Military Update: Tricare completes transition
November 6, 2004
Though surprise transition problems frustrated some beneficiaries, Tricare this month completed a major shift, to larger regions and performance-based contracts, to improve customer service and access to care for 9.1 million beneficiaries.
The Defense Department announced two years ago that Tricare would consolidate 12 regions into three, simplify support contracts, and impose tougher standards on contractors, from answering phone calls and setting appointments, to making physician referrals and paying claims.
On Tuesday, Dr. William Winkenwerder, assistant secretary of defense for health affairs, declared the transition complete as Humana Military Healthcare Services Inc., of Louisville, Ky., accepted beneficiaries from the final states to join the new South Region.
The new North Region, run by Health Net Federal Services Inc., of Sacramento, Calif., was completed Sept. 1. The West Region began full operations Oct. 1 with the TriWest Healthcare Alliance Corp., of Phoenix providing health services and managerial support.
The contracts were awarded in August 2003. They direct no change to benefits, patient costs or the enrollment process. Still, by last summer, both contractors and beneficiaries faced unexpected problems.
In an interview, David J. McIntyre Jr., president and CEO of TriWest, discussed the challenges that began to surface last spring, at least in the West Region. TriWest’s five-year, $10.5 billion contract is to cover 2.7 million beneficiaries across 21 states, including 16 states of the former “Central Region” that TriWest was servicing under its earlier contract.
An early priority for the new region, said McIntyre, was re-signing at least 85 percent of physicians in the Tricare network for five Pacific coast states previously managed under a contract with Health Net. The first of these states to join the region would be Oregon and Washington on June 1.
When not enough providers were signed as the date approached, TriWest sought authority from the government to roll the old physician networks into the new region for 90 days to protect beneficiaries. When that idea was rejected, TriWest was forced to send letters to 43,000 beneficiaries advising them that they might need new doctors by June. The letter, which many patients apparently shared with their physicians, produced a wave of new contracts. But 19,600 beneficiaries did have to change doctors.
In July, California, Hawaii and Alaska came into the region, and TriWest “got absolutely crushed” with phone calls, said McIntyre. Some of the unexpected volume came from mobilized Reserve and National Guard members whose families are less familiar with Tricare.
“Our job is to make sure they get answers” and timely care, said McIntyre. “It’s not to say, ‘Hey, we’ll ship you a manual. You figure and it and call us if you have any questions.’”
But the typical call from a reserve family lasts five to seven minutes, he said, twice as long as other callers. This extends wait times for other callers. The new contracts specify that beneficiary calls are to be answered in 30 seconds for TriWest get dinged financially. At one point in July, the average wait exceeded 20 minutes.
Number and length of calls weren’t the only problem. TriWest was the only Tricare contractor to structure its communication system around new technology, the Voice-Over Internet Protocol. VoIP allows both phone calls and e-mail to be carried simultaneously over the same lines. But in this case, McIntyre said, system designers underestimated the capacity of those lines to handle six large customer-contact centers and 90 smaller offices across the region.
“Calls were just evaporating,” McIntyre said, as a cell-phone user might experience leaving a coverage area. “We had to re-architect our system,” he said, adding computers, trunk lines and staff, enough to accommodate 25,000 phone calls and 8,000 physician referrals a day.
“Within three weeks we had our key lines tripled,” McIntyre said. By the middle of August, the issue of lost calls and long wait times was resolved.
Some higher call volume has been felt by other contractors, McIntyre said, but the greatest challenge they share has been the Defense Department’s delay in launching an Enterprise-Wide Referral and Authorization System to manage doctor referrals electronically. One was promised but won’t be ready until next year or later.
Consequently, Tricare contractors and military hospitals are coordinating referrals manually and with faxes. This has slowed the process and raised staff requirements, said McIntyre. For a few weeks, he added, TriWest struggled to meet its contract standard of “urgent” referrals within 24 hours and routine referrals within three days.
“Did anyone’s healthcare get negatively impacted? That’s hard to know,” McIntyre said.
TriWest, which is owned by a consortium of regional Blue Cross/Blue Shield companies, now has 2400 employees and maintains a network of 80,000 healthcare providers. In early October, when accepting beneficiaries from the final 16 states, the West Region was better prepared. Average wait times for callers rose to more than two minutes but by November, 75 to 80 percent of calls were being answered again within the 30-second standard.
Region operations are stabilizing after some difficult months, said McIntyre. He would give TriWest a performance grade of B or B-minus for June and July, and A or A-minus for the final leg of the transition this fall.
When a problem surfaced, he said, “we have responded aggressively and very quickly,” which is what Tricare beneficiaries should expect.
To comment, write Military Update, P.O. Box 231111, Centreville, VA 20120-1111, e-mail email@example.com or visitwww.militaryupdate.com