MILITARY UPDATE
TRICARE Standard users: Help is on the way
By Tom Philpott
Military healthcare beneficiaries will be mailed information packets this year, explaining benefits under TRICARE, the triple-option health plan.
The mailing will coincide with the June-through-November phase-in of new TRICARE support contracts, which will merge 11 stateside TRICARE regions into three, require all contractors to operate under the same rules and set contractor performance goals based on customer satisfaction.
The mass mailing is unprecedented for a different reason, however. It will mark the first time since TRICARE began in 1993 that the system has reached out to all those eligible — including more than 2 million users of TRICARE Standard, the military's traditional fee-for-service health insurance.
More steps to support Standard users will follow, passed by Congress in last year's defense bill. They include a nationwide survey of civilian healthcare providers to measure reluctance to accept Standard patients; a U.S. Comptroller General review of Defense Department procedures to ensure access to Standard benefits; and a communication plan, Active Outreach, to widen information flow between TRICARE administrators, and TRICARE beneficiaries and providers, particularly Standard users and their caregivers. Officials outlined the plan this month in a six-page report to Congress.
For all the activity swirling around oft-neglected Standard users, it isn't clear how far the government will go to help them find doctors. Possible actions range from encouraging Standard users to tap existing TRICARE networks of physicians, to spending millions of dollars to build, and update frequently, a kind of nationwide Yellow Pages of Standard providers.
Beneficiary advocates have testified that fewer physicians are willing to accept TRICARE patients and, of those who do, more are refusing to accept TRICARE fees. Finding TRICARE Maximum Allowance Charges (TMAC rates) inadequate, doctors are adding up to 15 percent, as the law allows and which patients must pay.
Evidence of the trend has been anecdotal rather than statistically based, leaving Congress sympathetic but, like defense health officials and TRICARE support contractors, not fully convinced that large numbers of Standard users are being denied access to affordable care.
Standard users don't enroll in TRICARE Prime, the managed care network, and aren't old enough for TRICARE for Life, the golden supplement to Medicare. Many turn to Standard, with its higher costs, to be able to choose their own physicians. Others only use Standard benefits because they live in rural areas, away from a TRICARE Prime physician network.
The cost difference can be steep. A married retiree enrolled in Prime pays $460 yearly for family coverage and modest co-pays for doctor visits. The same retiree under Standard pays a $300 annual deductible plus 25 percent of the TMAC rate on each medical procedure. They pay an additional 15 percent when doctors or hospitals don't accept the TRICARE Maximum Allowance Charge, TMAC.
Sue Schwartz, a health benefits expert for the Military Officers Association of America, views the congressional initiatives as positive and the outreach effort for Standard users with cautious optimism. She is bullish on a provider-directory link for Standard users that was recently added to the TRICARE Web site at www.tricare.osd.mil/standardprovider.
Steve Strobridge, MOAA's government relations director, is more skeptical. He expects gains for Standard users to be a long-term process.
"We know they don't want to spend any money," he said, referring to defense officials. But the congressional initiatives already passed, "if you do them right, (they) cost more money and take more resources."
James E. Woy, president of Health Net Federal Services of Rancho Cordova, Calif., manages TRICARE for states on the West Coast.
His top responsibility, he said, "is to build a network in Prime service areas to meet the needs of all TRICARE eligibles, whether enrolled or not."
Woy noted that of 1.5 million beneficiaries in his region, 900,000 are enrolled in Prime and 525,000 are not enrolled but still live within network areas. Only 75,000 live too far from a network to enroll in Prime.
Woy said he is confident his network has physicians to accommodate all 525,000 Standard users if needed. Of the 75,000 beneficiaries living in remote areas, however, "I don't have a requirement yet to find them providers. I don't know who they are or how to help them."
David McIntyre, president of TriWest Healthcare Alliance Corp. of Phoenix, which will manage the Western Region, noted that Medicare, like TRICARE Standard, is a fee-for-service plan. Congress, he said, wouldn't consider approving a costly system to track down doctors for Medicare patients. Also, he suggested, most TRICARE Standard patients have a ready alternative: access to a managed care physician network.
Questions, comments and suggestions are welcomed. Write to Military Update, P.O. Box 231111, Centreville, VA 20120-1111, or send e-mail to: milupdate@aol.com. Or visit Tom Philpott's Web site.
