Operation Just Cause... ...for as long as it takes
Sent in by Veterans News and Information Services
by Harriet E. Rice
MCLEAN, Va. (Army News Service, Nov. 18, 1999) - Military medical care was a hot topic among the 123 delegates at the 1999 Army Family Action Plan Conference held Nov. 15-19 in McLean, Va.
During the conference's opening session, Brig. Gen. Kevin Kiley, the assistant Surgeon General for force projection, provided the delegates an overview of the TriCare program, the military's managed health care system. He also spoke of the challenges of providing quality health care to both Army families, and tactical troops.
Surveys say service members and their families consider health care as a key component of quality of life. Consequently, quality military health care is an important retention tool for the military. A transition from inpatient direct care to outpatient managed care for military and their families has been underway in the Department of Defense since 1995.
"We are trying to get to a proactive, prevention method [of delivering health care]. We've enrolled 3 million people in the last five years," said Kiley.
However, said Kiley, the first priority of the Army's doctors, nurses and medical technicians is to keep the force fit to fight.
"The Army Medical Department's mission is to deploy the fighting force, to deploy the medical force and then manage the health care of family members at home stations," he said. "There's no question that contract health maintenance organizations can provide the health care at Fort Bragg and Walter Reed under a very different set of circumstances, but then how we do maintain, train and regenerate yearly, the capable fighting medical force to support forces on the battlefield?"
Manning the medical corps, both active and reserve, is not a simple matter of hiring doctors and nurses. "It's a very complex process of recruiting people through medical school, nursing school, and ROTC, then forming them into trained and ready medical units to go to war," said Kiley. "You can't just put them in suspended animation on the shelf."
With 8.4 million eligible beneficiaries, TriCare is a network that consists of military and civilian health care including 1,980 hospitals and 22,000 pharmacies. Kiley cited some of the achievements in the program: implementation worldwide, 3.5 million enrollees in TriCare Prime, more than 28,000 beneficiaries enrolled in TriCare Senior Prime, a national mail-order pharmacy, and a 92 percent acceptance rate for TriCare payment by providers nationwide.
There are also standards in place. They include access standards: maximum travel time (30 minutes for primary care, 60 minutes for specialty care), maximum wait times (one day access for urgent care, one week for routine care), and 24/7 emergency services with no pre-authorization required. Kiley noted that getting the word out about TriCare is critical. He described several educational initiatives underway including 200,000 copies of an easy-to-understand, comic-book-art illustrated publication called "The Provider," designed specifically for junior enlisted soldiers. The booklet appeared as an insert in the July issue of SOLDIERS magazine. There are also 100,000 copies of an interactive CD-ROM that answers questions and provides a personalized assessment of options, a toll free help line: 1-888-MHS-MSSO (647-6676); and an e-mail address:
The conference delegates and TriCare users in general should "have a broader, wider understanding and perspective of what it is we at the Army level are trying to do in unison with the other services to get DoD to deliver what we want for us and our families," said Kiley.
"I'm encouraged; we've made a lot of gains. We've improved a lot of things. We have taken lessons learned and fixed contracts," he said. TriCare, however, has had its teething problems. Kiley said: "The division commander, the medical activity commander, the installation commander - they have to voice their concerns and displeasure over issues sometimes." Changes, said Kiley, are made through the contract modification process. "Some things can be simple rule changes at DoD, but they look at the impact," he said. "Everything has to be cost-neutral -- that's very frustrating. If you implement something here that costs money, you have to stop something over here that was using money." Kiley described AMEDD's focus for the near future.
"What we in the Surgeon General's office are looking at is a further maturing and improving of TriCare as it relates to: 1) implementing a new contract 2) addressing and resolving the TriCare remote issues, and, 3) squarely facing the issues of our retiree - and particularly the over-65 population," he said. "We see those as three major campaign issues for us to make TriCare even better. It's going to take us another year or two to get all of this right.
"And when we do all of that, we'll be in a position to say that we've got a first-class medical delivery system, a first-class health care program that cares for soldiers and families and retirees around the world."
(EDITOR'S NOTE: Rice is the U.S. Army Community and Family Support Center's Public Affairs Officer.)
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