Cost, Access, Quality Shape TRICARE Success in Northwest

A survey of more than 10,000 DoD health care beneficiaries in TRICARE Region 11 -- Washington, Oregon and part of Idaho -- measured the delivery of health care to some 340,000 beneficiaries between 1994 and 1998. TRICARE began in the area in 1993. Dr. James Sears, TRICARE Management Activity executive director, called the survey "all good news."

"In a time when there's significant inflation in health care costs, they found no increase in cost to the government or beneficiaries," Sears said. At the same time, the survey reported that Region 11 medical providers maintained high quality standards. "There's even a plus-up in perception [among survey respondents] of quality," he said.

In terms of access, improvements were noted in several categories, Sears said. "They're getting their primary care when they need it, they're getting preventive services they need and they aren't using the ER as much. Not having to go to the ER to get their primary urgent or acute care is a sign of a healthy system.

Sears said he's particularly pleased with Region 11 beneficiaries' increased reliance on preventive health services. "That's a major goal we're after -- to keep people healthy so they don't have to use health care services as much," he said.

CNA Corp. and the Institute for Defense Analyses conducted the Region 11 survey and will perform similar surveys in all regions over a four-year period, Sears said. Congress mandated the study, which looks at "before" and "after" data to determine TRICARE's impact on military health care. Although the survey measured just one region, Sears said it reflects what he expects to find in every region.

"It's the same program we have put in place across the country," he said. "As the survey reaches all the other regions over the next two years, we anticipate similar results. There's no reason to think this program would be any less successful in other regions."

Next on tap for the survey this spring are regions 3 (Southeast), 4 (Gulf South), 6 (Southwest), 9 (Southern California), 10 (Golden Gate) and 12 (Pacific), and a second look at Region 11. Regions 7 and 8 (Central) will be surveyed in 2000 and Regions 1 (Northeast), 2 (Mid-Atlantic) and 5 (Heartland) will follow in 2001.

Outcomes from the Region 11 survey "are in the direction we want them to be," Sears said. "But we've got a lot of feelers out to learn how the program is doing. This study is just one of them."

Annual and monthly customer surveys help Sears and his staff learn about and solve problems in the TRICARE system. "Most of the changes we're making, where we're placing new or additional emphasis, are based on feedback we're getting from these multiple channels," he said. "We're using this information to improve the current structure and future contracts."

What this and other surveys tell Sears is that TRICARE is doing well where it has matured, in Southern California, for example. "We just have no negative noise level of any significance from the places where TRICARE has been in place and operating for awhile," he said.

In Southeast, Gulf South and some other newer regions, problems that existed a year ago have been corrected, he said. "We had problems with claims, networks and appointments. As of today, however, their networks are developed, they're paying claims and their telephone issues are history."

Sears said the same types of "hiccups" occur in every regional startup, and a similar maturing process eventually smoothes out the wrinkles. The Central region matured rapidly, he said, and he expects the Northeast, Mid-Atlantic and Heartland regions to improve quickly.

TRICARE has met with similar success overseas, an area perceived to be a medical care trouble spot in the early 1990s, according to Air Force Maj. Brian Hurley, senior health analyst for military health systems operations at TRICARE. Surveys, he said, detected few claims turnaround problems and found high patient satisfaction with health care access and quality.

But surveys aren't the only tool DoD's using to gauge the health of health care. TRICARE management discusses health care issues regularly with the Military Coalition, a 5-million-member group of 26 military support associations, and the 3-million-member Military/Veterans Alliance. Sears has conducted meetings with the services' senior enlisted representatives to uncover and fix health care problems of enlisted members and their families. And Rudy de Leon, undersecretary of defense for personnel and readiness, has started conducting regional town hall meetings with medics and patients.

TRICARE is accomplishing all it was designed to do, but that doesn't mean it can't be improved, Sears said. "We want to continue showing improvement in every area, keeping costs down and ensuring every beneficiary, whether active duty or retired or family member, has quick access to quality care."