Posted on: Monday, November 8, 2004

MILITARY UPDATE

By Tom Philpott

Though unexpected transition problems frustrated some beneficiaries, TRICARE this month completed a major shift, to larger regions and performance-based contracts, to improve customer service and access to care for 9.1 million beneficiaries.

The Defense Department announced two years ago that TRICARE would consolidate 12 regions into three, simplify support contracts, and impose tougher standards on contractors, from answering phone calls and setting appointments, to making physician referrals and paying claims.

Dr. William Winkenwerder, assistant secretary of defense for health affairs, declared the transition complete this month as Humana Military Healthcare Services Inc., of Louisville, Ky., accepted beneficiaries from the final states to join the new South Region.

The new North Region, run by Health Net Federal Services Inc., of Sacramento, Calif., was completed Sept. 1. The West Region began full operations Oct. 1 with the TriWest Healthcare Alliance Corp., of Phoenix, providing health services and managerial support.

The contracts were awarded in August 2003. They direct no change to benefits, patient costs or the enrollment process. Still, by last summer, contractors and beneficiaries faced unexpected problems.

David J. McIntyre Jr., president and CEO of TriWest, discussed the challenges in the West Region.

An early priority for the new region, said McIntyre, was re-signing at least 85 percent of physicians in the TRICARE network for five Pacific coast states previously managed under a contract with Health Net. The first of these states to join the region would be Oregon and Washington June 1.

When not enough providers were signed as the date approached, TriWest sought authority from the government to roll the old physician networks into the new region for 90 days to protect beneficiaries. When that idea was rejected, TriWest was forced to send letters to 43,000 beneficiaries advising them that they might need new doctors by June. The letter, which many patients apparently shared with their physicians, produced a wave of new contracts. But 19,600 beneficiaries did have to change doctors.

In July, California, Hawai'i and Alaska came into the region, and TriWest "got absolutely crushed" with phone calls, said McIntyre. Some of the unexpected volume came from mobilized Reserve and National Guard members whose families are less familiar with TRICARE.

"Our job is to make sure they get answers" and timely care, said McIntyre. "It's not to say, 'Hey, we'll ship you a manual.'"

But the volume of calls overwhelmed the system. TriWest was the only TRICARE contractor to structure its communication system around new technology, the Voice-Over Internet Protocol. VoIP allows both phone calls and e-mail to be carried simultaneously over the same lines. But in this case, McIntyre said, system designers underestimated the capacity of those lines to handle six large customer-contact centers and 90 smaller offices across the region.

"Calls were just evaporating," McIntyre said, as a cell-phone user might experience leaving a coverage area. "We had to re-architect our system," he said, adding computers, trunk lines and staff, enough to accommodate 25,000 phone calls and 8,000 physician referrals a day.

"Within three weeks we had our key lines tripled," McIntyre said. By the middle of August, the issue of lost calls and long wait times was resolved.

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