Tricare Prime and Military Health

TRICARE Prime and Military Health Personnel

This paper analyzes TRICARE, a health system and management activity that enables management and other key providers especially those working in the military health system with a single source they can use to gather and collect information on and provide information to healthcare providers and plans and participants. This universal health management system is useful for healthcare practitioners in the military and in public or private practice to implement policies includes those related to the administration of vaccines, provisions for dental services, changes in compensation for future fiscal periods and more. The TRICARE program operates using contractors located throughout the world providing services including general healthcare services to active duty members and their families.

The Military Health System uses TRICARE via the U.S. Department of Defense to post updates to policies including changes to health policies, and medical and dental officer pay plans during various fiscal years (MHS, 2007). One may consider TRICARE an "enterprise resource system" or a system that enables all members of an entity or organization to gather and analyze information in a single location for review and commentary. This information may be gathered and disseminated online or through proprietary systems at hospitals, health facilities, officer's offices and more (MHS, 2007).

TRICARE Management Activity (TMA) formally defined is a family health plan (TMA, 2007) offering military personnel networks of "community-based, not-for-profit" healthcare systems and organizations in six regions throughout the United States (TMA, 2007). Each system or region provides its own services and governs a specific regional or geographical area, such a the Brighton Marine Health Center, which incorporates and serves parts of the Northern New England states including Connecticut, New Hampshire (southern), and Rhode Island (TMA, 2007).

Like many healthcare services, the Department of Defense's plan, which is a worldwide health access program for service members working in uniform and their families, offers "managed care" options referred to as "prime service areas" which are healthcare entities located near military bases or service points allowing for ease of access for healthcare participants in the military and their families (TMA, 2007). Military personnel have the option of joining the TRICARE Prime system, the primary managed care plan offered by the U.S. Dept. Of Defense. In doing so, much like any ordinary HMO, the member will have TRICARE Prime assign them a managed care officer or primary care manager (physician) who is responsible for referring participants when necessary to specialists working within the TRICARE system or network for care the primary specialist is not able to provide as a stand-alone service (TMA, 2007).

One of the advantages of TRICARE for plan participants including military personnel and their families is the managed care program allows individuals to seek quality medical without paying much in the way of deductibles or "out-of-pocket" expenses, something that typically prevents people from receiving the care they need in ordinary managed care plans (TMA, 2007). Despite some of the advantages of the managed care or Prime Program, many officials or personnel elect the POS or "point of service" option, which allows them greater flexibility or the ability to choose the physicians they would like to see, even allowing for some specialist care in many cases without a referral (TMA, 2007). However, personnel and family members using this POS service will have more out-of-pocket expenses, because they may work with providers that are not members of the network and thus, do not have to agree to "standard" charges as is the case with the managed care plan (TMA, 2007; MHS, 2007).

Within the primary or "prime" TRICARE option are several sub-sections. For examples, members that serve the military stationed throughout the world can access healthcare if they select the PRIME option; this I beneficial especially incases where active duty service men or women require immediate healthcare. The managed healthcare program abroad is very similar to the one used in the State's, meaning an active duty service member will have to use a primary case manager or physician to direct healthcare services. Another service plan that is a subsection of the TRICARE Prime basic function is the "TRICARE Prime Remote" or TPR option. This option provides service personnel that are active duty members working more than 50 miles from the military center they are assigned to and work at the ability to take advantage of options and services under the managed care or prime program as long as they live within an area the government has designated as a "TPR" remote area, or an area that the military can select primary managers in to provide care to personnel (TPA, 2007). Family members of military service personnel, like active duty service members, can also receive healthcare using the same system. The military health system offers other Prime subtypes of the plan including the overseas service option for military family members that live overseas and the "global remote overseas" option that enables service personnel managed care benefits when they work overseas and live in remote locations (TPA, 2007).

As with any healthcare system TRICARE offers other options to service members and beneficiaries. "Active" service members typically must enroll in the managed care option offered by TRICARE Prime, however there is another subset of the program called "TRICARE Standard and Extra" that is available to beneficiaries of service personnel, though active duty personnel are not able to participate in this service plan alternative, but do have to enroll in TRICARE Prime if they want the Standard and Extra service available to their beneficiaries. This subset allows beneficiaries more options than the Prime program; plan participants for example, may see anyone provider they like without being assigned a provider, as long s they visit a provider or health services that the TRICARE system considers "in-network" or approved to provide services under the provisions of the main policy. While there are options available that will enable individuals to see an out of network provider, the beneficiary will have to pay more in the way of out-of-pocket expenses to do so.

As evident through this review one can see the TRICARE health management system adopted by and developed for active duty military personnel and their families is a tool service members can use to receive quality healthcare. One of the advantages of this program is it enables service members to seek quality care from TRICARE approved case managers and providers even if they live overseas or are on active duty in remote locations (MHS, 2007). This is a benefit for many service members that do not have any other options with respect to receiving healthcare. The service goes as far as offering Medicare Part a and B. coverage when they qualify without having to pay a premium to enroll in these additional services using the TRICARE life program or TFL (MHS, 2007).

The Office of the Assistant Secretary of Defense for Health Affairs or the OSD/HA implemented and governed this plan in an effort to ensure all military members and their beneficiaries or dependents have access to healthcare whether through managed care services as is the case with TRICARE Prime or through a point of service program that enables service members to allow their beneficiaries to select their own primary healthcare providers as long as they agree in this case to pay higher fees or out-of-pocket expenses (HMHSI, 2007).