Sharing Resources Expands Health Services

The goal of TRICARE is to properly balance cost, quality and access the trinity of health care, said Larry Naehr, director of Foundation Health Federal Services, which manages the TRICARE support contract for Region 11 (Washington, Oregon and parts of Idaho). "Through resourcesharing agreements with civilian providers, we can maximize the effectiveness of our treatment programs," he said.

Resourcesharing agreements also may provide military caregivers space in civilian hospitals, Naehr said. The agreements could mean the difference between free health care and charging the government and patient for care.

"For example," he said, "Fairchild Air Force Base [in eastern Washington] is undergoing an electricalheating upgrade project, so at the end of February it closed all inpatient services. We negotiated an agreement to temporarily occupy a ward at Sacred Heart Hospital in Spokane."

The Air Force nursing staff moved onto the ward and admits patients directly to Sacred Heart, Naehr said, and Air Force physicians perform the surgeries. Admitting patients to the Air Force ward at Sacred Heart reduces TRICARE Standard (CHAMPUS) costs and patient travel to distant military hospitals for surgery, he asserted.

TRICARE also strengthens the ties between military facilities in the region, Naehr said. It's not uncommon to see specialists from Madigan Army Medical Center holding clinics at Bremerton Naval Hospital.

Bremerton provides a showcase of resourcesharing agreements, officials said. An Army gastrointestinal specialist from Madigan sees patients there twice a week. And Bremerton departments use contractors to provide services in the hospital otherwise available only downtown.

For instance, a contractor provides the majority of physical therapy to Bremerton patients. "The contractor brought in people and equipment, and we provide the space," said Dan O'Brien, a Navy managed care analyst who helps set up resourcesharing agreements.

In June, Bremerton's obstetrics/gynecology department will add 21 contract employees to its staff. The hospital expects to increase deliveries of babies 50 percent, to more than 100 a month, O'Brien said.

"We're also looking at staffing an unused operating room with a contractor," he said.

These agreements reduce TRICARE Standard costs and offer patients the convenience of "onestop shopping," O'Brien said. "By bringing services into the hospital, patients can visit their doctor, the laboratory and the pharmacy at a single location. And they get cohesive care in a military environment they're used to.

"We're exploring other ways of regionalizing and swapping services between military treatment facilities in Region 11," O'Brien continued. "TRICARE has created an environment where there is less interservice rivalry. In Region 11, we're taking a DoD team approach to delivering health care."