In War and Peace,TRICARE Prime Soldiers On
What impact do overseas deployments have on health care service provided to TRICARE beneficiaries?
By Karen Kopp DuTeil

As the USNS Comfort prepared to deploy last winter as part of Operation Enduring Freedom, the National Naval Medical Center (NNMC) in Bethesda, Md., faced a situation that could give health care administrators nightmares — how to maintain an adequate level of service for the many TRICARE Prime families in the Washington, D.C., area seeking health care while losing more than a thousand of the center’s medical personnel and support staff to shipside duty.

Yet as of early March, the NNMC was experiencing only minor scheduling delays in some of its departments, testimony to the emergency contingency plans and network of military and civilian service providers built into the TRICARE Prime program. According to Ann Ham, public affairs officer for Army Maj. Gen. Kevin C. Kiley, the lead agent for TRICARE’s Region 1 (which includes the Northeast and Washington, D.C., and its surrounding suburbs), while the region’s medical facilities have been hit hard by deployments, beneficiaries may not notice much of a change in services thanks to a bit of juggling of providers and sharing of resources.

For instance, as USNS Comfort was preparing to leave U.S. shores, the NNMC already was making plans for backfilling temporarily vacant positions with military reservists. In addition, the facility has been able to bring in staff from other military facilities that have not lost as many personnel to deployment. As needed, the NNMC also will be sharing resources with other local military treatment facilities (MTFs) and Department of Veterans Affairs (VA) hospitals and adding additional civilian personnel through short-term contract positions. Finally, the NNMC plans to send patients out to civilian providers within the TRICARE network if necessary.

“We’re working on ways of being able to switch patients back and forth” between MTFs and civilian providers, says Ham, if there is a shortage of providers. “It wouldn’t change a person’s enrollment [in TRICARE Prime], but [patients] could be sent out to a network provider for one episode, and we would help them set up that appointment.”

The same all over

Other MTFs are facing similar situations. At Naval Hospital Bremerton in Bremerton, Wash., for example, staff members are dealing with the February deployment of Fleet Hospital Bremerton, the Tier One fleet hospital on the West Coast. While physicians, nurses, corpsmen, and administrative support staff are called into service overseas, the remaining staff have reorganized into new care teams.

As of early March, “most of our MTFs seem to be doing well,” says Lisa Maher of Health Net Federal Services, which administers the TRICARE program in regions 6, 9, 10, 11, and 12 (including Alaska, Arkansas, California, Louisiana, Oklahoma, Oregon, Texas, and Washington). “So far all of our services have been able to keep up with [personnel losses from] deployments.”

According to Maher, Health Net, as a managed care support contractor, has set several goals for supporting MTFs as well as the beneficiary population they serve. “Our first goal,” she says, “is to provide resource sharing ‘inside the walls’ ” of the MTF. If the health care provider has a need for support, Health Net acts almost as a temporary agency by finding needed medical personnel who can fill in as necessary. This means beneficiaries still are able to access care at the MTF. If, however, an MTF does need to limit access to or shut down a unit, the contractor then takes steps to ensure that beneficiaries can go into the civilian network of health care providers.

“Resource sharing is really an ongoing thing,” even during peacetime, says Maher. “Because of the call-ups, we have been much more active in this area. Whatever the MTFs need, we work with a spectrum of resources, and we have the ability to find whatever is needed.”

Still, even with as many hands on deck as possible, beneficiaries may experience some changes and slowdowns in medical services. Sierra Military Health Services, the TRICARE contractor for Region 1, for example, is advising patients that additional military actions and deployments could create reductions in service availability at military hospitals and clinics. Specialty medical personnel (especially those needed in the field, such as surgeons and operating room and critical care personnel) will be in especially short supply, a shortage that may necessitate cancellation of elective surgeries and other procedures.

In addition, beneficiaries can expect care within MTFs to operate according to the following priority status:
1. active duty servicemembers;
2. active duty family members (as well as survivors of military sponsors who died on active duty) who are enrolled in TRICARE Prime;
3. retirees and their family members enrolled in TRICARE Prime and TRICARE Plus members (primary care only); active duty family members (and survivors of military sponsors who died while on active duty) who are not enrolled in TRICARE Prime;
4. retirees and their family members and survivors who are not enrolled in TRICARE Prime, as well as those enrolled in TRICARE For Life; and
5. all other eligible beneficiaries.

Those enrolled in TRICARE Standard likely will be referred to civilian TRICARE network providers.

Get the care you need

So how can you ensure that you get the care you need during the current deployments?

• Keep apprised of your MTF’s operating status through either its Web site or telephone information line. The NNMC, for instance, has reduced its pharmacy hours for the time being and maintains an updated status report of other services on its Web site. 
• Avoid peak times (usually between 11 a.m. and 1 p.m. and between 4 p.m. and 5:30 p.m.) for nonappointment services, such as pharmacy, radiology, and laboratory. 
• Consider alternatives to prescription refills, such as network pharmacies and the TRICARE Mail Order Pharmacy program. 
• Allow yourself extra time to arrive and park at the MTF, depending upon the current security level. 
• Finally, keep in mind that you may have to wait a bit longer than usual for routine preventive-care appointments, elective surgeries, and certain nonemergency procedures, as MTFs work to rebuild their staffs.

Beneficiaries who are enrolled in TRICARE Prime should be aware the Department of Defense is still under a contractual obligation to provide care in a timely manner while ensuring access to appropriate, high-quality health care. Regardless of current MTF staffing levels, TRICARE Prime provider networks must provide access to ample numbers and types of providers to assure that all covered services are available within TRICARE Prime’s access standards. If you are enrolled in Prime, TRICARE must be able to provide you with emergency care 24 hours a day, seven days a week; urgent care within 24 hours; routine primary care within seven days; and specialty care within 30 days. If your local MTF cannot meet these standards, you have the option to be referred in a timely manner to a civilian provider within the access standards noted above. 

Despite the ongoing nature of the deployments, all involved with TRICARE agree beneficiaries still will be able to get the attention they need, even if it means waiting to get an appointment or going to a TRICARE network provider instead of an MTF. 

“We are going to take care of you,” says Ham. “You may have to wait in line a little longer at the gate, but you will get the care you need.”