Office of the Secretary of Defense Public Affairs
Story by Donna Miles
01.07.2011 WASHINGTON - Though Defense Secretary Robert M. Gates seeks modest premium increases for working-age military retirees who use the TRICARE Prime health plan, the benefit will remain free to service members, defense officials emphasized Jan. 7.
"For some time, I've spoken about the department's unaffordable health costs, and in particular the benefits provided to working-age retirees under the TRICARE program," the secretary told reporters.
"Many of these beneficiaries are employed full-time while receiving their full pensions, and often forego their employers' health plan to remain with TRICARE," he said. "This should not come as a surprise, given that the current TRICARE enrollment fee was set in 1995 at $460 a year for the basic family plan, and has not been raised since."
Gates noted the dramatic increase in insurance premiums during that period for private-sector and other government employees. Federal workers pay roughly $5,000 a year for a comparable health insurance program, he said.
"Accordingly, with the fiscal year 2012 budget, we will propose reforms in the area of military health care to better manage medical cost growth and better align the department with the rest of the country," Gates said. "These will include initiatives to become more efficient, as well as modest increases to TRICARE fees for ... working-age retirees, with fees indexed to adjust for medical inflation."
These initiatives could save the department as much as $7 billion over the next five years, he said.
Military retirees aren't required to report whether they have jobs that offer insurance plans, Camacho said, noting that having other insurance does not take them off the TRICARE rolls. Rather, he explained, TRICARE becomes the "second payer" for health care, picking up co-payments and deductibles from the primary insurance plan.
Meanwhile, the senior TRICARE officer told American Forces Press Service the system is poised to support Gates' new efficiency measures and already is making progress as it strives to provide the best health care at the best cost.
"All of these things help us work together to help us achieve the secretary's goals, and we are already starting to make progress," Navy Rear Adm. (Dr.) Christine S. Hunter said. "We need to be very aware that there is a pressure [to improve efficiency and control costs] and the resources are not infinite. But we are all part of the solution."
As Defense Secretary Robert M. Gates presses for a modest increase in health plan premiums for working-age military retirees to help offset rising health care costs, the head of the TRICARE Management Activity reported progress already made in improving efficiencies as well as the quality of health care services.
"We've been hearing the secretary talk all year about how concerned he is about health care costs. We are too," Navy Rear Adm. (Dr.) Christine S. Hunter told American Forces Press Service shortly after Gates announced his plan yesterday to seek a premium increase for working-age military retirees in the fiscal 2012 budget request.
"We want to use our benefits wisely, and we want to be responsible about the costs," Hunter said. "But most of all, we want to be responsible to our patients."
Cost-effective health care management is a pillar in what Hunter calls TRICARE's "quadruple aim."
"We want to have readiness for the military members and their families, and we want to do that through the best possible health [for beneficiaries] and enhance the patient experience," she said. "And then we want to do so at a responsible cost."
TRICARE officials have worked hard to manage the per-patient cost of health care, Hunter said. TRICARE Prime, the managed-care option that covers all active-duty members and many retirees, costs the government $4,202 per beneficiary per year, program spokesman Austin Camacho reported. TRICARE Standard, the program's fee-for-service plan, costs $3,584 per beneficiary per year. TRICARE for Life, for beneficiaries age 65 and older, costs the government $3,874 per patient per year.
"We are doing a pretty good job of managing costs on a per-patient basis, and year-over-year growth is low," Hunter said.
In their drive to balance cost considerations with other "quadruple aim" priorities, officials are focusing heavily on preventive medicine.
"If we work together to get to better health, it will cost less," Hunter explained. "So whatever we can do to work together to use the benefit most wisely then allows the benefit to be as robust as it can be for as many people as possible. We get the most for all of us."
Hunter cited several initiatives already bearing fruit. More beneficiaries are using the lower-cost mail-order pharmacy option to fill prescriptions. They're getting their immunizations and increasingly participating in a new concept called "patient-centered medical homes" that provide more comprehensive and personalized health care. They're making greater use of online appointment services and health care education materials. And they're increasingly using expensive emergency-room services only for actual emergencies.
"All of these things help us work together to help us achieve the secretary's goals, and we are already starting to make progress," she said. "We need to be very aware that there is a pressure [to improve efficiency and control costs] and the resources are not infinite. But we are all part of the solution."
Hunter said she's confident the TRICARE organization and its beneficiaries will continue working together to streamline costs and promoting efficiencies so the system can remain robust.
"The momentum has started for us to work together with patients and leaders to achieve this," she said. "We have a community of TRICARE leaders and patients that together can help to achieve what America is trying to achieve. We would like to be as healthy as possible, and we would like to have the right health care there when we need it."