MHS Reform and What It Means to You

The military health system (MHS) is changing in an effort to better serve members of the military community and their families. But what does that mean for you? What is changing? How will changes impact your medical care? How is MOAA fighting for you during this modernization effort? Continue for answers to these questions and more.

What Is MHS Reform?

Starting with the basics, MHS reform is the reevaluation of the entire military health system. While this has been a topic of conversation for decades, Congress has outlined a transformation addressing a variety of problems with both medical readiness and the provision of beneficiary care, including:

• Suboptimal military treatment facility (MTF) caseload for maintaining uniformed medical provider currency in skills needed for combat casualty care.
• Low surgical volumes leading to patient safety issues and concerns about uniformed surgeon skill degradation.
• Patient dissatisfaction with access and quality of care/patient experience within MTFs.
• A lack of focus on value and patient outcomes in the TRICARE purchased care network.

 

The Key Elements & Why They Matter

The MHS is wildly complex; the FY17 National Defense Authorization Act alone includes 131 pages of MHS reform provisions. For this reason, it is easiest to think about MHS reform in three main buckets:

 

1. TRICARE Reform

• Military families are already living with TRICARE Reform.
• TRICARE Standard/Extra has been replaced with TRICARE Select.
• The main differentiator between TRICARE Standard/ Extra and TRICARE Select is you can visit any TRICARE-eligible provider. You are not required to visit or get a referral from a primary care provider before doing so.

Military families have a new enrollment requirement for Select. Some families are paying higher copays or enrollment fees, although MOAA fought to ensure these were lower than the proposed increases. MOAA also successfully blocked a proposed TRICARE For Life enrollment fee.

 

[MORE ON TRICARE: MOAA's 2020-21 TRICARE Guide]

 

2. Transition

• MTF transition from service branches to the Defense Health Agency (DHA) is happening behind the scenes.
• The result should be the standardization of best practices across the system.
• This will benefit mobile military families who currently encounter varying policies and processes as they move from one MTF to another.
• A key milestone in this transition was just announced with the migration of MTF websites to the TRICARE.mil domain, providing beneficiaries with a modernized and standardized web experience across the system.
• As the MTF transition continues, MOAA is advocating for enhanced beneficiary communication as any policy changes are rolled out and a clear problem reporting and resolution process for families who encounter challenges because of standardization.
  
  

 

3. Transformation

• Transformation refers to the restructuring of MTFs and consolidation of specialty care in military medical centers of excellence.
• MTF restructuring is in the analysis and planning phase.
• Over the next three to five years, some care may be transitioned out of smaller MTFs and into the surrounding civilian medical systems.
  
  

MOAA has successfully advocated for more robust reporting requirements and congressional oversight to ensure continued access to high-quality care throughout this process.

Its History

It is important to note that MHS reform has been talked about for decades. For the sake of this article, we are outlining the most pertinent dates that contributed to moving the needle of MHS reform.

• 2015: A Military Compensation and Retirement Modernization Commission (MCRMC) report highlighted numerous MHS shortfalls in both its readiness and beneficiary care missions. The MHS has also been the focus of negative media coverage, including a 2014-15 New York Times series on patient safety concerns and a recent US News & World Report investigation. After the MCRMC report was released, leaders of both the House and Senate Armed Services Committees promised a major reform and oversight effort of the MHS.
  
  
• 2016: Congress holds a series of hearings, roundtables, briefings, and information sessions to shape MHS reform legislation.
  
  
• 2017: Congress passes MHS reform with the FY 17 NDAA.
  
  
• 2018: Implementation of MHS reforms and additional DoD proposals and legislation.

 

MOAA’s Stance on MHS Reform

MOAA understands Congress is serious about MHS reform, and we are serious about protecting the military health care benefit. We acknowledge and appreciate Congress’ intent to improve the MHS, but we must play a critical oversight role in the MHS reform process.

• MOAA acknowledges direct care system reforms are intended to increase efficiencies, improve the readiness of uniformed medical providers, and address problems with the provision of beneficiary care.
• We do not oppose congressionally directed reforms intended to downsize or close MTFs that are not contributing effectively to the readiness of uniformed medical providers as long as high-quality civilian care is available in surrounding communities.

 

We support the consolidation of uniformed medical personnel in military medical centers of excellence, and initiatives such as civilian partnerships and expanded MTF eligibility for veterans and civilians with medical needs that support the clinical currency of uniformed providers.

 

As these reforms move toward implementation, MOAA is focused on ensuring continued beneficiary access to high-quality medical care by demanding thorough analysis of civilian care availability and mitigation planning for care transferred out of MTFs, together with transparency and congressional oversight. We will also fight for an acceptable degree of beneficiary choice regarding travel to military medical centers of excellence for care.

 

MOAA will oppose any cuts to the military medical system that seems driven primarily by cost. We have grave concerns about the proposed medical billet cuts and will continue to raise awareness about the potential negative impacts on readiness, medical provider recruiting and retention, and beneficiary access to care.

 

Most recently, MOAA was successful in getting several provisions in the FY 2021 NDAA to advance these objectives. Such provisions include Hazardous Duty Incentive Pay (HDIP) Parity, more COVID-19 Support, better transitional health care, Improved mental health care, and maternity leave credit.