Geographically Separated Units to Gain TRICARE Access

Original support contracts excluded geographically separated units -- some recruiters, for example -- from enrolling in Prime. Instead, they had to either travel long distances to military facilities or obtain care under local agreements that varied from location to location. Family members of these active duty members generally had to use standard CHAMPUS to pay for health care, with little assistance in helping them find qualified providers.

In 1996, however, DoD began a test to extend full TRICARE benefits to them. By December, Region 11 (Oregon, Washington and northern Idaho) had made Prime available to 90 percent of geographically separated service members and families.

"Senior leaders have expressed a strong interest in extending Prime's availability," said Air Force Col. Jerry Luby, DoD director of TRICARE operations and policy. "After testing the feasibility, we're now going to seek concurrence from the service secretaries to expand this initiative to other regions. It's likely we will have this program in effect for all regions by early 1998. Of course, it will be phased in, but I think we're going to ask the contractors to make Prime available for everyone in their region within six months of the date we modify their respective contracts."

Luby said the option also should extend to isolated units overseas, such as Marine detachments at U.S. embassies. "Contractual arrangements will differ, but the process and benefit should be the same," he said.

Delivering Prime to small units or even single individuals didn't originally seem economically feasible to TRICARE planners, Luby said. "The idea was to spend less on CHAMPUS, so we were trying to get economies of scale," he said.

As a result, the first support contract, for Region 11, stipulated Prime be offered generally only to those living within about one hour's drive of a military medical facility and at base realignment and closure sites, and some selected areas such as Portland, Ore.

The Region 6 contract (for most of Texas, Oklahoma, Arkansas and Louisiana) added major metropolitan areas with significant DoD populations. Later, two other regional contracts stipulated Prime delivery to all locations or justification for not making the benefit available. And three contracts slated for implementation later this year and in early 1998 stipulate Prime coverage availability for all eligible beneficiaries.

Identifying every unit or person not assigned near a military medical facility is no simple task. "There's no formal definition of what a geographically separated unit is," Luby said. "We decided to include any person assigned to a location that falls outside an hour's drive of where we currently offer Prime. However, the service personnel systems can't precisely identify these people, so lead agents and service medical personnel have had to do a lot of digging to properly identify all these units."

That's not all. "Once we have these people identified, it's sometimes difficult to make contractual relationships, particularly in small, rural towns that have never heard of managed care," Luby said. "We worked through most of those problems in Region 11, but extending Prime will differ in every region."

What won't change, Luby said, are the basic benefits and cost-shares of Prime. "We'll deliver the benefit to geographically separated units as closely as possible to the way we now deliver elsewhere," he said. "However, access standards may differ a little in remote areas."

The TRICARE Prime access standard is 30 minutes' drive time for primary care and 60 minutes' drive time for specialty care. "If those standards aren't feasible, we'll default to the community norm," Luby said.

"Delivering Prime everywhere our people live and work is a quality of life issue, not a money issue," he said. "We believe it will improve retention in the service and possibly make assignments such as recruiting duty more attractive. We hope this will make the line community happier as well, because their people won't have to travel long distances for health care and won't be off the job as long.

"We want to take TRICARE to wherever we've got people stationed and then, to the greatest extent possible, make it the same for everybody."