As of 9/14/ TRICARE 101 TRICARE Management Activity SGM Harry Robinson, Jr. Senior Enlisted Advisor TMA 18 June 2002

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

As of 9/14/ The Big Picture SOCOM TRANSCOMSPACECOM STRATCOM JFCOMPACOM EUCOMCENTCOMSOUTHCOM Functional CINCs Geographic CINCs The President Chairman, JCS USMC AIR FORCE NAVY ARMY SERVICES OSD SecDef ASD (HA) TMA SG J1J2J3J4J5J6J8J7 The Joint Staff

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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 9/14/ TRICARE is the same as before (CHAMPUS = TRICARE Standard) Plus More (TRICARE Prime, Extra, TRICARE For Life and TRICARE Plus) TRICARE is a Better Benefit

As of 9/14/ 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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10 TRICARE Goals Improve Medical Readiness Improve Access Maintain High Quality Contain Costs

As of 9/14/ Beneficiary Counseling & Assistance Coordinator (BCAC) & Debt Collection Assistance Officer (DCAO) Program Update

As of 9/14/ 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 9/14/ BCACs & DCAOs are here for YOU! Major Customer Service Initiative Legislative Mandate Expert Assistance -- Utilize Them! World-wide listing on web

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As of 9/14/ 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 9/14/ 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 9/14/ TRICARE Provides Real Choice Enrollment Fee Co-Pay Deductible No Yes Standard CHAMPUS NoYes No Prime (HMO) No for Active Duty & Family Members Yes for Retirees & Family Members Extra (PPO) TRICARE OPTIONS No

As of 9/14/ 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

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

As of 9/14/ 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 9/14/ 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 Health Costs are expected to grow at a rate of 7.3% annually between now and 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 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 Source: Washington Post, 3/11/2002

As of 9/14/ TRICARE Prime has maintained stable enrollment fees since its inception. Also... TRICARE Standard (CHAMPUS) deductibles have not increased since 1992 But not so with TRICARE

As of 9/14/ 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)

As of 9/14/ If you have a…, or a you have access to unlimited, free, accurate information about TRICARE

As of 9/14/ 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 9/14/ Satisfaction: Moving in the Right Direction Source: Annual Health Care Survey of DoD Beneficiaries

As of 9/14/ TRICARE Program Evaluation Significant 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 GOOD

As of 9/14/ 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

As of 9/14/ 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 Dec 01 Cat Cap 30 Oct Dec 01 Travel Entitlement 30 Oct Feb 02 TPR-FM 1 Oct 01 1 Sep 02 TFL 1 Oct 01 1 Oct 01

As of 9/14/ 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, 02Oct 03* Custodial Care Definition (NAR) Dec 28, 01 TBD Custodial Care Definition (AR) Dec 28, 01Oct 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 9/14/ NDAA 02 Effective Date Implementation Date Durable Medical Equipment DiscretionaryTBD Rehabilitative Therapy DiscretionaryTBD Travel Expense Reimbursements Dec 28, 01Apr 1, 02 Payment Rates for Institutions Dec 28, 01 Apr 1, 02 and Balance Billing NAS Dec 28, 03TBD or start date of new contracts Transitional Health Care Demonstration Dec 28, 01 TBD Enhanced Benefit Dec 28, 01TBD

As of 9/14/ Uniform Formulary Pharmacy Copay Structure

As of 9/14/ Where TFL Beneficiaries Go For Help Senior Pharmacy DOD-MEDS TRICARE For Life DOD-LIFE Local MTF Retiree Affairs Offices National Mil Coalition/Mil Vets Alliance

As of 9/14/ 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:

As of 9/14/ If you Educate them first...

As of 9/14/ They’ll be ready to do this …

As of 9/14/ Leadership is the key

Questions

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