Health care reform: DoD's TRICARE a useful model?

By Steve Hammons

One model of health care services administration that could be explored in current national discussions on health care reform is the TRICARE program run by the U.S. Department of Defense.

This program serves active-duty military service members and retirees, and their families.

In recent years, because so many Reserve Component (Reserves and National Guard) personnel have been called up for Iraq and Afghanistan, steps were taken to allow some of them to access the TRICARE health services system.

TRICARE is administered in partnership with private companies. Several partner organizations are involved in the diverse aspects of the program. TRICARE Management Activity (TMA) coordinates the program.

The program is similar in some ways to the one designed for federal employees – the Federal Employees Health Benefits Program (FEHBP).

NUTS AND BOLTS

On the TRICARE Web site, www.tricare.mil, there are rich sources of information about how TRICARE functions, what it provides and other important aspects of this interesting health services program.

The Web site's "press room" section, at www.tricare.mil/pressroom, is one useful doorway to find out more about TRICARE. In the TRICARE "Transparency" section of the Web site, www.tricare.mil/transparency, information is presented in a straightforward manner about TRICARE operations.

Benefit plans in the program include TRICARE Standard, TRICARE Extra, TRICARE Prime, US Family Health Plan and TRICARE Reserve Select. These benefit plans have different structures, similar to other health care insurance models.

The various TRICARE benefit plans are administered across the U.S. in large, multi-state regions. Private companies compete and bid to administer the program in these regions.

TRICARE is truly a joint activity, involving several areas of the Defense Department in cooperation with private companies involved in health care administration.

The program seems to have a reputation for keeping up with trends in administrative efficiencies, customer service and current technologies.

GOOD PROGRAM DESIGN?

The Defense Department's TRICARE health program provides valuable and crucial services for U.S. troops and their families.

Is it perfect? Like any system or organization, there is probably room for improvement. The program has evolved since it replaced the previous system, known as the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS).

You might say that CHAMPUS morphed into TRICARE.

The health care system approaches for U.S. military personnel have evolved over time. The systems used after World War II and in subsequent decades continued to change.

Now, the TRICARE system – using private health care companies – contracts with nearly every kind of health care provider across the country, creating provider networks linked to the benefit plans they offer and the geographic areas involved.

How can the TRICARE model be explored in current discussions about U.S. health care? Is TRICARE a reasonable platform for the delivery of health care services? What are the pros and cons of the TRICARE model?

These might be good questions for all interested parties.