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TRICARE South Reserve/Guard Advisory Committee

TRICARE South Reserve/Guard Advisory Committee. 12 March 2008. Overview. Welcome TRICARE Programs Update TRICARE Access Standards TRICARE Provider Network Issues TRICARE Educational Opportunities Feedback from the Field Closing Comments. TRICARE Programs Update.

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TRICARE South Reserve/Guard Advisory Committee

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  1. TRICARE South Reserve/Guard Advisory Committee 12 March 2008

  2. Overview • Welcome • TRICARE Programs Update • TRICARE Access Standards • TRICARE Provider Network Issues • TRICARE Educational Opportunities • Feedback from the Field • Closing Comments

  3. TRICARE Programs Update

  4. TRICARE Programs Update • TRICARE Reserve Select • TRICARE Prime Remote • TRICARE Pharmacy • TRICARE Dental • Behavioral Health Provider Locator & Appointment Assistance • Problems Experienced by Guard/Reserve Members - Eligibility (DEERS) - Web Access for TRS Enrollment • Solution to These Problems - Educate Service Members at All Levels

  5. South Region TRICARE Reserve Select by State Source: TRICARE Regional Office South, Network Operations, Jack Shircel, 210-292-3219; M2, 5 Mar2008 (Data as of 1 Feb 08) 5

  6. TRICARE Prime Remote • Regions North, South, & West: 193,610 • South Region: 49,097 (Guard/Reserve: 29,552 – 60%) • South Region Enrollment Increased (since Dec 07): 1,222

  7. Pharmacy Costs for Non-ADSMs Big Cost Savings When Using the TRICARE Mail Order Pharmacy (TMOP) Option: Co-pay costs for one year supply of non-formulary medication using retail and TMOP: Retail Pharmacy:$264 vs. TMOP: $88 (Save $176) Savings for other medication types using TMOP for one year medication supply: Brand Name: $72 Generic: $24 TMOP PHONE # - (866) 363-8667

  8. TRICARE Region South - Guard / Reserve Pharmacy Usage Number of Prescriptions Guard / Reserve Sponsor Guard / Reserve Family Member • Direct care is most cost-effective option; TMOP is next best • TMOP saves DoD and beneficiaries money • Beneficiaries can save up to 66% for maintenance meds • DoD pays 30-40% less for prescriptions compared to retail • 1% shift of prescriptions from retail to TMOP saves DoD $24 million/year 8 Source: TRICARE Regional Office South, Network Operations, Jack Shircel, 210-292-3219; M2, 5 Mar 2008 (Data as of 1 Feb 08)

  9. Behavioral Health Provider Locator & Appointment Assistance • One on one assistance for ADSMs and Prime enrolled ADFMs with locating and scheduling appointments with behavioral health providers. • Toll free: 1-877-298-3514 • New behavioral health access standard: - Urgent < 24 hours - Routine < one week

  10. TRICARE Prime Access Standardsand Travel Benefit

  11. TRICARE Prime Access Standards • Primary Care Appointments - Emergency Care 911/Report to the Nearest ER - Time30 Minutes to Primary Care Manager - Urgent Care Seen in 24 Hours - Routine Care Seen Within 7 Days - Wellness Visits Seen in 28 Days • Specialty Care Appointments - 60 Minutes Drive Time From Primary Care Manager’s Office - Urgent Specialty Care Seen Within 24 Hours - Routine Specialty Care Seen Within 28 Days

  12. Prime Travel Benefitand Claims Processing • Prime Travel Benefit - Non-AD Prime Enrollees - PCM Referred Specialty Care/More Than 100 Miles Away • Travel Requests - MTF Enrolled -- travel coordinated thru MTF - Network Enrolled -- travel coordinated thru TRO - South

  13. TRICARE Provider Network Issues

  14. TRICARE Provider Network Issues Network Development • Benefits of 100% Prime for Guard and Reserve (in South Region) - Building the Network with you in mind - What to do if local care is not available: -- Contact Humana Military (HMHS) at 1-800-444-5445 • Average Drive Time for Primary Care and Specialty Care - Primary Care Manager = 3.3 miles - Specialist/Hospital = 6.5 miles • Recruiting Providers - Referrals Outside the Network is an indicator of potential network need - Providers interested in joining network contact HMHS at 1-800-444-5445 - Possible solutions -- solicitation of state medical associations -- Governor/legislative support

  15. TRICARE Educational Opportunities

  16. TRICARE SouthEducational Opportunities Direct 2U - TRO-S Web-based Interactive Training Types of TRICARE Briefings - Mobilization/Demobilization - Targeted Briefings (i.e. Pre-retirement) Scheduling TRICARE Briefings - On-line Request Form http://www.tricare.mil/trosouth/Reserve-Guard_Education.cfm

  17. HMHS STAR FORCE ENHANCED SUPPORT PLAN Outreach to Senior Leaders and Families Customer Service National Guard and Reserve Members and Dependents Education And Training Web Site Development STAR FORCE = Skilled Trained and Ready Focus on Reserve Components - Enhanced

  18. STAR FORCE EDUCATION & TRAINING • Education and Training Offered: • Senior Leader Briefings • HMHS Web Site (Guard and Reserve Page) • Video Briefings (Guard and Reserve Page) • Video (7 modules) http://www.humanamilitaryguardreserve.com/skins/ngr/home.aspx • Education and Training Completed: • Unit Briefings • 311 in 2007 (67 scheduled in 1st qtr of 2008) • National, Regional and State Conferences • ROA, NGAUS, EANGUS, REA, and State Associations

  19. FEEDBACK FROM THE FIELD

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