Presentation on theme: "TRICARE Overseas Pacific Year in Review, Today’s Challenges, Tomorrow’s Solutions Director, TAO-Pacific."— Presentation transcript:
TRICARE Overseas Pacific Year in Review, Today’s Challenges, Tomorrow’s Solutions Director, TAO-Pacific
2 TMA Announcement/Direction Request For Proposal & New Overseas contract is off limits and will NOT be discussed. Any questions should be directed to POC below: Mr. Thomas L. Griffin Contracting Officer TRICARE Management Activity Ph: 303.676.3823 FAX: 303.676.3987
3 Military Health System (MHS) Mission Our team provides optimal Health Services in support of our nation’s military mission — anytime, anywhere.
4 MHS Mission Patient Care, Sustain Skills and Training Promote & Protect Health of the Force Deploy to Support the Combatant Commanders to and In Peace & War Manage Beneficiary Care Deploy A Healthy Force Manage Beneficiary Care Deploy A Healthy Force Deploy Medical Force Manage Beneficiary Care
5 MHS Vision The provider of premier care for our warriors and their families An integrated team ready to go in harm’s way to meet our nation’s challenges at home or abroad A leader in health education, training, research, and technology A bridge to peace through humanitarian support A nationally recognized leader in prevention and health promotion Our nation’s workplace of choice
6 TRICARE Facts and Figures 9.2 million TRICARE Eligible Beneficiaries 5.0 million TRICARE Prime Enrollees 2.2 million Non-enrolled Users 1.6 million TRICARE For Life 167,000 TRICARE Plus 96,000 US Family Health Plan 75,000 Age 65 & older (not TRICARE For Life) 57,000 TRICARE Reserve Select
7 TRICARE Facts and Figures MHS Direct Care Facilities 63 Military Hospitals 413 Medical Clinics 413 Dental Clinics 133,500 MHS Personnel 89,400 Military 44,100 Civilian
8 $42.2 billion FY07 Budget (Unified Medical Program) $23.7 billion Defense Health Program $11.2 billion Medicare Eligible Retiree Accrual Fund $6.9 billion Medical Military Personnel $0.4 billion Medical Military Construction
9 A Week in The Life of the MHS 18,500 Inpatient Admissions 4,800 Direct Care 13,700 Purchased Care Outpatient Workload (Direct care only) 664,000 Professional Outpatient Encounters 2,240 Births 980 Direct Care 1,260 Purchased Care
10 A Week in The Life of the MHS 2.3 million Prescriptions 1.2 million Retail Pharmacies 940,000 Direct Care 175,000 Mail Order 3.7 million Claims Processed $809 million Weekly Bill – Purchased care
12 Wounded Warrior Program Most significant Military Health Issue Walter Reed and Disability System Issues DOD and Congressional Support VA Partnerships TMA and Service Initiatives “More than just medical care at the bedside, but the comprehensive levels of coordination, communication, and caring for America’s heroes”
13 The Dole-Shalala Commission Recommendations (10/2007) : 1.Modernize and improve the disability and compensation systems 2.Aggressively prevent and treat post traumatic stress disorder (PTSD) and traumatic brain injury (TBI) 3.Significantly strengthen support for families 4.Create comprehensive recovery plans to provide the right care and support at the right time in the right place 5.Rapidly transfer patient information between DoD and the VA 6.Strongly support Walter Reed by recruiting and retaining first- rate professionals through 2011
14 PTDS, MH, Wounded Warrior On-line tools for AD and family (PTDS/MH) –http://www.afterdeployment.org/ –http://www.MilitaryOneSource.com –http://www.mentalhealthscreening.org/http://www.mentalhealthscreening.org/ –http://www.tricare.milhttp://www.tricare.mil –http://www.militarymentalhealth.org Wounded Warriors – Service Links –http://www.aw2.army.milhttp://www.aw2.army.mil –http://www.npc.navy.mil/commandsupport/safeharborhttp://www.npc.navy.mil/commandsupport/safeharbor –http://email@example.com –http://www.m4l.usmc.milhttp://www.m4l.usmc.mil
15 Sesameworkshop.Org http://archive.sesameworkshop.org/tlc/index.php This bilingual (English and Spanish) multimedia outreach program is designed to support military families with children between the ages of two and five who are experiencing deployment, multiple deployments, or a parent's return home changed due to a combat-related injury. To order your FREE kit, visit Military OneSource.visit Military OneSource Download the materials: Magazine for Parents and Caregivers (PDF) Magazine for Parents and Caregivers Children's Poster (PDF) Children's Poster Facilitator Guide (PDF) Facilitator Guide Supplement to the Facilitator Guide (PDF) Supplement to the Facilitator Guide Download the videos: Deployments (WMV) Deployments Deployments (For Grown Ups) (WMV) Deployments (For Grown Ups) Homecomings (WMV) Homecomings Homecomings (For Grown Ups) (WMV) Homecomings (For Grown Ups) Changes (WMV) Changes Changes (For Grown Ups) (WMV) Changes (For Grown Ups) Download the music: Proud (MP3) Proud Change (MP3) Change Change - Raul Midon (MP3) Change - Raul Midon We Can Do It (MP3) We Can Do It
16 Seamless transition of health services from MHS and the VA - critical elements: A full understanding of medical care capabilities within both agencies by all medical providers involved, Clear communications of the transition plan between providers in each agency and with the patient and patient's family, Timely transfer of all pertinent medical records before or at the time of transfer of the patient, and Ongoing communication after the transfer of the patient between the medical providers in each agency and with the patient and patient's family.
17 Centers Dedicated to Wounded Warrior Care Walter Reed Army Medical Center Amputee Care Center and Gait Laboratory National Naval Medical Center’s Traumatic Stress and Brain Injury Program Center for the Intrepid - state-of-the-art rehabilitation facility and Brooke Army Medical Center Burn Center at Ft. Sam Houston Naval Medical Center San Diego Comprehensive Combat Casualty Care Center The multi-site DoD/VA Defense and Veterans Brain Injury Center for patient care, education, and clinical research Warrior Transition Units – later brief
18 Overseas Contract Off limits for conference discussion See Section C in RFP for Identification of Contract Requirements
19 ADSM Travel Benefit Expanded TGRO benefit to MTF countries Implemented on April 14, 2008 Covers urgent and emergent care throughout Overseas Countries -(Deployments / Exercises / TDY / Leave) –Guarantee of Payment –Referral and Medical Advice –Right of First Refusal ADFM benefit (emergent care) October 2
20 ADSM Claims Processing - WPS Pacific ADSM not referred under supplemental health care program can now file claim through WPS Previously, ADSM had difficulties getting reimbursement from Units or MTFs Does not substitute for Supplemental Health Care Program
21 Shipboard Referral for Care Seventh Fleet message – Aug 1, 2008 –Clarifies program, roles and responsibilities 7 th Fleet SG / TAO-P Medical Director will discuss in more detail in later session
22 TAO-P Satellite Offices Philippines support >12K retirees/families –More detail in later session Korea – Senior leadership request/support –Deputy Director TMA working with Leadership –Update from Korea in later session
23 Retiree Dental Program Startup in Overseas Locations 10/1/2008 Monthly Premium: –Single: $37 2-Person: $71 Family: $118 For more information, see TRDP.Org Retirees continue to get Space-A care Provides insurance for HN referrals
24 TRICARE Cost and Workload Does Not Include Supplemental Health Care Claims
30 Upfront Payment HN Care Challenge: Financial burden on patients/ Impact on HN provider relationships Solutions: Supplemental Health Care Program Relief Societies – no cost loan MOU HN support for delayed payment TSC support for claims filing – later brief See Section C
31 Supplemental Health Care 32 C.F.R. § 199.16 Supplemental Health Care Program for active duty members –(a.3) This section applies to all health care services covered by the CHAMPUS. For purposes of this section, health care services ordered by a military treatment facility (MTF) provider for an MTF patient (who is not an active duty member) for whom the MTF provider maintains responsibility are also covered by the supplemental care program and subject to the requirements of this section. MTFs should work with Service Resource Management to clarify Service positions
32 Supplemental Health Care The SHCP exists under authority of 10 USC 1074(c) and 32 CFR 199.16(a)(3). The use of the SHCP for pay for care referred by MTF providers is governed by Assistant Secretary of Defense (Health Affairs) (ASD(HA)) Policy Memorandum 96-005, “Policy on Use of Supplemental Care Funds by the Military Departments” (October 18, 1995). That policy states, in pertinent part: “Circumstances where supplemental funds may be used to reimburse for care rendered by non-governmental health care providers to non-active duty patients are limited to those where a medical treatment facility (MTF) provider orders the needed health care services from civilian sources for a patient, and the MTF provider maintains full clinical responsibility for the episode of care. This means that the patient is not disengaged from the MTF that is providing the care.”
33 Network Providers Challenge: MOU providers are not network providers / Acceptance of our Patients Solutions: Clear Communication and Understanding Roles and Responsibilities for MTFs, HN Providers and Beneficiaries Timely and Accurate payment is Key See Section C
34 Understanding HN Care Challenges: Patients don’t know what to expect when referred to HN providers Solutions: –Guide to understand differences between US and Japan/Korea/Guam/Remote health care systems –Pregnancy and Delivery Guides –Videos and Books –Sensitivity to HN provider’s profession/culture
35 Emergency Care in Japan Have your local address available Off Base dial 119; On Base dial 911 Do not hang up until directed to do so Helpful phrases: Emergency. HelpKyuu-kan desu I don't speak JapaneseNihongo Wakarimasen Do you speak English?Eigo Wakarimasuka I need an ambulanceKyuu-kyuu sha O negai shimasu -- Preauthorization is not required for emergency care -- If you are treated in a host nation hospital, contact the TRICARE Service Center or your unit as soon as possible. Visits by MTF staff or relocation to an MTF may be possible.
36 Emergency Care in Korea Have your local address available Off Base dial 911; On Base dial 911 Do not hang up until directed to do so Helpful phrases: Emergency. Help.Eung Geup! Do Ah Joo Sae Yo! I don't speak Korean.Han Gook Mar Mot Hae Yo. Do you speak English?Young Uh Ha Sae Yo? I need an ambulance.Am Bue Lan Ce Boo Juh Hoo Sae Yo!
37 Command Sponsored Prime Challenges: Non-command sponsored ADFM not eligible for Prime. Solutions: –Seek command sponsorship – Personnel issue –If Services allow, use supplemental health care for referrals –Relief Societies for no cost loan ADFM non Prime Responsibilities: –$1000 catastrophic cap / 20% copayment / $150 Individual or $300 family deductible
38 DoD Civilian / Contractor Care Challenges: HN provider expect MTFs to pay for all “American” care / Issues with civilians and contractors affect TRICARE Solutions: –Educate HN providers and de-link TRICARE –Clear understanding – patient “on own” –Identify participating HN providers for insurance carrier (Next slides) –Not in Section C
39 Blue Cross/Blue Shield Hospitals Seoul, Korea Seoul Adventist Hospital General Hospital 29-1 Hwi Kyung-Dong Seoul, South Korea Soon Chun Hyang University Hospital General Hospital 657 Hannam Dong Seoul, South Korea Seoul Wooridul Spine Hospital Orthopedic/Spine Treatment 47-4 Chungdam-Dong Gangnam-Gu Seoul, South Korea
40 BC/BS Providers (22 in Seoul) Chai, Soo Eung, Urology Samsung Medical Center #50 Ilwon-Dong Chu, In Sook, Pediatrics Samho Apt.Annex Room 201, Seocho-Ku Kim, Young Joe, Orthopedics Samsung Cheil Hospital Lee, Eil-Soo, Dermatology Samsung Medical Center #50 Ilwon-Dong Lee, Je Ho, Obstetrics & Gynecology Samsung Medical Center #50 Ilwon-Dong Linton, John, Family Practice Severance Hospital, Intl Clinic
41 Find a Provider – Blue Cross / Blue Shield (Seoul, Korea)- similar in Japan 25 providers matched your search criteria. To arrange service with a provider, or if you did not find a suitable provider, please contact the Overseas Service Center 1-800-699-4337 or call collect at 1-804-673-1678. Civilian or contractor – patient responsibility! Clearly communicate! No confusion for MOU providers.
42 Infrastructure Changes Challenges: Planning for force structure changes (Guam/Japan), Normalization (Korea), Deployments (All) Solutions: Work with Services to ensure right size of MTF for capabilities and capacities See Section C Use business planning tools (later brief) Later briefings of Footprint changes
43 Drive Times to HN Providers Challenges: Long drive times to HN providers for emergencies Solutions: USFK or USFJ medivac system (Heli) MOU or contract with local host nation medivac system – Dr. Heli Travel times are relative – compare with Medivac to Hawaii or CONUS
44 Host Nation Providers Challenge: Cultural Differences, Quality of Care, Acceptance of referrals Solutions: Educate Beneficiaries –What to expect when referred Visit Providers, Survey patients Pay bills, See Section C Later briefings to cover
45 HN Relationship Building Don’t just focus on CEOs, middle managers (Admissions, Billing) may be just as important Tea is ok, but sake/soju/scotch may be better Invite to base, MTF, golf course Understand the culture and traditions –Small gifts, coins, letters of appreciation Respect – they don’t need our business Good Relationships are Key for Success – MTFs will need to foster even under new contract
47 U.S Health Care Despite spending over $2 trillion a year on health care - 18% of the U.S. GDP and twice as much as any other nation –United States ranks only 45th in life expectancy and 37th in a World Health Organization study on the performance of national health systems. 1,2 1 CIA: The World Factbook, June 19, 2007.The World Factbook 2 "Health Systems Performance Assessment," World Health Organization
48 U.S. Health Care In 1960, health care accounted for $1 of every $20 spent in the US economy In 2008, it is $1 of every $6 Congressional Budget Office estimates it could be $1 of every $4 by 2025 How Does DOD Health Spending Compare?
49 Growth in the Unified Medical Budget (Excluding GWOT)
50 Value of Managing Defense Health Spending If DoD Health Budget grows at recent trend rates, it will reach $64 B, or 12% of DoD topline in 2015 If DoD Health Budget managed to 8% of DoD topline, budget will reach $44 B in 2015 2006 DoD Health Budget = 8% of total DoD Budget Projections are for 12% by FY 2015
52 MHS Predictions Defense budget increases will slow Shift of healthcare resources from DOD to Veterans Affairs Continued Shift of Health Care Resources from MTFs to Civilian Sector Transparency will increase for cost and quality of medical care – Performance Senior DoD leadership will Challenge MHS to become more efficient and effective
53 Fixing our Health Care System The public needs to be educated about the differences between wants, needs, affordability, and sustainability at both the individual and aggregate level Ideally, health care reform proposals will: Align Incentives for providers and consumers to make prudent decisions about the use of medical services, Foster Transparency with respect to the value and costs of care, and Ensure Accountability from insurers and providers to meet standards for appropriate use and quality Ultimately, we need to address four key dimensions: access, cost, quality, and personal responsibility
54 Key Leadership Attributes Needed for These Challenging Times Courage Integrity Creativity Partnership Stewardship