As of 04/19/23 1

TRICARE 101TRICARE Management Activity

SGM Harry Robinson, Jr.

Senior Enlisted Advisor TMA

18 June 2002

As of 04/19/23 2

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

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

As of 04/19/23 5

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

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

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

As of 04/19/23 9

As of 04/19/23 10

TRICARE Goals

• Improve Medical Readiness

• Improve Access

• Maintain High Quality

• Contain Costs

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

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

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 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)

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

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

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

“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 ksaldarini@govexec.com

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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

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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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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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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If you have a…

, or a

you have access to unlimited, free, accurate

information about TRICARE

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

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

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

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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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

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.

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

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

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

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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If you Educate them first...

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They’ll be ready to do this …

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LeadershipLeadership

is the keyis the key

Questions

As of 04/19/23 39