Shelton Ready to Tackle TRICARE Issues

"To have implemented TRICARE worldwide in five years with its 8.3 million beneficiaries is quite an accomplishment," Army Gen. Henry Shelton, chairman of the Joint Chiefs of Staff, said in opening remarks at the four-day 2000 TRICARE Conference here. "A tremendous amount has been achieved, but I'm sure you'll all agree with me that we still have a long way to go."

Shelton told his audience of some 400 civilian and military healthcare providers and administrators that healthcare is one of DoD's "big four" quality-of-life issues -- the building blocks of a quality volunteer force. The other three are pay and compensation, retirement benefits, and housing.

He cited the 4.8 percent pay raise, pay table reform and repeal of the Redux retirement plan in the fiscal 2000 budget as examples of the defense leadership's commitment to recruit and retain a quality force. Also, Defense Secretary William Cohen in January announced a major initiative to eliminate out-of-pocket housing costs within five years.

"This year we've got to address healthcare," Shelton said. "The bottom line is that our service members and their families must be able to count on their healthcare system. Our fighting men and women on the frontlines of freedom need to know that their families are being taken care of."

He told the group that thanks to e-mail, today's deployed troops know almost immediately if there is a problem with healthcare at home. "While they are doing their job taking care of the nation's defense, they expect us to provide an effective, user-friendly healthcare system," he said.

Overall, TRICARE beneficiaries may say they're satisfied with the healthcare they receive, but many complain about the process of getting that care, Shelton said. "Every time I talk to them, one of their most frequent complaints is ... with the process it takes to finally get the care they need," he said.

"To the health system's credit, once our men and women and families receive care, few of them complain about the quality of care or the attitude of the healthcare providers," he told the conference attendees. "This is a bright spot in the system, and when it works it is the result of the hard work that you all do."

Shelton said many frustrations can be traced to poor customer relations and bad business practices. TRICARE's regional structure works against consistency in such "common-sense areas" as appointments, claims and enrollment, he noted.

"As many of you know, TRICARE requires that members re- enroll every time they change regions, something that occurs frequently as our service members and their families must pick up and move every two to three years," he said. "This adds to their stress and frustration, and oftentimes, their workload."

Another concern is that there are differences in benefits between those stationed stateside and those stationed overseas. "These challenges require our urgent attention," Shelton said. He noted that Dr. Sue Bailey, assistant secretary of defense for health affairs, addressed the Joint Chiefs in January and laid out a plan and a schedule to fix these issues. But that's still not enough, he said.

"We ask our service members to be ready to serve any time, anywhere. They expect no less from their healthcare system," he said. "If a service member can't count on TRICARE when it's needed, then when the time comes to re- enlist, the answer might just be 'no.' In short, TRICARE can't be just an insurance agency; it must be much more."

Shelton said he has testified before the Senate Armed Services Committee that improving medical care is a top DoD priority in the fiscal 2001 defense budget. He said improvements should focus on several areas:

• Fully funding and placing more emphasis on the Defense Health Program. Shelton said the program has been underfunded for several years. "We are encouraging unit leadership, from the senior flag officers to the platoon leaders, to understand, get involved and become advocates for the military health system," he said. "This is clearly a program that deserves command attention and support." 
   
• Ensuring every installation has a TRICARE hot line, "(This is) not to bypass the chain of command, but to bring medical care issues to the attention of the appropriate people at the appropriate levels," Shelton said. 
   
• Increasing retirees' benefits. Important first steps would be to increase pharmacy benefits and to fully fund and expand TRICARE Senior Prime. "Our retirees deserve the healthcare that they have earned and DoD committed to," he said. 
   
• Establishing a healthcare network to meet the needs of all beneficiaries. Start this with automatic enrollment of all active duty members and their families, Shelton said. He said beneficiaries should have quick, easy access to case managers, and fair and timely claim payments. All enrollees need to know who their primary case manager is and how to contact them. "I applaud your recent initiative to make sure that the patient knows his doctor by name," he said. "This is just plain good medicine." 
   
• Changing "navigation" to make the system as customer- focused and easy to use as possible. "Many service members' attitudes toward TRICARE stem from their experiences on the telephone," Shelton said. "Our service members and their families should not be forced to wait on the phone and listen to recordings for 20 minutes just to secure an appointment." He said another irritant, the claims process, should be "invisible to the active duty members and simplified for all others."

The chairman told the group his staff will work actively with DoD's new Defense Medical Oversight Committee, which aims to address current irritants and future benefits of the military healthcare system.

He urged managers to test their own systems. "For those who are military healthcare members, try not wearing your uniform one day -- you've got my permission -- and walk into the TRICARE offices you're responsible for to see how you're treated," he said. "If you find things not to your liking, fix them.

"Remember, if it's hard for you, imagine what it's like for the young, inexperienced mother of two whose husband is deployed to Bosnia or Kosovo or any of the other garden spots our troops are deployed to," Shelton said.

He told the group they should act as advocates for their beneficiaries, not adversaries. "You work on behalf of our warriors and their families. They need your support, and I know that you are committed to helping them," he said. "It is my goal that a future chairman a few years from now can come before you and say with conviction, 'Our healthcare system is a success and better than any other in the world, bar none.'"