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TRICARE 101 TRICARE Management Activity

TRICARE 101 TRICARE Management Activity. SGM Harry Robinson, Jr. Senior Enlisted Advisor TMA 18 June 2002. RADM Mayo JCS, J4 MRD. George W. Bush The President. VADM Cowan NAVY SG. Congress. Donald Rumsfeld SecDef. LTG Peake ARMY SG. The Military Coalition. David Chu USD (P&R).

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TRICARE 101 TRICARE Management Activity

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  1. TRICARE 101TRICARE Management Activity SGM Harry Robinson, Jr. Senior Enlisted Advisor TMA 18 June 2002

  2. RADM Mayo JCS, J4 MRD George W. Bush The President VADM Cowan NAVY SG Congress Donald Rumsfeld SecDef LTG Peake ARMY SG The Military Coalition David Chu USD (P&R) Lt Gen Carlton Air Force SG William Winkenwerder JR ASD (HA) TBD Clinical Programs & Policy TBD Health Operations Policy Mr Carrato TMA TBD Health Program Integration & External Affairs TBD Health Budgets & Financial Policy The Big Picture

  3. OSD J1 J2 J3 J4 J5 J6 J7 J8 TRANSCOM SPACECOM SOCOM STRATCOM The Big Picture SERVICES The President ARMY SecDef SG ASD (HA) AIR FORCE TMA SG NAVY Chairman, JCS SG USMC The Joint Staff JFCOM PACOM EUCOM CENTCOM SOUTHCOM Functional CINCs Geographic CINCs

  4. 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

  5. TRICARE isthe same as before(CHAMPUS = TRICARE Standard)Plus More(TRICARE Prime, Extra, TRICARE For Life and TRICARE Plus)TRICARE isa Better Benefit

  6. 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

  7. TRICARE Goals • Improve Medical Readiness • Improve Access • Maintain High Quality • Contain Costs

  8. Beneficiary Counseling &Assistance Coordinator(BCAC)& Debt Collection Assistance Officer(DCAO) Program Update

  9. 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

  10. BCACs & DCAOs are here for YOU! • Major Customer Service Initiative • Legislative Mandate • Expert Assistance -- Utilize Them! • World-wide listing on web

  11. TRICARE Options • TRIPLE OPTION • TRICARE PrimeHMO Option (Requires Enrollment and Cost Shares) • TRICARE ExtraPPO (Deductibles and Cost Shares) • TRICARE StandardStandard CHAMPUS (Fee For Service)

  12. TRICARE Prime:A Superb Health Benefit • Occupational Therapy • Prescription Drugs • Mail Order Discount Plan • Vision Benefits • Mammography • Mental Health • Dental Superior to Most Civilian Health Plans

  13. Yes Yes Standard CHAMPUS No Yes Yes TRICARE ProvidesReal Choice Enrollment Fee Co-Pay Deductible TRICARE OPTIONS No for Active Duty & Family Members Yes for Retirees & Family Members No Prime (HMO) No Yes No Extra (PPO)

  14. 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

  15. Office of Personnel Management, Government Executive Article, 18 September 2000: “2001 Costs to Rise 10.5% in Federal [Civilian] Health Plan” Source: September 18, 2000, “Health premiums rise even higher than expected” , by Katy Saldarini ksaldarini@govexec.com

  16. 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

  17. 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

  18. But not so with TRICARE TRICARE Prime has maintained stable enrollment fees since its inception. Also ... TRICARE Standard (CHAMPUS) deductibles have not increased since 1992

  19. 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)

  20. If you have a… , or a you have access to unlimited, free, accurate information about TRICARE

  21. Access Standards • 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

  22. Satisfaction:Moving in the Right Direction Source: 1995 - 1998 Annual Health Care Survey of DoD Beneficiaries

  23. TRICARE Program EvaluationSignificant Findings, FY2001 • 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 GOOD Source: Center for Naval Analyses, Congressionally-directed evaluation of all of the TRICARE regions, Draft Version July 2001

  24. Effects of Region Maturity Percentage of Prime Enrollees Satisfied with Indicator Source: Center for Naval Analyses, Congressionally-directed evaluation of eight TRICARE regions, August 2000, DRAFT

  25. NDAA 01 Effective DateImplementation 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

  26. NDAA 02 Effective Date Implementation Date Skilled Nursing Facility-PPS Benefit Dec 28, 01Feb 03* Payment Apr 1, 01Feb 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.

  27. 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

  28. Uniform Formulary Pharmacy Copay Structure

  29. 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

  30. 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

  31. If you Educate them first...

  32. They’ll be ready to do this …

  33. Leadership is the key

  34. Questions

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