August 15, 2014
A July 31 Government Accountability Office (GAO) report recommends eliminating the U.S. Family Health Program (USFHP) benefit, citing duplicate services and unnecessary costs.
The report stems from the FY 2013 National Defense Authorization Act which required the GAO to review DoD’s health care contracts, including USFHP.
The GAO was tasked specifically with studying the role of the USFHP within the military health system, and the extent to which the USFHP affects DoD’s health care costs. The review determined that the program is duplicative and results in unnecessary costs to the government.
The USFHP provides managed health care (TRICRARE Prime) for military beneficiaries using the patient-centered medical home model of enhanced access and places a strong focus on wellness and prevention.
The small program consists of six providers throughout the country:
- Johns Hopkins Medicine, serving Maryland, Washington, D.C., parts of Pennsylvania and Delaware;
- Martins Point Health Care, serving Maine, New Hampshire, Vermont and northeastern New York;
- Brighton Marine Health Center, serving Massachusetts and Rhode Island;
- Saint Vincent Catholic Medical Centers, serving New York city, New Jersey, parts of Pennsylvania and western Connecticut;
- Christus Health, serving southeast Texas and southwest Louisiana; and
- Pacific Medical Center, serving the Puget Sound area of Washington State.
The problem, according to the GAO, is that the establishment of the TRICARE network in the 1990s made the USFHP largely redundant.
GAO states that the TRICARE contracts provide Prime coverage to 4.5 million beneficiaries. By contrast, only 134,000 beneficiaries receive Prime through USFHP. A majority of current USFHP beneficiaries live in Prime Service Areas, making them eligible for both benefits.
In addition to overlapping coverage, the GAO notes the USFHP fails to maximize utilization of military treatment facilities (the most cost effective means of providing military health care) and flaws in its contract with DoD do not require it to disclose administrative costs and profits – making it difficult to determine the program’s efficiency.
Reviewing the military health care system to increase efficiencies makes sense, but the quality of health care and choice must factor into any decisions along with costs.
Boasting a patient satisfaction rate of over 92 percent, beneficiaries using USFHP report the plan consistently exceeds customer expectations, and its satisfaction rates are not only the highest within the TRICARE system, but far surpass the national average of commercial plans. MOAA believes that a robust, high quality health care benefit is an essential element to maintaining the all-volunteer force. Eliminating the program as a purely budget driven move would be a major blow to the beneficiaries currently enrolled in the program.
It is important to note that the GAO report is only a recommendation at this point. There are no current proposals to eliminate the USFHP benefit. However, this proposal could surface as part of the FY 2016 budget submission next year.
The Military Compensation and Retirement Modernization Commission (MCRMC) is looking at the military health care system – including USFHP – as it prepares its recommendations for reform in a February 2015 report. The outcome of the MCRMC report could have significant implications on military health care and compensation. You can share your comments with members of the MCRMC on the USFHP or any other form of military compensation.