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As of 04/19/23 1
TRICARE 101TRICARE Management Activity
SGM Harry Robinson, Jr.
Senior Enlisted Advisor TMA
18 June 2002
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As of 04/19/23 2
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As of 04/19/23 3
George W. BushThe President
Donald RumsfeldSecDef
David Chu USD (P&R)
William Winkenwerder JR ASD (HA)
Mr CarratoTMA
TBDHealth Program Integration
& External Affairs
TBDHealth Budgets & Financial Policy
TBDClinical Programs & Policy
TBDHealth Operations Policy
VADM CowanNAVY SG
LTG PeakeARMY SG
Lt Gen CarltonAir Force SG
Congress
The Military Coalition
RADM MayoJCS, J4 MRD
The Big Picture
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As of 04/19/23 4
The Big Picture
SOCOM
TRANSCOM SPACECOM
STRATCOM
JFCOM PACOM
EUCOM CENTCOM SOUTHCOM
Functional CINCs Geographic CINCs
The President
Chairman, JCS
USMC
AIR FORCE
NAVY
ARMY
SERVICES
OSDSecDef
ASD (HA)
TMA
SG
SG
SGJ1 J2 J3 J4 J5 J6 J8J7
The Joint Staff
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As of 04/19/23 5
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As of 04/19/23 6
What is TRICARE?
A Healthcare Program Using Military Healthcare as the Main Delivery System
• Augmented by a Civilian Network of Providers and Facilities
• Serving our Active Duty, Their Families, and Retired Military/Families World Wide
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As of 04/19/23 7
TRICARE isthe same as before
(CHAMPUS = TRICARE Standard)
Plus More(TRICARE Prime, Extra, TRICARE For
Life and TRICARE Plus)
TRICARE isa Better Benefit
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As of 04/19/23 8
Why TRICARE?
• 1980’s: DoD faced with rising health costs• 1990’s: Modernization vs. Infrastructure• Flat DoD budget, decreasing active duty, medics• Our beneficiaries still need access• Makes good business sense• TRICARE managed care strategy initiated
– Preserve readiness mission– Increase choice, Improve access– Control costs
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As of 04/19/23 9
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As of 04/19/23 10
TRICARE Goals
• Improve Medical Readiness
• Improve Access
• Maintain High Quality
• Contain Costs
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As of 04/19/23 11
Beneficiary Counseling &Beneficiary Counseling & Assistance CoordinatorAssistance Coordinator (BCAC)(BCAC) & &
Debt Collection Assistance Debt Collection Assistance OfficerOfficer (DCAO)(DCAO)
Program UpdateProgram Update
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As of 04/19/23 12
BCAC & DCAO Roles & Responsibilities Overview
• Responsible for casework and resolution for all cases presented
• Assist beneficiary in determining basis for debt collection
• Collect copies of all pertinent documentation; i.e., provider bills and notices, TRICARE EOBs, letters from providers/credit reporting agencies, etc.
• Obtain Privacy Act Notice from beneficiary• Assign case number and maintain tracking sheet • Notify provider(s), collection or credit reporting agency
that beneficiary’s case is under review.• Adhere to predetermined reporting requirements of
TMA as outlined in the DCAO Training Guide
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As of 04/19/23 13
BCACs & DCAOs are here for BCACs & DCAOs are here for YOU!YOU!
• Major Customer Service Initiative
• Legislative Mandate
• Expert Assistance -- Utilize Them!
• World-wide listing on web
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As of 04/19/23 14
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As of 04/19/23 15
TRICARE Options
• TRIPLE OPTION
• TRICARE Prime HMO Option (Requires Enrollment and Cost Shares)
• TRICARE Extra PPO (Deductibles and Cost Shares)
• TRICARE Standard Standard CHAMPUS (Fee For Service)
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As of 04/19/23 16
• Occupational Therapy • Prescription Drugs
– Mail Order Discount Plan
• Vision Benefits • Mammography• Mental Health• Dental
TRICARE Prime:A Superb Health Benefit
Superior to Most Civilian Health Plans
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As of 04/19/23 17
TRICARE ProvidesReal Choice
Enrollment Fee Co-Pay Deductible
No
YesYes
Standard CHAMPUS
No Yes Yes
YesNoPrime (HMO)
No for Active Duty & Family Members
Yes for Retirees & Family Members
Extra (PPO)
TRICARE OPTIONS
No
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As of 04/19/23 18
TRICARE Costs
Active Duty Members• No Cost for Care to Active Duty Members• Care Normally Provided in Military Facilities• Supplemental and/or Emergency Care in
Civilian Facilities Paid for 100%• Active Duty Enrolled in Prime
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“2001 Costs to Rise 10.5% in Federal [Civilian] Health Plan”
Premium Increases 1998-2002
FEHBP TRICARE
1998 7.2% 0%
1999 9.5% 0%
2000 9.3% 0%
2001 10.5% 0%
TOTAL 36.5% Increase No Increase
Office of Personnel Management, Government Executive Article, 18 September 2000:
Source: September 18, 2000, “Health premiums rise even higher than expected” , by Katy Saldarini [email protected]
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As of 04/19/23 20
7%5%
22%
18%18%
15%
15%Impact of Litigation
Fraud, Abuse and other costs
Drugs, Medical devices and other medicaladvances
Rising Provider Expenses
Inflation
Increased Demand
Government Mandates and Regulation
Health Care Costs
Factors contributing to the rising cost in health care insurance premiums
Source: “Employer Health Costs Rise 10%,” Miami Herald, 5/3/2002
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As of 04/19/23 21
Health Costs Could Double by 2011
• By 2011, Americans are expected to spend $9,216 per person on health care, about double what
they spent in 2000.
• Health Costs are expected to grow at a rate of 7.3% annually between now and 2011.
• Health Care spending could reach $2.8 trillion, or 17% of the nation’s gross domestic
product, by 2011, up from 13.2 percent in 2000.
• Spending on prescription drugs, the fastest growing part of health spending, is
expected to slow, dropping from 17.3% growth in 2000 to 10.1% in 2011.
Source: Washington Post, 3/11/2002
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As of 04/19/23 22
TRICARE Prime has maintained stable enrollment fees since its inception.
$0
$100
$200
$300
$400
$500
1995 1996 1997 1998 1999 2000 2001
Enr
ollm
ent F
ees Retiree Family $460
Retiree/Individual $230
Active Duty & Family $0
Also ... TRICARE Standard (CHAMPUS) deductibles have not increased since 1992
But not so with TRICARE
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As of 04/19/23 23
Where Beneficiaries Go For Help
• Local Military Treatment Facility (MTF)
• Local TRICARE Service Center (TSC)
• Beneficiary Counselors and Assistance Coordinators (BCAC)
• Debt Collection Assistance Officers (DCAO)
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As of 04/19/23 24
If you have a…
, or a
you have access to unlimited, free, accurate
information about TRICARE
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As of 04/19/23 25
• TRICARE Prime Access Standards• Emergency Care (911 or Nearest Emergency Room)
– 24 Hours a Day, 7 Days a Week
• Primary Care Wait Times– 1 Day - Acute Illness
– 1 Week - Routine Visit
– 1 Month - Well Visit
• Well/Specialty Care Wait Times– 1 Day - Urgent Care
– 1 Month - Routine Visit
• 24 Hour Toll Free Health Care Information Line
• 24 Hour Toll Free TRICARE Service Line
Access Standards
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As of 04/19/23 26
Satisfaction:Moving in the Right Direction
44%
59% 63%69%
64%
74% 74%
79%
66%
71%76%
81%
0%
20%
40%
60%
80%
100%
Per
cen
t Sat
isfie
d
Satisfaction WithAccess to Appointments
Satisfaction WithAccess to System
Resources
Satisfaction WithQuality
All Beneficiaries, All Sources of Care
1995 1996 1997 1998
Source: 1995 - 1998 Annual Health Care Survey of DoD Beneficiaries
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As of 04/19/23 27
TRICARE Program EvaluationSignificant Findings, FY2001
Source: Center for Naval Analyses, Congressionally-directed evaluation of all of the TRICARE regions, Draft Version July 2001
• In All of the Regions, TRICARE:– Improved access to care
» Greater use of preventive care» Easier to get appointments» Shorter wait to see provider» Decreased ER use
– Increased satisfaction with quality of care
• Satisfaction with TRICARE increases over time
• Results consistent across TRICARE regions
GO
OD
GO
OD
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As of 04/19/23 28
Effects of Region Maturity
Percentage of Prime Enrollees Satisfied with Indicator
Region Maturity (Years Into TRICARE)
Measure Pre-TRICARE +1 +2 +3
Access to carewhen needed 59% 71% 73% 78%
Overallquality of care 68% 77% 80% 85%
Source: Center for Naval Analyses, Congressionally-directed evaluation of eight TRICARE regions, August 2000, DRAFT
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As of 04/19/23 29
NDAA 01
Effective Date Implementation Date
MOH 30 Oct 00 1 Apr 01
Survivor Ext. 30 Oct 00 1 Apr 01
Senior Pharm 1 Apr 01 1 Apr 01
ADD Copays 1 Apr 01 1 Apr 01
TPR FM-Waived Charges 30 Oct 00 1 Aug 01
School Physicals 30 Oct 00 15 Dec 01
Cat Cap 30 Oct 00 15 Dec 01
Travel Entitlement 30 Oct 00 15 Feb 02
TPR-FM 1 Oct 01 1 Sep 02
TFL 1 Oct 01 1 Oct 01
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As of 04/19/23 30
NDAA 02
Effective Date Implementation Date
Skilled Nursing Facility-PPS
Benefit Dec 28, 01 Feb 03*
Payment Apr 1, 01 Feb 03*
Home Health Care-PPS
Benefit Dec 28, 01 Oct 03*
Payment Apr 1, 02 Oct 03*
Custodial Care Definition (NAR) Dec 28, 01 TBD
Custodial Care Definition (AR) Dec 28, 01 Oct 03*
ECHO (Modified PFPWD) Dec 28, 01 TBD
Prosthetics, Hearing Aids, Discretionary TBD
Augmentative Communication Devices
*These are Government estimates, subject to contract negotiations.
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As of 04/19/23 31
NDAA 02 Effective Date Implementation Date
Durable Medical Equipment Discretionary TBD
Rehabilitative Therapy Discretionary TBD
Travel Expense Reimbursements Dec 28, 01 Apr 1, 02
Payment Rates for Institutions Dec 28, 01 Apr 1, 02
and Balance Billing
NAS Dec 28, 03 TBD
or start date
of new contracts
Transitional Health Care
Demonstration Dec 28, 01 TBD
Enhanced Benefit Dec 28, 01 TBD
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As of 04/19/23 32
Uniform Formulary Pharmacy Copay Structure
Point of Service Generics Brand NameMilitary Treatment
Facility$0 $0
National MailOrder Pharmacy(up to a 90 day
supply)
$3 $9
TRICARE RetailNetworks (up to a
30 day supply)
$3 $9
Non-networkPharmacies
$9 or 20% of total cost (whichever isgreater) Existing deductibles apply
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As of 04/19/23 33
Where TFL Beneficiaries Go For Help
•• Senior Pharmacy•1-877-DOD-MEDS
•• TRICARE For Life•1--888-DOD-LIFE
• www.TRICARE.osd.mil• Local MTF• Retiree Affairs Offices• National Mil Coalition/Mil Vets Alliance
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As of 04/19/23 34
NDAA Conclusions
• Major Change in the Military Health Care Benefit• DoD has Implementation and Contracting
Responsibilities – Quality Health Care Delivery– Public Review and Comment on New Changes– Good Steward of Taxpayer Dollars
• More Information will be Released as Quickly as Possible
• Best Info Source Including Latest Version of this Briefing: www.tricare.osd.mil/ndaa
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As of 04/19/23 35
If you Educate them first...
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As of 04/19/23 36
They’ll be ready to do this …
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As of 04/19/23 37
LeadershipLeadership
is the keyis the key
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Questions
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As of 04/19/23 39