DoD to Remedy TRICARE Ills

Defense Secretary William S. Cohen told reporters in early January he would soon make a major announcement on how DoD plans to improve military health care. He and Army Gen. Henry Shelton, chairman of the Joint Chiefs of Staff, have both pledged that the improvement of health care is one of their top priorities in the year ahead.

Service members receive quality health care, but related business practices are causing headaches, Mary Gerwin recently told the American Forces Press Service. After she visited troop bases in Italy and the Balkans, the deputy assistant defense secretary for health affairs said access to health care is a major concern to service members.

"Even though our surveys find that people are very happy and satisfied when see the doctor and get the care they need, there is a problem getting appointments," Gerwin said. People complain about having to hold for long periods when they call to make an appointment and that it takes too long to get to see a doctor, she said. People feel that "access standards" allowing patients to be seen within a few days or a few weeks are not being met, she said.

DoD officials are determined to fix these types of problems. Dr. Sue Bailey, assistant defense secretary for health affairs, has directed that military treatment facilities adhere to established access standards and to have more of a standardized appointment system. Officials want to make it easier to get appointments and to ensure patients are directed to the right caregiver, Gerwin said.

"What we find sometimes is that patients will have a lot of their time wasted because they're sent to the wrong clinic," she said. A patient with a shoulder injury, for example, may be sent to a knee specialist. "They're sent to the wrong clinic because the person making the appointments from a centralized appointment system is not familiar with the actual clinic and what it does. So that's very frustrating from the patient's standpoint."

Service members also say they're having a difficult time getting claims paid, Gerwin said. Families are getting notices that the doctor bills have not been paid or, in cases where they paid the bill up front, service members are not getting reimbursed. Incorrectly completed claim forms are being returned to the provider, she noted, thereby delaying payment.

"We're working hard to fix the claims processing system so that a service member and his or her family will never get a notice that says the bill was not paid," Gerwin said. "That is our goal so that service members don't have the feeling that they're going to get bad credit because they had an unpaid bill."

DoD health affairs officials are addressing these problems in several ways. "We're reforming the claims process so that we're paying our claims in a shorter period of time," Gerwin said. "We're also trying to simplify the process so that it's easier for providers to submit claims."

Service members' concerns about care after retirement affect recruitment and retention. When they hear claims about broken promises from retirees in their communities, service members naturally question whether health care will be there for them when they retire," Gerwin explained. DoD is now exploring ways to best extend coverage to people over age 65. "At age 65, you're no longer eligible for CHAMPUS," she said. "That's why we have to find other ways of doing it."

DoD officials are particularly concerned about caring for service members' families when units deploy. Service members should not have lingering concerns about their families' care, Gerwin said. "We have to try harder to get those bills paid on time, because health care is a high quality of life issue for our troops."

Many service members acknowledge that TRICARE is still fairly new and getting used to it is taking some time, Gerwin said. Commanders, in particular, say they need more education -- more help in being able to explain the program.

"We've got a big education effort under way," she said. "Our job is to simplify the system as much as possible and then educate commanders and people within the community so they're able to answer service members' and their families' questions."

Families can sign up for one of three health care options, Gerwin said. The first is TRICARE Prime, DoD's managed care plan that resembles civilian HMOs, she noted. Enrollees get a primary care manager, and there are set access standards.

The second option is TRICARE Standard, which is basically the old CHAMPUS program. Service members and families use any participating provider they wish, but pay higher out- of-pocket expenses for the privilege. They have to submit claims forms and are responsible for providers' charges that exceed TRICARE's payment schedule.

The third option is TRICARE Extra, which limits families' expenses whenever they use "preferred providers" -- a limited list of caregivers who meet certain standards and accept the TRICARE schedule as payment in full. Co-payments are 5 percent lower than TRICARE Standard's.

Health care is complicated, Gerwin said. "We're trying to simplify the message as much as possible. We really encourage people to get good briefings when they sign so they know who to call for care and how that care is going to be delivered," she said.

Military and civilian consumers are dealing with many of the same health care issues, Gerwin noted. These include high prescription drug costs, claims processing snafus, a more complicated health care system, and patients having to do more to manage their own care.

"We can only go as fast as the overall health care industry does," she remarked. "What we can do is make sure we've adequately budgeted for our program, so we have enough to give that very good level care.

"A good example of that is our prescription drug costs. Much like the rest of the overall health care system, we have prescription drug costs that are skyrocketing. We have to make sure we put enough dollars in the system so the drugs are available for individuals."

DoD's goals, she said, are to "get the onus off the beneficiary" and make the system as easy to use as possible. "The major initiatives are to make sure those phones are answered, that people are able to get their appointments on time, that they get their claims paid, and that they feel they have the access to the care they deserve."

The TRICARE Web site entry point is www.tricare.osd.mil.

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