# 99011. Cost, Access, Quality Shape TRICARE Success in Northwest

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By Douglas J. Gillert
American Forces Press Service

WASHINGTON -- Reports from DoD's oldest TRICARE region show a 
high level of success in controlling costs, improving access and 
maintaining quality.

A survey of more than 10,000 DoD health care beneficiaries in 
TRICARE Region 11 -- Washington, Oregon and part of Idaho -- 
measured the delivery of health care to some 340,000 
beneficiaries between 1994 and 1998. TRICARE began in the area 
in 1993. Dr. James Sears, TRICARE Management Activity executive 
director, called the survey "all good news."

"In a time when there's significant inflation in health care 
costs, they found no increase in cost to the government or 
beneficiaries," Sears said. At the same time, the survey 
reported that Region 11 medical providers maintained high 
quality standards. "There's even a plus-up in perception [among 
survey respondents] of quality," he said.

In terms of access, improvements were noted in several 
categories, Sears said. "They're getting their primary care when 
they need it, they're getting preventive services they need and 
they aren't using the ER as much. Not having to go to the ER to 
get their primary urgent or acute care is a sign of a healthy 
system. 

Sears said he's particularly pleased with Region 11 
beneficiaries' increased reliance on preventive health services. 
"That's a major goal we're after -- to keep people healthy so 
they don't have to use health care services as much," he said.

CNA Corp. and the Institute for Defense Analyses conducted the 
Region 11 survey and will perform similar surveys in all regions 
over a four-year period, Sears said. Congress mandated the 
study, which looks at "before" and "after" data to determine 
TRICARE's impact on military health care. Although the survey 
measured just one region, Sears said it reflects what he expects 
to find in every region.

"It's the same program we have put in place across the country," 
he said. "As the survey reaches all the other regions over the 
next two years, we anticipate similar results. There's no reason 
to think this program would be any less successful in other 
regions."

Next on tap for the survey this spring are regions 3 
(Southeast), 4 (Gulf South), 6 (Southwest), 9 (Southern 
California), 10 (Golden Gate) and 12 (Pacific), and a second 
look at Region 11. Regions 7 and 8 (Central) will be surveyed in 
2000 and Regions 1 (Northeast), 2 (Mid-Atlantic) and 5 
(Heartland) will follow in 2001.

Outcomes from the Region 11 survey "are in the direction we want 
them to be," Sears said. "But we've got a lot of feelers out to 
learn how the program is doing. This study is just one of them."

Annual and monthly customer surveys help Sears and his staff 
learn about and solve problems in the TRICARE system. "Most of 
the changes we're making, where we're placing new or additional 
emphasis, are based on feedback we're getting from these 
multiple channels," he said. "We're using this information to 
improve the current structure and future contracts."

What this and other surveys tell Sears is that TRICARE is doing 
well where it has matured, in Southern California, for example. 
"We just have no negative noise level of any significance from 
the places where TRICARE has been in place and operating for 
awhile," he said. 

In Southeast, Gulf South and some other newer regions, problems 
that existed a year ago have been corrected, he said. "We had 
problems with claims, networks and appointments. As of today, 
however, their networks are developed, they're paying claims and 
their telephone issues are history."

Sears said the same types of "hiccups" occur in every regional 
startup, and a similar maturing process eventually smoothes out 
the wrinkles. The Central region matured rapidly, he said, and 
he expects the Northeast, Mid-Atlantic and Heartland regions to 
improve quickly. 

TRICARE has met with similar success overseas, an area perceived 
to be a medical care trouble spot in the early 1990s, according 
to Air Force Maj. Brian Hurley, senior health analyst for 
military health systems operations at TRICARE. Surveys, he said, 
detected few claims turnaround problems and found high patient 
satisfaction with health care access and quality. 

But surveys aren't the only tool DoD's using to gauge the health 
of health care. TRICARE management discusses health care issues 
regularly with the Military Coalition, a 5-million-member group 
of 26 military support associations, and the 3-million-member 
Military/Veterans Alliance. Sears has conducted meetings with 
the services' senior enlisted representatives to uncover and fix 
health care problems of enlisted members and their families. And 
Rudy de Leon, undersecretary of defense for personnel and 
readiness, has started conducting regional town hall meetings 
with medics and patients. 

TRICARE is accomplishing all it was designed to do, but that 
doesn't mean it can't be improved, Sears said. "We want to 
continue showing improvement in every area, keeping costs down 
and ensuring every beneficiary, whether active duty or retired 
or family member, has quick access to quality care."

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