The new regional contracts are the fourth generation of Managed Care Support Contracts since 1994. As with each generation of Managed Care Support Contracts, the Military Health System (MHS) seeks to improve the delivery, quality, and cost of health care services from previous contracts.
The new contracts were awarded on July 21, 2016. The East Region contract goes to Humana Government Business, Inc. of Louisville, Kentucky, and the West Region contract goes to Health Net Federal Services, LLC of Rancho Cordova, California. These contracts will provide:
- A solid foundation for future initiatives.
- A more cost-effective and efficient managed care contract.
- Improvements to enable better health care benefit administration.
There are two key changes in the new contracts.
Improved Integration across the MHS
The MHS consists of Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care and Purchased CareThe TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts.purchased care. To enhance our beneficiaries’ experience of care, the new contract improves integration between direct care and purchased care by requiring the Managed Care Support Contractors to:
| Change |
Resulting in ... |
| Process referrals electronically |
- Decreased wait times for beneficiaries to get specialty care.
- Less administrative burden for military hospitals and clinics
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Share more data across the enterprise
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- Improved beneficiary care coordination and access to care.
- Real time access to data on utilization and medical management.
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| Increase the use of analytics and standardized metrics |
- Fewer gaps in care.
- Improved clinical quality and patient safety.
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Reduction of Three TRICARE Regions to Two
There are currently three TRICARE regions in the United States: North, South, and West. The new contract reduces the number of regions to two.
- East Region (merges current North and South Regions)
- West Region (same as the current West Region)
The two-region concept supports consistency in benefit administration by reducing administrative variation across regions, reducing administrative cost, and providing seamless support to a mobile TRICARE beneficiary population.
There is a 9-month transition period between the contracts. Visit the TRICARE website and sign-up for email alerts about the new contracts.
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Article
8/1/2016
The Government Accountability Office (GAO) notified the Defense Health Agency (DHA) that multiple vendors have filed formal protests against the TRICARE 2017 East Region Contract and TRICARE 2017 West Region Contract award announcements made July 22, 2016.
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New Regional Contracts to Administer the TRICARE Benefit
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