Prescription Costs for TRICARE Beneficiaries to Increase January 1

The cost of prescription drugs for TRICARE beneficiaries will increase on January 1, 2020.

Effective Jan. 1, 2020, a 90-day supply of generic drugs received through TRICARE’s Express Scripts mail-order pharmacy will increase from $7 to $10. Co-pays on brand-name drugs received through the mail will go from $24 to $29; the price rises from $53 to $60 for non-formulary drugs.

Generic drug prescriptions filled at retail pharmacies will see the cost rise from $11 to $13 for a 30-day supply, while the same supply of brand-name medications will increase from $28 to $33. Non-formulary drugs — those not on Tricare’s list of approved and covered medications — will go up from $53 to $60.

Prescriptions filled on base will continue to be free.

The price increases were mandated by Congress as part of the National Defense Authorization Act for Fiscal Year 2018 in an effort to bring the amount TRICARE beneficiaries pay into line with the actual costs of prescription drugs. Because the US Family Health Plan is a TRICARE Prime program, the prescription drug price increases mandated by Congress will apply to US Family Health Plan beneficiaries.  Annual increases are planned through 2027.

DHA Announces TRICARE Open Season and Federal Benefits Open Season

The Defense Health Agency announced the two open seasons for military beneficiaries:  TRICARE Open Season and Federal Benefits Open Season.

TRICARE Open Season applies to anyone enrolled in or eligible for TRICARE Prime (including the US Family Health Plan) or TRICARE Select.  Federal Benefits Open Season is for enrollment in the Federal Employees Dental and Vision Insurance Program (FEDVIP).  Both the TRICARE and FEDVIP open seasons begin on Nov. 11 and end on Dec. 9. Enrollment choices made during this period will take effect on Jan. 1, 2020.

If you are now enrolled in US Family Health Plan, you will be automatically re-enrolled in the Plan for the coming year.  This means you don’t need to do anything during Open Season.  However, if you want to change your TRICARE coverage for 2020, you must make this change during Open Season.

To get ready for open season, you can use tools on the TRICARE website, like the TRICARE Plan Finder and TRICARE Compare Cost Tool.  These resources help you see which plans you’re eligible for and help you to compare plans and costs.  On the FEDVIP enrollment website, you can enroll in or make changes to your FEDVIP plan.  The website also provides tools to help you find the right dental and/or vision plans for you and your family.

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US Family Health Plans Again Rated Among Nation’s Top Private Health Insurance Plans

The independent National Committee for Quality Assurance (NCQA) has again rated two member organizations in the US Family Health Plan Alliance among the top private health insurance plans in the country.

Johns Hopkins US Family Health (MD, DE, DC, and parts of PA, Northern VA and WV) and Martin’s Point US Family Health Plan (ME, NH, NY, PA, VT) were among 46 private health plans in the country that received 4.5 out of 5 ratings in the NCQA’s Private Health Insurance Plan Ratings 2018–2019. Read more

TRICARE Enrollment Changes for 2018

On January 1, 2018, many changes were made to the TRICARE program.  Importantly, TRICARE continues to offer several different health plans, and plan availability still depends on who you are and where you live. Two of the key changes concern TRICARE plan options and new enrollment requirements.

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US Family Health Plans Again Earn Top National Ratings for Private Health Insurance

The US Family Health Plan once again has two of the highest-rated private health insurance plans in the country, according to the independent National Committee for Quality Assurance (NCQA).

In NCQA’s Private Health Insurance Plan Ratings 2017–2018, NCQA gave a 5 out of 5 rating to the Johns Hopkins US Family Health Plan and a 4.5 out of 5 rating to Martin’s Point US Family Health Plan (ME) – two of the US Family Health Plan’s six regional health plans – demonstrating a continued commitment to excellence in health care.

“The latest NCQA ratings affirm that the US Family Health Plan is keeping our members satisfied by providing them with high quality health care for improved care outcomes,” said Jim Schweiter, US Family Health Plan Alliance CEO.

The NCQA report rates private, Medicare, and Medicaid health insurance plans on a 5-point scale for customer satisfaction, prevention and treatment. The ratings are based on clinical quality, member satisfaction and NCQA Accreditation Survey results to emphasize care outcomes and what patients say about their care. Both Martin’s Point and Johns Hopkins are NCQA-accredited.

Johns Hopkins, the top-rated private health insurance plan in Maryland, is just one of five private plans in the country to earn a 5 out of 5 rating out of the more than 1,000 plans rated in the report. The plan also received an NCQA Health Plan Accreditation of Excellent, scoring 94.26 out of a possible 100.

“To be among the highest-rated plans in the country is an honor, as well as a motivator,” said Mary Cooke, vice president of Johns Hopkins US Family Health Plan. “Everything that we do is in pursuit of serving our military families and retirees with the highest quality of care possible. The NCQA rating will make us work even harder to maintain our standards and hopefully reach new levels of quality.”

The Martin’s Point US Family Health Plan – based in Portland, Maine – is the top-rated private plan in the state and one of only 42 plans nationwide to earn a 4.5 out of 5 rating.

“We are excited and honored to receive a 4.5 out of 5 rating from NCQA. Our aim is to provide the highest quality care and service, and this rating validates all of our efforts to keep our members satisfied and well cared for,” said David Howes, M.D., president and CEO of Martin’s Point Health Care.

The US Family Health Plan has been labeled as a model for exemplary patient satisfaction nationwide by the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, which gave the plan a 91.5 aggregate member satisfaction rating in 2017. CAHPS scores are incorporated into the NCQA rating system.

“Our top priority continues to be the health and satisfaction of our members, as it has been for more than 30 years. We are proud of the care we deliver as part of the Military Health System and remain a committed partner to them in their mission,” Schweiter said.

Hurricane Harvey: Important Information for USFHP Members in Louisiana and Texas

The situation related to Hurricane Harvey in our US Family Health Plan Texas and Louisiana service areas continues to evolve, and we remain mindful of the needs of our members.

A brief update of the status of CHRISTUS facilities in Southeast Texas and Louisiana is below:

Southwestern Louisiana Update
The remediation trailer, which arrives with an array of tools and resources to clean up and address damage or leaks, has arrived in Lake Charles.

Southeast Texas Update

  • Our health care ministry in CHRISTUS Southeast Texas continues to work hard to serve the community during this difficult storm. However, due to further deterioration of weather conditions in the area, the following changes were announced today:
  • All patients whose elective procedures and cases for CHRISTUS St. Elizabeth and St. Mary Hospitals, including the St. Elizabeth outpatient pavilion, have been affected will be contacted and rescheduled as appropriate.
    Elective procedures and surgeries are planned to continue at Jasper Memorial Hospital.
  • The CHRISTUS St. Elizabeth outpatient pavilion is planned to reopen on Thurs., Aug. 31 for normal business hours.
  • CHRISTUS Southeast Texas Outpatient Center Mid County Emergency Services and supporting services to the Emergency Department will remain open. All other services are planned to reopen on Thurs., Aug. 31 for normal business hours.
  • CHRISTUS Orthopedic Specialty Center/Beaumont Bone & Joint has been restored to full city power, but due to the deterioration in the weather, they have canceled clinic, surgeries and rehab throughout the week. They will assess capabilities as conditions dictate.
  • At a time when several emergency centers throughout the region have closed, all four CHRISTUS facility Emergency departments and life-saving Trauma Services will remain open 24/7 and available for the community.
  • A discharge lounge is being set up at St. Elizabeth Hospital to accommodate patients who may be fully discharged but cannot get to a safe location. Essential staff will be required to be available for Emergency, Trauma and existing patients housed in our facilities, to ensure the safety and care they may need throughout the storm. Essential staff who believe they cannot get back to the facility will be housed in the facility. All non-essential CHRISTUS SETX staff were to be released at 1 p.m. today.

Our facilities and clinics will work feverishly to resume business as usual operations as soon as it is reasonably safe.

All CHRISTUS Health plan operations have been open without disruption from the storm.

US Family Health Plans Earn Top National Ratings among Private Health Insurance Plans

Consistently rated one of the best care programs in customer satisfaction, the US Family Health Plan now boasts two of the highest-rated health insurance plans in the country, according to the independent National Committee for Quality Assurance (NCQA).

In NCQA’s Private Health Insurance Plan Ratings 2016–2017, NCQA gave 5 out of 5 ratings to both Martin’s Point US Family Health Plan (ME) and the Johns Hopkins US Family Health Plan – two of the US Family Health Plan’s six regional health plans.

“Our goal is to provide high quality health care to our members and to keep them extremely satisfied,” said Jim Schweiter, US Family Health Plan Alliance CEO. “The latest NCQA ratings prove that the US Family Health Plan program delivers the results our military family and retiree members deserve.”

The NCQA report rates private, Medicare, and Medicaid health insurance plans on a 5-point scale for customer satisfaction, prevention and treatment. It also considers NCQA Accreditation standards scores. Both Martin’s Point and Johns Hopkins are NCQA-accredited and were among just 13 private plans in the country that earned a 5 out of 5 rating, out of the more than 1,000 plans rated in the report. Both plans improved on their 4.5 out of 5 ratings from last year’s Private Health Insurance Plan Ratings.

The Martin’s Point US Family Health Plan, based in Portland, Maine, is the top-rated private plan in the state.

“The NCQA ratings demonstrate the effectiveness of the US Family Health Plan’s model in managing care, achieving better health outcomes and delivering top-rated care to our members. We are proud of this recognition and proud to serve the military community,” said Dr. David Howes, President and CEO of Martin’s Point HealthCare.

The Johns Hopkins US Family Health Plan is one of two private plans based in Maryland that received an overall rating of 5 out of 5.

“We are honored to earn the NCQA’s five of five rating in service to our members. We learn so much from the military families and retirees we serve, and we pledge to continue to deliver the exceptional care that led to the NCQA rating,” said Mary Cooke, vice president of the Johns Hopkins US Family Health Plan.

The US Family Health Plan has been labeled as a model for exemplary patient satisfaction nationwide by the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey, which gave the plan a 91.5 aggregate member satisfaction rating in 2015 – more than 25 points higher on a 100-point scale than the national average for commercial health plans. CAHPS scores are incorporated into the NCQA rating system.

“The health and satisfaction of our members has been our top priority in delivering care to beneficiaries of the Military Health System for more than 30 years, and we look forward to continuing to provide high quality care in the years ahead,” Schweiter said.

Senate Staff Attend US Family Health Plan Showcase on Capitol Hill

United States Senate staff had an opportunity to learn first-hand about the best in care, quality and patient satisfaction for military families and veterans last week at a briefing on the US Family Health Plan.

To view highlights from the USFHP Senate briefing, click here.

Part of the Military Health System since 1981, the US Family Health Plan provides the TRICARE Prime benefit through six non-profit regional health care provider organizations that serve military families and veterans with quality coordinated care and best-in-class patient satisfaction. The briefing was hosted by Senators Susan Collins (R-Maine) and Barbara Mikulski (D-Maryland), who represent states in which US Family Health Plan member providers Martin’s Point HealthCare and Johns Hopkins Health Care operate.

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US Family Health Plan executives and beneficiaries speak to Senate staff on Thursday, March 17, in the Russell Senate Office Building. At left, retired Chief Master Sergeant Michael Tedford offers personal anecdotes about the care he has received through a US Family Health Plan provider after a 30-year career in the U.S. Air Force.

“The US Family Health Plan is an amazing health plan,” said Linda Marzano, chair of the US Family Health Plan Alliance’s board of directors and CEO of Seattle-based Pacific Medical Centers. “We offer high-quality care and high patient satisfaction for all of our beneficiaries. Our vision is to really simplify healthcare for everyone.”

“Serving the families that have served our country is our highest priority,” added Jeff Bloom, senior vice president at St. Vincent’s Catholic Medical Centers of New York. “We believe establishing a strong culture of compassion improves quality of care, and we take pride in delivering exceptional healthcare benefits to all our members.”

Unique among TRICARE programs, the US Family Health Plan provider organizations serve more than 145,000 beneficiaries through fixed price contracts and using a capitated care model. David Chicoine, senior Vice President and plan CEO for Brighton Marine Health Center, the US Family Health Plan provider in Massachusetts and Rhode Island, explained how care capitation allows for greater focus on disease prevention, wellness programs and improved care access for beneficiaries.

“The US Family Health Plan is the only fully at-risk managed care plan that the Department of Defense offers,” he said. “What that means is the government pays the programs a fixed annual premium for each member who enrolls in the health plan. Transferring the risk to deliver all of the healthcare to us compels us to create an environment in which patient engagement and effective access to care is optimized. We are responsible for providing all of their care, regardless of what they need.”

Retired Col. William E. Hall, USAF, speaks with an aide to Sen. Sherrod Brown (D-Ohio), following the US Family Health Plan briefing on March 17. Colonel Hall is a US Family Health Plan beneficiary of Martin’s Point Health Care in Maine.

Retired Col. William E. Hall, USAF (center), speaks with an aide to Sen. Sherrod Brown (D-Ohio), following the US Family Health Plan briefing on March 17. Col. Hall is a US Family Health Plan beneficiary of Martin’s Point Health Care in Maine.

Staffers representing 16 different U.S. Senate offices heard compelling testimony from service members who have entrusted the US Family Health Plan with their health care. Retired U.S. Air Force chief master sergeants Michael Tedford, a Johns Hopkins beneficiary, and Charles Halsted, a Martin’s Point beneficiary, shared examples of their families’ positive experiences with the US Family Health Plan.

“One of the big focuses on care mimics the old cliché – an ounce of prevention is worth a pound of cure. That approach seems inculcated into the culture of the plan,” said Tedford, who retired after a 30-year career that included stints on the aircrew of Air Force One. “Over the years, I’ve been able to share my experiences with a bunch of fellow military retirees, and a lot of them have signed up for the [US Family Health Plan] and have had pretty much the same positive experiences that I’ve had.”

Chief Halsted offered a deeply personal story about the quality care his wife received.

“My beautiful wife is a constant gardener,” Halsted said. “She’s highly susceptible to skin cancer, and like me she wears heavy glasses. In the last two years, she’s had a problem with one eye, which required cataract surgery, and in this last year, she had a case of skin cancer near the eye. Martin’s Point jumped right into it, arranged for all the tests, surgeries and post-op work that had to be done. I don’t know what more you can ask from a care provider. It means that I can be assured of her care and my care through my extended life, and I plan to push it hard. It means that I have people I can go to, and I’ll tell you how important that is.”

Mary Cooke, Vice President of the Johns Hopkins US Family Health Plan program, discussed how the privilege of working with Plan beneficiaries also benefits civilian hospitals.

“The civilian healthcare community has learned so much from the military community,” she said. “We are honored to be part of the Military Health System. With that privilege comes responsibility, and look at our beneficiaries – how can you not love them? This partnership is magic, and it’s kind of a two-way street: we always raise the bar for each other, and I think the closer we can work together, the better we can serve our common military community.”

Chief Halsted left attendees at the close of the briefing with a ringing endorsement of the US Family Health Plan.

“I can’t emphasize to you enough the importance of quality care for people who have stepped forward for our country,” he said. “As [Chief Tedford] said, it’s keeping a promise we gave those people when they put their hand up. To think that some people in our government would start to tweak this operation to make a buck…if that is what it comes down to, it’s a travesty. You have to support this type of operation. These people are really doing a great service.”

Study: Providing Quality Care for Military Families Requires Understanding Military Culture

A new study from the University at Buffalo, published in Military Behavioral Health, concludes that health care provider networks that serve veterans and families in the military community need to have a fundamental understanding of military culture in order to provide effective care and improve patients’ health outcomes.

The new findings underscore the critical importance of understanding how military service impacts care utilization—fundamentals that the US Family Health Plan provider organizations have standardized in their enduring tradition of serving nearly 150,000 military family members and veterans.

A unique quality identified in the research about this population is that military family members and veterans often “don’t complain about little things” – a phrase which is included in the subtitle of the final research report – and may feel unsupported and underappreciated by those providing them care. The University of Buffalo researchers found that veterans and military families often feel that health care providers minimize their concerns or do not communicate clearly with them.

The US Family Health Plan view is that service members and their families deserve the greatest respect for their service, and also the highest-quality health care. The US Family Health Plan has been a leader in quality care for military families, retirees and other beneficiaries in the Military Health System for more than 30 years, systemically instilling the critical components of care outlined in the study’s findings:

  • An in-depth knowledge of military culture, values and ideals;
  • An understanding of the stressors of military life and post-service adjustment;
  • Recognition that a person’s military service might influence his or her care utilization habits;
  • Avoidance of individual barriers to a patient-provider relationship.

By knowing who our patients are, understanding their needs, and clearly communicating their care and treatment options, the US Family Health Plan provider organizations effectively care for chronic conditions, reduce emergency room visits and achieve better health and wellness outcomes. Our beneficiaries get appointments when they need them, and they receive sustained and reliable access to care through a 24-hour nurse help line, in-home monitoring and other advanced approaches to care delivery. It’s no wonder that US Family Health Plan beneficiaries are among the most satisfied patients in the country.

Congress Learns about Military’s Only Capitated Health Care Model

Members of Congress have been looking for solutions to curb the rising cost of military healthcare, and on Nov. 3 representatives of US Family Health Plan briefed congressional officials about key features of the only fixed price, value-based capitated care program in the Military Health System.

U.S. Rep. Adam Smith (D-Washington), Ranking member of the House Armed Services Committee, introduces US Family Health Plan executives Linda Marzano (left) and David Chicoine (right) at a Nov. 3 Capitol Hill briefing on population health management.

U.S. Rep. Adam Smith (D-Washington), Ranking member of the House Armed Services Committee, introduces US Family Health Plan executives Linda Marzano (left) and David Chicoine (right) at a Nov. 3 Capitol Hill briefing on population health management.

“The US Family Health Plan is the alternative model of care that the country is striving for,” said Linda Marzano, chair of the US Family Health Plan Alliance’s board of directors and CEO of Pacific Medical Centers, located in Seattle. “We have high quality, high patient satisfaction and a lower cost of care. We are achieving what the entire country is trying to move toward.”

Patient-Centered Healthcare Leads to Member Satisfaction

Marzano’s remarks on Capitol Hill come after the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey confirmed that US Family Health Plan patients are some of the most satisfied in the country. The CAHPS report this year showed that the US Family Health Plan’s aggregate member satisfaction rating in 2014 was 91.5 percent—more than 25 points higher on a 100-point scale than the national average for commercial health plans.

(Left to right) US Family Health Plan executives Linda Marzano (Pacific Medical Centers), David Chicoine (Brighton Marine Health Center) and David Howes (Martin’s Point Healthcare) discuss the high-quality, patient-centered healthcare that has been provided to military families for more than 30 years.

(Left to right) US Family Health Plan executives Linda Marzano (Pacific Medical Centers), David Chicoine (Brighton Marine Health Center) and David Howes (Martin’s Point Healthcare) discuss the high-quality, patient-centered healthcare that has been provided to military families for more than 30 years.

The six designated provider organizations that make up the US Family Health Plan operate a capitated-care model in which they are reimbursed at a fixed rate for the cost all patient services, and they are at risk if the cost of care exceeds that rate. This arrangement incentivizes investment in population health and disease management programs that help people live healthier lives and avoid expensive episodes of inpatient care.

“Each year, we’ve been able to offer great care at an affordable cost,” explained Dr. David Howes, president and CEO of Martin’s Point HealthCare. “Because people enroll with us, we know the people for whom we are responsible. We establish their preventive care needs, risks and chronic diseases, so we can help them to optimize their care, minimize hospitalizations and complications and remain healthy for as long as possible.”

David Chicoine, senior vice president and plan CEO for Brighton Marine Health Center, explained that each US Family Health Plan enrollee has an assigned primary care provider to coordinate care based on population models, health screenings and the patient’s previous medical history.

“Delivering very patient-specific healthcare is critical to achieving the high patient outcomes that we do,” Chicoine said.

“The Level of Care is Extraordinary”

Two US Family Health Plan members, retired Navy Rear Adm. Bill Center and retired Air

US Family Health Plan members—retired Navy Rear Adm. Bill Center (second from right) and retired Air Force Chief Master Sergeant Michael Tedford (far right) explain why the US Family Health Plan is the best option for their families’ healthcare.

US Family Health Plan members—retired Navy Rear Adm. Bill Center (second from right) and retired Air Force Chief Master Sergeant Michael Tedford (far right) explain why the US Family Health Plan is the best option for their families’ healthcare.

Force Chief Master Sergeant Michael Tedford, explained why they chose the US Family Health Plan from among the TRICARE choices for health care. Tedford discussed how, after retiring from the U.S. Air Force, he and his family moved between various health providers before settling on the US Family Health Plan, and noted how the preventive care approach helped catch a significant illness at a very early stage.

“The plan’s focus on preventive care is high, and I think it’s really instituted in the culture of all the care providers,” Tedford explained. “It sort of mimics that old cliché—an ounce of prevention is worth a pound of cure. I’ve had nothing but good things to say about [the US Family Health Plan], and I plan on staying in it until I’m kicked out.”

Rear Admiral Center, who served the U.S. Navy for 35 years, noted the high quality care and personal respect he and his wife receive through the US Family Health Plan at Pacific Medical Center, which he touted as a model for future of the Military Healthcare System.

“The quality of care we’ve received is extraordinary,” he said. “I’m grateful we have this plan, and if it were up to me, I would want a plan like this for all military retirees. Our medical benefit is the most important of all of our retirement benefits, and when I talk to other retirees I get the same sentiment, especially as we grow older. [The US Family Health Plan’s] model lends itself to a true partnership between the military and retiree healthcare providers, and I think a seamless partnership is really important as we go forward in the future.”