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# TRICARE striving to provide best care at best cost

By Donna MilesAmerican Forces Press Service

WASHINGTON - With slight modifications to premiums, TRICARE's focus remains on providing the best possible care and services at the best cost, TRICARE Management Activity's outgoing deputy director said.

Navy Rear Adm. Christine Hunter said that includes promoting initiatives she moved to the front burner during her tenure in charge of the military health plan: improving efficiency, making contracting more competitive and promoting prevention, among them.

"It's a very difficult balancing act," Hunter said. "We should run a good plan and get good prices [from care providers], get the best quality outcomes, and have care be as successful as it can be."

Cost-effective health care management is a pillar in what Hunter calls TRICARE's quadruple aim. She said it boils down to four principles: assuring military readiness, improving overall health, enhancing the patient experience and responsibly managing the cost of care.

"We see this as a pivot point of which all our other efforts revolve," she said.

TRICARE's goal, to achieve the quadruple aim in a balanced fashion, to support readiness through population health and a positive patient experience and a responsible management of the cost was really what the military was seeking for its health system to do."

A major consideration in the health system balancing act is that it's cheaper to provide care to healthy patients than sick ones, Hunter added, so she has focused on prevention.

The admiral said it's an effort being attacked on a variety of fronts such as, making care and services more convenient, encouraging people to get immunizations and screenings, and helping them in their own health.

TRICARE officials rolled out the medical home concept last year and are working to attract more civilian medical providers certified to this standard into its network. Medical home provides a team approach to health care and establishes a consistent, long-term relationship between patients and a provider team, Hunter said.

In September 2009, officials waived all cost shares for TRICARE Standard beneficiaries for colorectal, breast, cervical and prostate cancer screenings, as well as for immunizations and well-child visits for children under age 6. Also, co-pays are waived for children over 6 for visits to healthcare providers that include one or more of these services.

A dental program started in August 2009 for active-duty service members assigned where they have no access to a military dental facility or are referred by a dentist to a civilian network for specialty care, or when timely appointments aren't available within the military facility.

In addition, Hunter said, the Moving Made Easy program launched in April provides a personalized way for beneficiaries to identify new health care providers when they relocate.

"When you get off the phone, you know exactly what you can expect and how you should get your health care in the new place," she said. "You know it's set up, and you don't have to wonder if anyone took action ... on your Internet request or form. The idea that we care about you and we want to make the program work for you ... has really resonated with people. They love it. We are getting 6,000 calls a week."

TRICARE has also made mental health care more convenient and accessible while working to take the stigma out of seeking care, Hunter said. Officials "dramatically increased" the number of behavioral health providers in its network, she added, and visits are up from about 119,000 a week to more than 230,000.

"We wanted to make care available, and then we wanted to do everything we could to make sure it was used," Hunter said. A Web-based video chat on the TRICARE portal provides 24/7 counselor support, she noted, with serious cases referred for treatment.

TRICARE has encouraged greater use of technology, the admiral said, including the TRICARE Online portal, to provide health care information, generate beneficiary-caregiver exchange, and improve beneficiaries' access to their health records. TRICARE online is beginning to be the place where your personal health history resides, including medications prescribed. Laboratory results and X-ray information will be included by the end of the year, she added.

TRICARE launched the Retired Reserve benefit in September 2010 for retired gray area reservists under age 60, Hunter said. The program enables retirees to purchase TRICARE health coverage for themselves and their eligible family members if they are not already enrolled in or eligible for the Federal Employees Health Benefits program.

Meanwhile, Hunter said TRICARE's Pharmacy Home Delivery program grew 10 percent in 2010 and continues to attract participation.

Hunter has advocated for the option over the more expensive pharmacy option for beneficiaries who don't have access to a military treatment facility to fill their prescriptions. The admiral said she expects slightly higher copayments to go into effect at retail pharmacies to increase use of the home-delivery and mail-order options.

"It won't be mandatory, but you will pay a couple of dollars more if you go to the retail pharmacy," she said. "It's a little more motivational incentive."

A new TRICARE pharmacy benefit smartphone app launched in July enables beneficiaries to use the TRICARE Express Rx mobile app and mobile-optimized website to manage their prescriptions and get related health information.

The plan's Young Adult program, started in May, offers a premium-based health care plan for qualified dependents. Military dependents under age 26 who are not married and not eligible for their own employer-sponsored health coverage may qualify to buy TRICARE Standard coverage for $186 per month.

As of Aug. 31, 8,000 people were enrolled, with several thousand additional enrollees in this month, Hunter said. An option to enroll in TRICARE Prime is slated to roll out this fall.

As these and other new initiatives take shape, Hunter said, the goal is to help keep TRICARE beneficiaries healthy, provide them the best care possible when they're not, and to give them a positive patient experience - all in the most cost-effective way.

"We want to be predictable and easy to use and offer as many services as reasonably possible," Hunter said. "But most of all, what we want to hear is that we helped people. We want them to know they have a good benefit and that we were there at important times in their life - and not just when they were sick."

For more information in TRICARE programs and benefits, please visit the TRICARE website.

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