TRICARE: The Wellness Approach

The logic is simple, and, if applied the results could be spectacular. Because a healthier force not only reduces the need and cost of health care, better health increases force readiness.

Such reasoning has pointed military medicine in a new direction. In the past, DoD focused on treating illness and injury. Now under TRICARE, implemented to contain costs and improve readiness the focus has shifted to prevention.

"It's good management to reduce the number of visits people make to the hospital or clinic," said Col. (Dr.) Paul Evans, a primary care manager at Madigan Army Medical Center, here. "For example, if somebody has a cold and wants to see a doctor today, is that appropriate, and if not, how do we educate that person?"

TRICARE reduces unnecessary visits to the doctor in many ways, Evans said. For example, Region 11, which encompasses Washington, Oregon, and six counties in Idaho, encourages people to call its nurse advisory service first.

The tollfree service is available around the clock. The number is printed on platinum cards all Region 11 enrollees receive. Once connected, callers talk to a nurse, describe their symptoms and get onthespot medical advice.

"Advice that often saves them a trip to the hospital," Evans said. "Quite often, people really don't need to see a doctor to take care of their health problems. The nurse adviser tells them what to do for relief from their current symptoms and also counsels them on how to prevent future problems. So it's a way to educate people and orient them toward healthier lifestyles."

To further cut back clinic visits, Madigan also offers a wellness clinic.

"We identify people who make more than 30 appointments a year (the average is 4 1/2 visits a year)," Evans said. "We then refer them to the wellness clinic for counseling and education. In most cases, these are people who aren't dealing well with their injury or illness who are stressed out. The wellness clinic works with the primary care physician to manage these patients."

Similar programs are available throughout the region, including nearby McChord Air Force Base, where a health and wellness center provides a "onestop shop" for wellness.

Capt. Jan Seladis, an Air Force registered nurse, directs the center, where, she said, all McChord beneficiaries are welcome to come for counseling, education and fitness programs.

"We offer a holistic approach to better health by dealing with our customers' physical, emotional and spiritual wellbeing," Seladis said. "People can learn to live a healthier lifestyle."

Health and wellness centers are a TRICARE phenomenon popping up at Air Force bases everywhere, Seladis said. The Air Force's fitness testing program, cycle ergometry, is being shifted there from gymnasiums, along with remedial training for those who fail the test and weightmanagement for airmen who don't meet weight standards.

Three times a week, Seladis hosts a brief orientation for new enrollees. "We find out what their specific needs are, train them on the equipment and sign them up for classes," she said.

Since the center opened in January, 300 people have joined.

"Our biggest users are active duty airmen and retirees," she said, and she's starting to see more dependents. The center also caters to base civilian employees.

Referring patients to the wellness center frees the McChord clinic's small staff to treat other patients, and it's also affecting nearby Madigan. Because McChord's clinic is small, it always has relied on nearby Madigan for patient assistance. For example, the clinic has no emergency room or after hours care. Airmen and their families needing those services must go to Madigan.

Thanks to TRICARE, those trips are down, said Capt. Bob Valentine, TRICARE director for McChord's 62nd Medical Group.

"In March 1995 [when Region 11 was activated], we were averaging 400 visits a month to the Madigan emergency room," Valentine said. Statistics show visits since have dropped below 350 a month.

"I use the nurse adviser all the time," said Debbie Pyle, an Air Force spouse with two asthmatic children. "Under TRICARE, it's also easier to get an appointment to see somebody. TRICARE has made military health care here a lot better."