Surveys Track TRICARE Progress

More than 200,000 adult eligible for Military Health System benefits were surveyed, with 37 percent responding. The response rate was down from 50 percent the previous two years, however, a telephone survey of those who didn't complete surveys failed to establish that there were significant differences in their satisfaction with TRICARE compared to those who completed surveys.

"Our beneficiaries largely are satisfied with the care when they can get to it," said Army Lt. Col. Thomas Williams, director of program evaluation for the TRICARE Management Activity. "And importantly, we're meeting or exceeding most national goals in preventive care for our beneficiaries."

Beneficiaries are more critical of TRICARE, however, when it comes to making appointments, Williams said. "We need to maintain our high performance in the care we deliver and the providers we attract and retain, but we also need to investigate how we can most efficiently get people into this system with a minimum amount of hassle."

"The TRICARE Management Activity wants comprehensive, high quality data that allows comparisons across systems of care," Williams said. Data for the current survey was drawn from patients' health care experiences during 1998. Questions in the 1998 survey were based on the Consumer Assessment of Health Plans, a nationally recognized standard for measuring health care systems. "Changing the survey to reflect national standards of consumer assessment puts us in a much better position to determine what's good or bad about TRICARE," he said.

"If you look at the benchmark data, when our beneficiaries comment about their personal physician and the care they get, we are comparable to national figures. Those figures reflect, I think, a large degree of satisfaction. "Those common measures of satisfaction start to drop the further removed that measure is from the interpersonal provider-patient relationship. So while the criticism we receive is characteristic of what is being discovered nationally, we're still not at the level we'd like to be."

TRICARE access goals also must be within reach, Williams said. "I think a realistic goal would be somewhat short of 100 percent satisfaction with the appointment systems," he said. "Our goals should be established with some recognition of what's going on outside of the Military Health System and what other systems have experienced."

Information from the annual survey is provided to medical commanders to help them shape local health care delivery. In addition, the information is used by the Center for Naval Analysis to compile an annual report to Congress, coupled with cost data derived from a variety of sources by the Institute for Defense Analyses.

The congressional report uses more sophisticated analytic tools to track beneficiary attitudes but still generally supports the annual survey findings, Williams said. The two contractors first reported on TRICARE in the Pacific Northwest, TRICARE's oldest active region. For the 1999 report to Congress, they revisited that region plus six others that have been active for at least one year. By 2001, all regions will be included in the report, Williams said.

The report comments on differences apparent between 1994 and 1997 on a number of issues regarding health cost, quality and access. "This is an ongoing effort to try to explain what has happened under TRICARE relative to what was going on in 1994 and where we think the old CHAMPUS would have gotten us," Williams said.

The CNA/IDA report looked at out-of-pocket costs to beneficiaries compared to what military health care cost them under CHAMPUS. They found that those enrolled in TRICARE Prime generally paid fewer additional annual costs in 1998 than they had from 1994 to 1997, while those not enrolled but using TRICARE for their health care paid more out-of-pocket expenses. Retiree costs went up, but Williams said that's mostly due to enrollment fees.

Although the surveys provide TRICARE with useful information, making changes to the military health care system isn't easy, Williams said. The challenge, he said, is to provide medical commanders the most current information available that they can then use to fine-tune the health care services they provide.

"They are interested in getting feedback more than on an annual basis," he said. "That indicates there is a need for more current information."

Williams said his office is going to give the commanders what they need, by performing future customer surveys quarterly instead of annually. TRICARE will still look at customer satisfaction over the past 12 months, but instead of surveying the entire sample once a year, it will break the sampling down into four quarterly segments, he said. "It's going to be a rolling snapshot of how they're doing."

To affect improvements across the system, national performance measures will be incorporated in future managed care support contracts, Williams said. Contractors may be paid incentives if they exceed national figures for meeting beneficiary needs in getting the care they need, getting that care when they need it, while receiving good customer service, including claims processing.

"Efficient, effective access is such an important issue," Williams said. "We recognize that it's not your personal physician; it's not the care you get; it's getting in the door. Our contractors may be an important source of support in tackling this issue."

The 1999 TRICARE Stakeholders Report provides an in-depth review of what the TRICARE Management Activity has done in the last 12 months to improve such beneficiary concerns as access, claims processing and customer service. The complete report is available on the Internet at http://www.tricare.osd.mil/briefs/pdf/stakeholder.pdf.