TRICARE established the Military Health System, a worldwide agency with 12 health service regions in the United States. Each region has a Lead Agent who is also the commander of the major medical facility located in the area.

TRICARE is a managed care operation that uses managed care support contracts to create civilian provider networks and other managed care support services.

TRICARE goals include:

• improving beneficiary access to care;
• asuring the security of a high quality, consistent health care benefit for all military beneficiaries, at low cost;
• preserving choice for all non-active duty participants; and
• containing overall DoD health care costs.

1. the military is the nation's largest employer (Starr, p. 74).
2. in 1884, Congress directed that the "medical officers of the Army and contract surgeons shall whenever possible attend the families of the officers and soldiers free of charge" (History of CHAMPUS).
3. In 1943, Congress authorized the Emergency Maternal and Infant Care Program (EMIC) that provided maternity care and care of infancts up to one year of age for wives and chidren of service members in the lower four pay grades during World War II (History of CHAMPUS).
4. In 1956, during the Korean conflict, the Dependents Medical Care Act became law. The 1966 amendments to this act initiated what would become CHAMPUS by authorizing ambulatory and psychiatric care for active-duty family members, effective October 1, 1967. The program began covering retirees, their family members, and certain surviving family members of deceased military sponsors on January 1, 1967 (History of CHAMPUS).
5. in 1993, the Pentagon spent about $15 billion on health care... about $3980 per year on each beneficiary, while health care for other federal employees costs the government about $2080 per year... private employers spent an average of $3968 on health care benefits in 1992 (Starr, p. 80)
6. TRICARE grew out of the CHAMPUS Reform Initiative which began in 1988 as a demonstration program for 860,000 CHAMPUS eligibles in CA and HI (Crowley & Tough, pp. 33-34).
7. TRICARE combines services provided by private contracts with HMOs and PPOs with services provided by military treatment facilities in local areas. The coordinated care plan aims to increase access and reduce costs in a local community or catchment area, which is defined as a 40 mile radius from the military treatment facililty. Access to care is managed so that as much care as possible is offered by the lowest-cost providers, in most cases the military treatment facilities (Starr, p. 76).
8. The Pentagon is both a provider and a user (Starr, p. 80).
9. No managed care plan will succeed is people do not participate (Crowley & Tough, p. 36).
10. [the military] program has many more tools than most managed care plans: federal preemption from conflicting state regulations; a relationship with government facilities; fiscal responsibility for a single collective population with strong incentives to enroll the highest users into the HOM option; and broad regional resources and negotiating leverage to dra upon (Crowley & Tough, p. 36).

    References:

    Crowley, D.D. & Tough, S.D. (1993). Turning swords into plowshares: Lessons from the military health system. Journal of American Health Policy, 3(4), 33-36.

    Starr, B. (1993). US military enters the managed care battle. Business and Health, 11(5), 74+.

    www.tricare.osd.mil/factsheets/history.pdf, HE HISTORY OF CHAMPUS AND ITS EVOLVING ROLE IN TRICARE, online 1 SEP 01

• Before TRICARE, each military service provided its own medical care: Air Force, Army, and Navy (includes Marine Corps)
• Assumption: Combining medical care services across military services will save money
• VALUE: must save money, that is, reduce DoD expenditures
• Assumption: Managed Care principles can help DoD reduce health care expenditures
• Assumption: Gatekeepers can reduce unnecessary specialty referral, and reduce cost

1. Access
2. Affordability (money issues)

   Access and Affordability addressed by Benefit Comparisons

   Recent changes in TRICARE expand benefits:

   • Senior Pharmacy Program effective 1 April 2001
   • TRICARE for Life effective 1 October 2001

3. Accountability

   TRICARE HEDIS Reports (electronic report card) present some accountability data

   Additions of programs for elders reflects policy changes associated with accountability.