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.
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.
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.
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.
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.
“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.”
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.”
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.
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.
“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.
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
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.”
A powerful congressional committee has formally recognized the contributions that the US Family Health Plans (“USFHP”) have made to the health of military families.
In a report accompanying the House version of the National Defense Authorization Act for Fiscal Year 2015, the House Armed Services Committee acknowledged the USFHP’s high quality of health care and customer satisfaction.
The congressional committee went one step further and encouraged the Military Compensation and Retirement Modernization Commission to consider the US Family Health Plans as the commission formulates its recommendations about how best to shape the future military health benefit.
“On behalf of the US Family Health Plan Alliance and its member plans, we are extremely gratified that the House Armed Services Committee has formally recognized the value of the US Family Health Plan program to the beneficiaries and the Military Health System,” said David Howes, President and Chief Executive Officer of Martin’s Point Health Care. “We are equally pleased that the Committee has encouraged the Military Compensation and Retirement Modernization Commission to evaluate the US Family Health Plan program as it deliberates about the best way to improve the Military Health System,” said Howes.
The Military Compensation and Retirement Modernization Commission was established by Congress in the Fiscal Year 2013 National Defense Authorization Act. Its mission is to review military pay and benefits, and recommend how to modernize the systems so that the United States can maintain a strong, all-volunteer force, in both peacetime and wartime, and the systems are fiscally sustainable. The commission has been soliciting information from military members, retirees and others. It will submit its recommendations to the President next year.
In the House Armed Services Committee report on the National Defense Authorization Act for Fiscal Year 2015 (H.R. 4435), the committee wrote:
“The committee is aware of the important role of the US Family Health Plans in providing quality health care, which consistently exceeds customer satisfaction expectations, to military beneficiaries. The committee notes that the Department of Defense strives to provide quality health care to its beneficiary population, which has grown significantly over the last decade. Given the budget challenges the Department is facing, it is important that all segments of the military health system make every effort to ensure that they are providing the most cost-effective quality services available. The committee recognizes the contributions provided by the US Family Health Plans to the health of service members and their families, particularly retirees. Therefore, the committee encourages the Military Compensation and Retirement Modernization Commission to address the role of the US Family Health Plan during deliberations regarding the future military health benefit.”
The US Family Health Plans provide high quality, managed care that utilizes the patient-centered medical home model. The plans place a strong focus on wellness and prevention, and also offer a full-range of specialty care. US Family Health Plans’ patient satisfaction rates are the highest in TRICARE, and patient satisfaction rates are far higher than the national average of commercial plans. In 2013, the plans achieved an overall patient satisfaction rating of 92.5 percent.
Please click on a question below to display the answer. Please click here to read the statement from US Family Health Plan Alliance Chief Executive Officer Henry J. “Jim” Schweiter, and David Howes, President and Chief Executive Officer of Martin’s Point Health Care and chairman of the Alliance Board of Directors, regarding the recently released fiscal year 2015 defense budget request, as it relates to military health care.
What are the changes to TRICARE being proposed to Congress by the Department of Defense (DoD)?
DoD is proposing to consolidate the various TRICARE options—TRICARE Prime, Extra, Standard, and other TRICARE Plans—into one consolidated plan, and to increase several beneficiary costs. Key changes would include:
- Increased Cost Shares: Cost shares will depend on beneficiary category (excluding active duty) and care setting. Cost shares would be the lowest in MTFs, higher in the network, and highest out of network.
- Increased Participation Fee (i.e., Enrollment Fee): Retirees (not medically retired), their families, and survivors of retirees (except survivors of those who died on active duty) would pay an increased annual participation fee or forfeit coverage for the plan year.
- Open Season Enrollment: Participants proposed consolidated plan would be required to enroll for a 1-year period of coverage or lose the opportunity for TRICARE coverage.
- Elimination of Referrals: Beneficiaries would no longer need to obtain authorizations when seeking civilian care; but costs to the beneficiary would be determined by the network status of the provider(s) they see.
- Deductibles: The proposed combined TRICARE plan would feature deductibles that would need to be met by the beneficiary before cost-sharing takes effect. Currently, TRICARE Standard and TRICARE Extra feature deductibles, but TRICARE Prime and US Family Health Plan do not.
- Catastrophic Cap: The Catastrophic Cap, which is the annual, per-family limit on out-of-pocket expenses, would increase slightly from the current amount. However, the participation/enrollment fee would no longer count towards the cap.
- Increase co-pays for pharmaceuticals: The proposed changes to beneficiaries’ pharmacy costs would be phased-in over a 10-year period, with some costs more than doubling over that period of time.
Have these proposed changes been made law?
No. Congress would first need to approve these proposed changes before they could take effect.
Is Congress likely to go along with DoD’s proposed changes?
No one has a crystal ball, but conventional wisdom suggests that it is unlikely Congress would adopt these changes during an election year. Nevertheless, you may wish to contact your elected representatives to understand their position on the proposal and to convey any concerns you may have.
Why is DoD proposing to consolidate the existing TRICARE plans into one plan?
DoD has stated that consolidating the existing plans would simplify TRICARE and save money. However, we believe that beneficiaries should have a choice and should be able to select a plan that best meets their individual needs, rather than a one-size-fits-all plan.
How would these proposed changes affect US Family Health Plan?
At this point it is unclear how these proposed changes—if enacted—might affect US Family Health Plan, as very few specifics have been provided. The US Family Health Plan was created in 1993 by congressional statute, and was moved under the TRICARE umbrella in 1997.
Why is DoD proposing to increase costs for TRICARE beneficiaries?
We believe the DoD is trying to reduce their cost to provide the TRICARE benefit. However, we believe that these costs should not simply be shifted on to beneficiaries. Furthermore, by eliminating the requirement for coordination of referrals to specialists by a primary care provider, the proposed consolidated plan would have beneficiaries navigating the health system on their own, and would likely lead to a lack of coordination of services among providers and higher health care costs in the long run.
Are these changes being proposed because of the Affordable Care Act (“Obamacare”)?
No. TRICARE is governed by a separate set of statutes, and is not directly affected by the Affordable Care Act.
What are the proposed changes to the enrollment fees?
The proposal specifies an enrollment fee increase for January 1, 2016. The enrollment fee would increase each year after that tied to that year’s cost of living increase:
Currently, TRICARE beneficiaries enrolled in Part B pay no enrollment fee. The Administration’s proposal would implement an enrollment fee for these beneficiaries beginning in fiscal year 2015. This fee would be a percentage of the sponsor’s retirement pay:
What are the proposed changes to beneficiary outpatient cost-shares in the FY2015 budget request?
These proposed outpatient cost-shares would take effect January 1, 2016:
What are the proposed changes to beneficiary inpatient cost-shares in the FY2015 budget request?
These proposed inpatient cost-shares would take effect January 1, 2016:
What are the proposed changes to pharmacy co-pays in the FY2015 budget request?
The following proposed pharmacy changes in the FY 2015 budget would take effect January 1, 2015 and be phased-in over a 10-year period:
What are the proposed deductibles?
The following proposed deductibles would take effect January 1, 2016:
General Deductible (out-of-network care)
- E1-E4 active duty family – $150 individual/$300 family
- E5 and others – $300 individual/$600 family
What are the proposed changes to the catastrophic cap?
The catastrophic cap is the maximum a family would pay out-of-pocket in a given year. The current catastrophic cap is $1,000 per year, per family for active duty families, and $3,000 per year, per family for retirees and their families. Currently, all out-of-pocket costs are applied to the catastrophic cap, including the enrollment fee. The Administration proposal would increase slightly the catastrophic cap as of January 1, 2016; however, the enrollment fee would no longer be applied to the catastrophic cap.
Catastrophic Cap (per fiscal year) – Active Duty Family
- $1,500 network/$2,500 combined
- $3,000 networks/$5,000 combined