# 99056. Leaders Unfold Plan to Modify, Strengthen TRICARE

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By Douglas J. Gillert
American Forces Press Service

WASHINGTON -- Defense health officials unfolded bold new ideas 
for making sure TRICARE works as planned to deliver quality 
health care in peace and war. The result could mean more care 
in-house and less from contractors.

Addressing the 1999 TRICARE conference here, DoD health chief 
Dr. Sue Bailey and others laid out a plan to address 
shortcomings in the managed health care plan. In the past six 
months, a group of Army and Air Force colonels and Navy captains 
has put together a scheme to re-engineer TRICARE administration.

Navy Dr. (Capt.) Donald Arthur, assistant chief of health care 
operations for the Navy Bureau of Medicine in Bethesda, Md., and 
a member of the re-engineering team, said the effort represents 
a complete "change of culture." He presented the plan Feb. 1 to 
several hundred TRICARE providers and administrators gathered 
here from around the world to discuss ways to fine-tune the 
health plan. 

The tri-service group's model ties staffing at military 
hospitals and clinics to their readiness mission. The facilities 
must have sufficient staffing to meet wartime requirements, he 
said, but they also must be augmented by available resources -- 
presumably a mix of civilian contract and military providers -- 
to meet peacetime requirements.

TRICARE was set up with the idea of complementing military 
resources with civilian contractors, so the plan doesn't seem 
like such a big change. But Bailey, assistant secretary of 
defense for health affairs, pointed out military resources are 
sometimes underused when DoD relies too much on contractors. She 
said that's going to change, beginning with the mostly 
contracted appointment system.

"I've initiated a review of the ratio of direct-care [in-house] 
phone awareness vs. contract," Bailey said. "I don't think we 
need to contract as much out." She said she plans to shifting 
functions back to the military is part of a larger effort to 
keep the promise and to restore members' trust in military 
medicine.

Bailey said the military has always provided quality health care 
to battlefields but hasn't been as faithful toward families. She 
there are inexorable links between wartime and peacetime 
medicine, including a well-trained medical team, a healthier, 
prevention-oriented beneficiary population and good information 
management. 

"We are the HMO that goes to war," Bailey said. "We need our 
bills paid, our phones answered and our appointments made." She 
said TRICARE's success depends greatly on improving the overall 
health of beneficiaries, of tracking their health through better 
recordkeeping, and through responding to patient concerns and 
perceptions.

"Perception is reality. We need to simplify the message, make 
our system user-friendly and keep congressional leaders informed 
of the link between peacetime and wartime health care," she 
said. And one old perception of military medicine she doesn't 
want TRICARE to repeat is that it's "better than nothing." 

"I want military medicine to be better than everything," Bailey 
said.

TRICARE Management Activity Director James Sears said the re-
engineering plan will enable TRICARE to reach its full 
potential. He said the necessity for change is absolute.

"There are many threats to dismantle TRICARE," Sears said. He 
said TRICARE administrators must figure out how to move military 
medicine "from sick call to managed care to a healthy 
population." Sears challenged the medics to build a more 
effective organization.

"We have it in our grasp," he said, "to make TRICARE work."

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