Transcript MHS Quality Measurements American College of Surgeons Annual

TRICARE Prime Service Area
Reductions
January, 2013
What is PSA Reduction?
• The primary purpose of a PSA is to augment the delivery of
health care around military treatment facilities (MTFs) and Base
Realignment and Closure (BRAC) sites
• The latest generation of TRICARE Managed Care Support
Contracts (T-3) request for proposals released in 2007 did not
require TRICARE regional contractors to develop PSAs in areas
remote from MTFs
• The PSAs affected under T-3 are not close to existing military
treatment facilities, and have never augmented care around
MTF or BRAC locations.
• PSA reduction assists DoD in controlling health care costs – will
save an estimated $45-$56M a year
www.tricare.mil/PSA
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PSA Reductions
No Impact on Active Duty
• Of approximately 1.6 million retirees and family
members currently in Prime, 171,000 potentially
affected across all three U.S. regions
• No impact on Active duty service members and their
families: Prime benefits maintained
• Affected Retirees and their family members living <100
miles from remaining PSA may be able to transfer their
Prime enrollment
• No impact on Medicare eligible beneficiaries
– TRICARE For Life and Pharmacy unaffected
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TRICARE Standard
• Impacted beneficiaries automatically have TRICARE
Standard/Extra
• TRICARE Standard is similar to “open choice” health plans
– You can choose any TRICARE authorized physician
– No enrollment fees
– No monthly fees
– No referrals
– Fewer authorizations
• Preventive care covered at no out-of-pocket cost includes:
– Cancer screenings
– Well child care
– Immunizations
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Differences Between Prime and Standard
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Cost Comparison: Standard/Extra vs Prime
Enrollment Fees
Prime
Standard/
Extra
Deductible
$269.28/year
individual
$538.56/year
family
None
E1-E4: $50
individual,
$150 family
E5 and above:
$150
individual,
$300 family
In-Network
Copay/
cost-share
Point of
Service
Fees
Annual
Catastrophic
Cap
E.R. visit $30
Outpatient
visit - $12
Annual
deductible
plus 50%
cost share
$3,000/ year
20% innetwork
25% outof-network
None
$3,000/year
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Communication
Thank You for Your Patience
• TRICARE is committed to
keeping beneficiaries informed
about changes in PSAs
• Multiple communication via US
Mail; media, customer service
support, web, Mil/Vet Assoc.
• Information will be updated at
www.tricare.mil/PSA where
you may also sign up for email updates
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Implementation Plan Highlights
Action/Tactic
Target Date
PSA Contract modifications to West/North/South
12/2012
Information Paper for Senior DoD Leadership/ Hill/ Surgeons;
PSA Fact Sheet
January 8, 2013
Tricare.mil/PSA launch
January 10, 2013
Customer Service FAQs/Military Associations Briefed
January 10, 2013
Notify Interested Media
January 10, 2013
TRICARE Region Communication to Commands
January 10, 2013
Military Association Execs Full Briefing
January 10, 2013
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Implementation Plan Highlights
Action
Target Date
HASC/SASC Full briefing
January 16, 2013
* February 7, 2013
Early notification letters for affected beneficiaries
* Dependent on Contractor
Printing/Mailing
ZIp Code Locator Tool on TRICARE Web
February 7, 2013
MHS Conference
02/11-14/2013
Customer Service Support in place for affected beneficiaries
04/01/2013
Health Matters Newsletter (Prime) to 1.5 M
05/2013
Media Roundtable with details; news articles; outreach to
affected communities
05/2013
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Implementation Plan Highlights
Action
Target Date
Second Notification Letter
06/2013
Beneficiary Prime Health Matters Newsletter Article
08/2013
Disenrollment letters for affected beneficiaries
08/2013
Response to question/reinforce information stream
08/201310/2013
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