A new mission statement recently unveiled by the Defense Health Agency (DHA) highlights a renewed focus on beneficiary care – one supported by MOAA in our work to ensure all servicemembers, past and present, and their families receive the service-earned health care benefits they deserve.

The new statement reads, “The Defense Health Agency supports our nation by improving health and building readiness – making extraordinary experiences ordinary and exceptional outcomes routine.” It applies to both patient care and the readiness mission, while the previous mission statement – “We support the National Defense Strategy and Service Military Departments by leading the Military Health System as an integrated, highly-reliable system of readiness” – focused primarily on readiness.

Two MOAA-backed changes would help DHA improve its beneficiary care processes:

1. Launch a digital problem-reporting system for access to care issues.
   
   
2. Establish a new Qualifying Life Event (QLE) to allow TRICARE Prime beneficiaries to switch health plans to TRICARE Select outside of open season if they encounter problems within their MTF.

[OCT. 24 MOAA WEBINAR: What You Need to Know for the TRICARE, Medicare, and FEDVIP Open Season]

The military health system (MHS) is designed to integrate military treatment facility (MTF) and TRICARE civilian network care. If the MTF doesn’t have the needed capability or can’t meet TRICARE Prime access to care standards, MTF-enrolled patients are referred to the TRICARE network.

Patients trying to access care in this complex system may face MTF primary care manager (PCM) appointment shortages, referral submission or processing delays, failure to release referrals to the network even when the MTF can’t meet access standards, and national provider shortages resulting in long waits for care in both MTFs and the TRICARE network (e.g., Developmental Pediatrics, mental health). It can be difficult for patients to understand where a breakdown has occurred in the process and to get help resolving it.

The patient advocate is the main resource for patients who run into difficulties at the MTF, but patients have no visibility to the process after they submit an issue. It’s unclear whether problems reported to patient advocates are reported up to DHA for analysis and resolution of systemic issues.

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Patients who encounter problems should also have the option of switching to Select as needed to move their medical care to the civilian network. Current QLEs are aligned with commercial plan rules and do not consider the unique nature of the direct care system that can lock a military beneficiary into a single MTF.

Both a digital problem reporting system and a new QLE would serve two purposes – allowing beneficiaries to seek resolution to their problems and ensuring DHA can track those problems and address systemic issues.

MOAA has taken these ideas to the Hill and looks forward to advancing solutions that ensure beneficiaries have resources to navigate the MHS, adequate options for self-directed care outside the MTF, and system improvements through problem-reporting transparency.