DoD Needs to Better Monitor TRICARE Care Providers: Report

September 21, 2018

This article by Amy Bushatz originally appeared on Military.com, the premier resource for the military and veteran community.

Pentagon officials need to do more to make sure civilian health care providers are giving military families good care, according to a new report from the Government Accountability Office (GAO).

The report, released Sept. 17, found that while military health care officials have created a way to monitor whether families and troops are getting quality care from military treatment facilities, those same benchmarks aren't applied to community-based providers.

"As a result, DoD's senior leadership has limited information on the extent to which Military Health System (MHS) beneficiaries receive consistently high-quality care across the MHS," the report states.

To keep track of health care performance, the Defense Department has two sets of measurements -- one for military treatment facilities and one for civilian care.

But for community-based care, rather than the providers and hospitals themselves, the Pentagon instead reviews the performance of TRICARE's two civilian health care contractors, Health Net and Humana, using what's known as the Purchased Care Dashboard. The Pentagon expects those contractors, in turn, to monitor individual doctors and hospitals.

But the providers' performance isn't based off the metrics created by the Pentagon, and details on whether the contracted doctors are providing good care aren't shared with military officials, the report found.

"According to MHS officials, the MHS does not require the contractors to ensure that each individual hospital, physician or other provider in these networks meets the performance standards related to the Purchased Care Dashboard measures," the report states.

And while the contractors are expected to make sure military families are receiving quality care, they aren't required to push out providers who don't perform, it adds.

"In practice, however, MHS officials said, and documents we reviewed show, that providers are rarely removed from the network," the report says. "For example, MHS officials reported that one contractor estimated that one provider was removed from its network over quality issues every one to two years."

Pentagon officials told GAO investigators that they don't require performance reports from individual doctors because they don't want to increase provider workloads. Instead, they said they are creating a series of "value-based" pilot programs that give extra incentives and rewards to providers who have good outcomes.

The GAO found fault with that plan, however, because even when completely in place in 2020, those incentive programs would affect only about 25 percent of care. That means the bulk of patient experiences would be left without DoD oversight.

"Without consistent performance standards and corrective action requirements, DoD is limited in its ability to address variation in the quality of care delivered and help ensure that its beneficiaries receive consistent high-quality care across the MHS," the report states.

Instead, the auditors recommend that the Pentagon fix the TRICARE East and West contracts to require action against providers who don't meet the standards.

Defense officials countered that when it comes to the contracts, their hands are tied -- at least for now.

"The Defense Health Agency will hold the contractor to the contractual performance standards, but currently cannot take action against individual providers based solely on performance," Pentagon officials said in a response included with the report.

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