TRICARE In Hawaii; Smooth Sailing

"Hawaii boasts a wealth of military medical facilities anchored by Tripler Army Medical Center near Honolulu," said Rear Adm. William J. McDaniel, U.S. Pacific Command surgeon. "Frankly, we have enough medical assets to take care of the vast majority of our folks. And we can refer patients any time we need to extremely well-qualified civilian physicians out in town."

Used to Hawaii's decades-old managed health care system, civilian providers agreed readily to form a preferred provider network to support the contract awarded Foundation Health Services and implemented April 1.

In many ways, Hawaii is the model for managed health care nationwide," said Air Force Lt. Col. Karen Jones, director of operations for "TRICARE Hawaii," the 12th of 12 TRICARE regions in the United States. "Thats important to us as we try to enroll people in TRICARE Prime, because many retirees and dependent spouses already have health insurance through their civilian employers."

The state requires employers to pay employee health insurance premiums. About 38 percent of TRICARE-eligible beneficiaries have such insurance, which reduces the demand for the DoD plan, Jones said. As a result, of the 84,554 people eligible for TRICARE, Jones' office has targeted only a little more than 52,000 for potential enrollment.

To encourage enrollment in the Prime option -- DoD's health maintenance organization plan -- medical facilities in Region 12 give Prime enrollees priority appointments. All others can get care only on a space-available or emergency basis.

It makes a difference. At Tripler's optometry clinic, for example, military deployments often deplete the staff, forcing patients either to wait up to eight months for an appointment or seek eye care downtown, Jones said. For off-post visits, Prime enrollees pay just $6 (pay grade E-4 and under) or $12.

As a result, Jones said, 5,000 people signed up in May, alone.

"Our TRICARE service center [where people go to enroll] was busier than the entire state of California (Regions 9 and 10) last month, and we had more enrollments as well," she added. "Many of the new enrollees had critical health care needs that Prime offset the cost of." For example, hospitalization under Standard TRICARE (CHAMPUS) costs $330 a day, Jones explained, but under Prime, the patient pays just $11 daily.

As in any TRICARE region, enrollment gives beneficiaries a choice of where to receive their primary care -- in the facility at their base or post -- or from one of the preferred providers in the civilian community. In Hawaii, a network of 700 physicians and 14 hospitals delivers health care to TRICARE-eligible residents, which includes about 13,000 military retirees and 18,500 retiree dependents.

The TRICARE contract and a common computer system make referrals easier, Jones said, while a toll-free health information line staffed by registered nurses precludes unnecessary trips and ensures problems needing medical attention got treated sooner.

To further enhance health care delivery, TRICARE Hawaii sends preventive medicine teams to the troops and their families -- wherever they are.

"This being Hawaii, we have a lot of sailors here, and sailors go to sea," Jones said. "We don't think they should have any less access to quality health care, so they're definitely included on our visitation schedule."

The schedule has two nurses, five medical technicians and an administrative specialist visiting sites to deliver health risk assessments.

"For example, we'll spend a day aboard a ship providing screenings and tests for blood pressure, cholesterol, body fat and other personal health assessments," Jones said. Team members use laptop computers to record the information and build a database of a unit's overall health and health risks. At the end of the visit, they provide the commander a health readiness report and identify service members who may need specialist care.

"Commanders love the service, because we're helping them maintain their ability to perform their mission," Jones said.

Besides visiting units, the team takes its services to family members, Jones added. At each military installation in Hawaii, they spend one or two evenings providing spouses and children the same screenings and advice they give to service members.

The primary role of TRICARE, explained McDaniel, is to improve the delivery of health care. The improved connectivity and resource sharing between military facilities, a robust network of civilian providers and effective preventive health measures, he said, have ensured a successful deployment of DoD managed care in Hawaii.

"All the services and [the Department of Veterans Affairs] here collaborate well," Jones said. "But TRICARE has brought us even closer together. Now, the emphasis is on the patient, where it needs to be."