First Hawaii, Now All of Pacific Comes Under TRICARE

It's not easy to link more than a quarter million beneficiaries scattered throughout this vast area of the world to a single health care plan, officials here admitted. But they've been up to the challenge, according to Army Dr. (Brig. Gen.) Warren Todd, Tripler commander and TRICARE Pacific lead agent.

"For Hawaii, alone, we lead the nation in TRICARE Prime [the plan's health maintenance option] enrollment," Todd said. More than 48,000 active duty service members are enrolled automatically, he noted, but in addition, 40,000 family members have signed up.

Not only have these people enrolled in TRICARE, but they're finding access to medical care easier than before, Todd said. "We're meeting all DoD standards for access," he said.

Todd said he's more concerned now with how to deliver quality health care to beneficiaries stationed at one of the more than 80 remote sites in the Pacific -- at embassies, for example.

"These folks may rely more than others on local health care resources," he said, "and local physicians may not deliver medicine to U.S. standards."

Todd began sending out joint-service teams last year to help identify quality health care at these Asian-Pacific locations. "One of the big questions has to do with payment for services rendered," he said. "In many countries, Japan included, hospitals and physicians require payment up front, before they deliver treatment. We're looking at how we might get TRICARE money into the hands of someone in the embassies who could then pay the local providers."

An executive committee made up of DoD health officials from throughout the theater helps Todd steer TRICARE Pacific. And within the walls of the Army medical center, an Air Force-Navy team guides the ever-expanding program.

Expansion of TRICARE Hawaii to the rest of the Pacific, including Asia and Alaska, kicked off in August 1996 with a two-day conference at Tripler. "We brought in commanders and patient administrators from every medical facility and laid out implementation plans," said Air Force Lt. Col. Karen Jones, director of TRICARE operations here. After establishing guidelines, the group agreed to stand up TRICARE throughout the region by July 1. "In some cases where they're having a little more difficulty setting up TRICARE, that date may be extended," Jones added.

An April conference helped refine the implementation plan to enroll some 190,000 beneficiaries in and around 14 major installations, and nearly 5,000 at remote sites, Jones said. No location is too small to warrant TRICARE assistance, she said, noting two officers and their families -- a total of five -- based in the Fiji Islands.

"Of course, in a place that small it's difficult to establish any sort of payment agreement," Jones said. "In fact, at a lot our remote sites, beneficiaries often must rely on the advice of people who've been there longer and know where to get the best quality care available. "TRICARE is a local issue wherever you go."

Besides the issue of payment before treatment, basic eligibility isn't as straightforward as in mainland United States. For example, military retirees living in Asia won't initially have access to the plan, said Navy Lt. Brian Hoskins, TRICARE Pacific director of plans and programs.

"We modeled TRICARE Pacific after TRICARE Europe, which preceded us in implementation by a couple years," Hoskins said. The European program taught officials here much about establishing TRICARE agreements with foreign health care providers.

"Capacity is our primary concern," Hoskins said. "Our medical facilities are sized to meet the treatment requirements of service members and their families stationed there. Anyone else would have to be treated on a space-available basis, and that space doesn't exist."

As agreements are made with local practices and facilities, however, retirees will find it easier to get DoD-sponsored health care, Hoskins said. Europe will begin enrolling retirees Oct. 1, he said, and Alaska has already decided it can enroll retirees along with other beneficiaries, also beginning Oct. 1.

Sometimes overlooked by other DoD programs -- schools and commissaries, for example -- are noncommand-sponsored family members. Service members on unaccompanied tours often choose to bring along their families anyway. "DoD made the decision that these people are beneficiaries entitled to health care benefits, so we will enroll them and take care of them just as we would sponsored families," Hoskins said.

Once enrolled in TRICARE Prime, people in the Western Pacific won't have to make co-payments. "However, if they're home on leave and need medical care, they will be charged co-payments there," Hoskins said. "In addition, families who don't accompany the service member to a Western Pacific assignment but are enrolled in Prime stateside [and receive their health care from a civilian provider] must follow the co-payment rule for that region." Co-payments typically run from $6 to 12 per visit, he said.

"There still are likely thousands of people out here eligible to enroll who we haven't accounted for," Todd said. "Many retirees settle in American Samoa, the Philippines and Guam, for example. We know they're out there, and our goal is to eventually reach them all."