
TRICARE OPTIONS
No for Active Duty Family Members Yes for
Retirees Family Members
No
Prime (HMO)
No
Yes
No
Extra (PPO)
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TRICARE Costs

• Active Duty Members
• No Cost for Care to Active Duty Members
• Care Normally Provided in Military Facilities
• Supplemental and/or Emergency Care in Civilian
  Facilities Paid for 100
• Active Duty Enrolled in Prime

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2001 Costs to Rise 10.5 in Federal Civilian
Health Plan
Source September 18, 2000, Health premiums
rise even higher than expected , by Katy
Saldarini ksaldarini_at_govexec.com
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Health Care Costs
Factors contributing to the rising cost in health
care insurance premiums
Source Employer Health Costs Rise 10, Miami
Herald, 5/3/2002
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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
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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
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Where Beneficiaries Go For Help

• Local Military Treatment Facility (MTF)
• Local TRICARE Service Center (TSC)
• Beneficiary Counselors and Assistance
• Coordinators (BCAC)
• Debt Collection Assistance Officers (DCAO)

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If you have a , or a
you have access to unlimited, free, accurate
information about TRICARE
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Access Standards

• TRICARE Prime Access Standards
• Emergency Care (911 or Nearest Emergency Room)
• 24 Hours a Day, 7 Days a Week
• Primary Care Wait Times
• 1 Day - Acute Illness
• 1 Week - Routine Visit
• 1 Month - Well Visit
• Well/Specialty Care Wait Times
• 1 Day - Urgent Care
• 1 Month - Routine Visit
• 24 Hour Toll Free Health Care Information Line
• 24 Hour Toll Free TRICARE Service Line

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SatisfactionMoving in the Right Direction
Source 1995 - 1998 Annual Health Care Survey of
DoD Beneficiaries
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TRICARE Program EvaluationSignificant Findings,
FY2001

• In All of the Regions, TRICARE
• Improved access to care
• Greater use of preventive care
• Easier to get appointments
• Shorter wait to see provider
• Decreased ER use
• Increased satisfaction with quality of care
• Satisfaction with TRICARE increases over time
• Results consistent across TRICARE regions

GOOD
Source Center for Naval Analyses,
Congressionally-directed evaluation of all of the
TRICARE regions, Draft Version July 2001
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Effects of Region Maturity
Percentage of Prime Enrollees Satisfied with
Indicator
Source Center for Naval Analyses,
Congressionally-directed evaluation of eight
TRICARE regions, August 2000, DRAFT
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NDAA 01

• Effective Date Implementation Date
• MOH 30 Oct 00 1
  Apr 01
• Survivor Ext. 30 Oct 00 1
  Apr 01
• Senior Pharm 1 Apr 01 1 Apr
  01
• ADD Copays 1 Apr 01
  1 Apr 01
• TPR FM-Waived Charges 30 Oct 00 1
  Aug 01
• School Physicals 30 Oct
  00 15 Dec 01
• Cat Cap 30 Oct 00
  15 Dec 01
• Travel Entitlement 30 Oct 00
  15 Feb 02
• TPR-FM 1 Oct 01
  1 Sep 02
• TFL 1 Oct
  01 1 Oct 01

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NDAA 02

• Effective Date Implementation Date
• Skilled Nursing Facility-PPS
• Benefit Dec 28, 01 Feb 03
• Payment Apr 1, 01 Feb 03
• Home Health Care-PPS
• Benefit Dec 28, 01 Oct 03
• Payment Apr 1, 02 Oct 03
• Custodial Care Definition (NAR) Dec 28, 01
  TBD
• Custodial Care Definition (AR) Dec 28, 01 Oct
  03
• ECHO (Modified PFPWD) Dec 28, 01
  TBD
• Prosthetics, Hearing Aids, Discretionary
  TBD
• Augmentative Communication Devices

These are Government estimates, subject to
contract negotiations.
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NDAA 02

• Effective Date Implementation Date
• Durable Medical Equipment Discretionary TBD
• Rehabilitative Therapy Discretionary TBD
• Travel Expense Reimbursements Dec 28, 01 Apr
  1, 02
• Payment Rates for Institutions Dec 28, 01
  Apr 1, 02
• and Balance Billing
• NAS Dec 28, 03 TBD
• or start date
• of new contracts
• Transitional Health Care
• Demonstration Dec 28, 01 TBD
• Enhanced Benefit Dec 28, 01 TBD

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Uniform Formulary Pharmacy Copay Structure
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Where TFL Beneficiaries Go For Help

• Senior Pharmacy
• 1-877-DOD-MEDS
• TRICARE For Life
• 1--888-DOD-LIFE
• www.TRICARE.osd.mil
• Local MTF
• Retiree Affairs Offices
• National Mil Coalition/Mil Vets Alliance

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NDAA Conclusions

• Major Change in the Military Health Care Benefit
• DoD has Implementation and Contracting
  Responsibilities
• Quality Health Care Delivery
• Public Review and Comment on New Changes
• Good Steward of Taxpayer Dollars
• More Information will be Released as Quickly as
  Possible
• Best Info Source Including Latest Version of this
  Briefing www.tricare.osd.mil/ndaa

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If you Educate them first...
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Theyll be ready to do this
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Leadership
is the key
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Questions
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