How DoD Must Protect Patients During the TRICARE Contract Changeover

How DoD Must Protect Patients During the TRICARE Contract Changeover
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Proper DoD oversight of new TRICARE provider contracts will be “essential” to maintaining beneficiary access to quality health care, MOAA and other advocacy groups wrote in an Aug. 9 letter to a top Pentagon official.

 

“Past TRICARE contract transitions have been rife with challenges, presenting military families with increased barriers to access, disruptions in care, and excessive wait times for customer service to address these issues,” per the letter from The Military Coalition (TMC), an umbrella group which represents about 5.5 million members of the uniformed services community (and includes MOAA among its founding members), addressed to Dr. Lester Martinez-Lopez, assistant secretary of defense for health affairs.

 

[RELATED: What the New TRICARE Contract Will Mean for Your Earned Benefit in 2025]

 

About 4.5 million beneficiaries live in states where providers will change. The switch will not affect those using TRICARE For Life.

 

TMC identified four key factors DoD must address to ensure a successful changeover to the new provider contract, known as “T-5”:

 

1. Build Better Networks

The new contract offers an opportunity to “fix network shortfalls in areas where providers exist but aren’t currently part of the TRICARE network,” the letter states. Strong provider networks “are paramount to access and key to minimizing care disruptions” – offering beneficiaries more care options is a key part of ensuring the world-class care promised by DoD leadership.

 

2. Support At-Risk Families

The TMC letter identifies two programs – the TRICARE Autism Care Demonstration and the TRICARE Childbirth and Breastfeeding Support Demonstration – where special care must be taken to “minimize care disruptions.”

 

MOAA has been monitoring both of these programs and their effect on available care for military families. The association recently took part in a public workshop addressing an upcoming report on the Autism Care Demonstration.

 

[RELATED: How MOAA Works to Support Maternal Mental Health for TRICARE Beneficiaries]

 

3. Address Chronic Conditions

While DoD has confirmed TRICARE appointments made before the T-5 changeover will be honored in the new year, many beneficiaries suffering from chronic conditions will need more than an extension under their current provider as the new contracts launch. DoD must ensure “warm handoffs” for these beneficiaries during this transition, the letter states, and allow for fast escalation of customer service complaints surrounding such care.

 

4. Solve Enrollment Problems

Despite all advance work to ensure those who’ve earned this coverage will continue to receive it, it’s likely some beneficiaries will slip through the T-5 cracks, losing coverage because of outdated records in the Defense Manpower Data Center, or because of issues with transitioning monthly fee payments, or other concerns. The Defense Health Agency (DHA) must prioritize call center support for these beneficiaries, per the letter, so such problems can be addressed without affecting access to care.

 

“[Government Accountability Office] evaluations of past TRICARE contract transitions have highlighted DHA’s essential role in transition guidance and oversight,” the letter states. It also calls for “ongoing engagement” between DHA and advocacy groups like those in TMC, allowing for problems to be identified and addressed in short order.

 

As part of this effort, MOAA asks its members to reach out with TRICARE feedback, especially concerns driven by the contract changeover, by emailing legis@moaa.org. Your input will help MOAA and TMC ensure all beneficiaries can navigate the T-5 transition and maintain the coverage they’ve earned.

 

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About the Author

Kevin Lilley
Kevin Lilley

Lilley serves as MOAA's digital content manager. His duties include producing, editing, and managing content for a variety of platforms, with a concentration on The MOAA Newsletter and MOAA.org. Follow him on X: @KRLilley