Download or read book TRICARE Managed Care Support Contracts written by United States. Congress. House. Committee on Armed Services. Subcommittee on Military Personnel and published by . This book was released on 2001 with total page 270 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Government Estimates in the Tricare Managed Care Support Contracts written by Michael Evi Jonasson and published by . This book was released on 2001-08-01 with total page 101 pages. Available in PDF, EPUB and Kindle. Book excerpt: In 1994, the Department of Defense (DoD) began a journey, to merge the Military Health System (MHS) with the concept of the Managed Care Support Contractor (MCSC). The DoD managed health care program, called TRICARE, includes the competitive selection of contractors to financially underwrite the delivery of civilian health care services with a uniform, stabilized benefit structure, triple option health benefit features, and a regionally-based health care management system. The goals of TRICARE are to maintain medical readiness, improve access to care, provide a secure quality health care benefit, provide a choice of health care options, and contain DOD health care costs. The Managed Care Support (MCS) contracts are fixed-price contracts, with risk-sharing features and a bid price adjustment process designed to periodically substitute projected/estimated health care costs with actual health care costs. MCS contracts are 5 1/2 year contracts, with a 6-month phase-in period prior to start-up of delivery of health care services, followed by 5 1-year option periods. This thesis will explore the bid price adjustment process within the MCS contract, and the Government's methodology used to project/estimate health care costs for use by offerors in the bidding process. Selected as an example for discussion is the Regions 3 and 4 MCS contract. This thesis explores whether the Government, in choosing and engaging a methodology for projecting/estimating health care costs, should have instead chosen another methodology or path; i.e., "the road not taken."
Download or read book An Evaluation of Resource Sharing Within Tricare s Managed Care Support Contracts written by Martin D. McCue and published by . This book was released on 1996-09-01 with total page 146 pages. Available in PDF, EPUB and Kindle. Book excerpt: To help reduce the overall cost of health care in the Military Health Services System, Managed Care Support Contracts include a provision known as Resource Sharing. Resource Sharing Agreements allow the contractor to provide personnel, equipment, or supplies to a military treatment facility to improve its capability to deliver health care. After reviewing civilian managed care programs, this thesis examines the Military Health Services System and its new managed care program known as TRICARE. Then the concept of Resource Sharing is examined and the process for identifying, evaluating, and using cost effective Resource Sharing Agreements is discussed. Case studies of different types of agreements are used to illustrate the complexity and importance of cost and workload estimates and key contract factors in understanding the agreements. The findings suggest that the contractor's and government's performance data and assumptions underlying the agreements should be continuously monitored to ensure the cost-effectiveness of the agreements.
Download or read book Defense Health Care written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-12-16 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: Defense Health Care: Acquisition Process for TRICARE's Third Generation of Managed Care Support Contracts
Download or read book Defense Health Care written by United States. General Accounting Office and published by . This book was released on 1995 with total page 60 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Defense Health Care written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-27 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: " DOD provides health care through TRICARE, its regionally structured health care program. In each of its regions (North, South, West), DOD uses contractors to manage health care delivery through civilian providers, among other tasks. UnitedHealth-an organization new to TRICARE-was awarded the contract in the West region. After health care delivery began, UnitedHealth experienced problems fulfilling some requirements and delivering care to TRICARE beneficiaries. GAO was asked to review the West region's transition to UnitedHealth. This report provides information on (1) the extent to which TMA provided guidance and oversight of the new contractor's transition period in preparation for health care delivery; and (2) how, if at all, TMA's guidance and oversight during the transition period contributed to issues with health care delivery. GAO reviewed and analyzed TMA guidance, contract requirements, and other relevant documentation, and interviewed TMA and UnitedHealth officials. "
Download or read book Defense Health Care Acquisition Process for Tricare s Third Generation of Managed Care Support Contracts written by U.s. Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-07-27 with total page 38 pages. Available in PDF, EPUB and Kindle. Book excerpt: " DOD provides certain health care services through its TRICARE Program, which complements the health care services provided in military treatment facilities. DOD acquires these health care services through MCSCs with private sector companies. As of October 1, 2013, DOD's Defense Health Agency is responsible for awarding, administering, and overseeing TRICARE's MCSCs. Prior to this date TMA handled these duties. DOD's health care costs have more than doubled from $19 billion in fiscal year 2001 to its fiscal year 2014 budget request of more than $49 billion. Senate Report 112-173, which accompanied a version of the National Defense Authorization Act for Fiscal Year 2013, cited concerns with the growth of DOD's health care costs and identified private sector health care contracts as an area for potential savings and efficiencies. The Senate report mandated that GAO review DOD's process for acquiring TRICARE's MCSCs. This report examines: (1) TMA's acquisition process to award TRICARE's third generation MCSCs; (2) the extent to which issues were raised in the bid protests involving these MCSCs, including identifying any common themes; and (3) lessons learned from the acquisition process to award these MCSCs and how these lessons may be used in future acquisitions.
Download or read book The TRICARE Managed Care Support Contracts an Analysis of the Bid Price Adjustment and Resource Sharing Mechanisms written by Robert R. Cox and published by . This book was released on 1996-12-01 with total page 95 pages. Available in PDF, EPUB and Kindle. Book excerpt: This thesis analyzes the primary question: what are the unique characteristics of the military's TRICARE MCS contracts, and are they functioning sufficiently to achieve the objectives of the TRICARE Program? In answering this question, the bid price adjustment (BPA) and risk sharing mechanisms are analyzed. The TRICARE Program is compared to past Military health care programs, and the considerations which led to the inclusion of the bid price adjustment (BPA) and risk sharing mechanisms are examined.
Download or read book Defense Health Care written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-12-16 with total page 44 pages. Available in PDF, EPUB and Kindle. Book excerpt: Defense Health Care: More-Specific Guidance Needed for TRICARE's Managed Care Support Contractor Transitions
Download or read book A Financial Analysis of Resource Sharing Agreements as Part of the TRICARE Managed Care Support Contracts written by Steven L. Hoeft and published by . This book was released on 1998-12-01 with total page 100 pages. Available in PDF, EPUB and Kindle. Book excerpt: Escalating health care costs and base closures have forced the DoD to improve access to health care while maintaining quality, controlling costs, and increasing medical readiness. The response is a Tri-service managed care system called TRICARE. One mechanism utilized within the TRICARE Managed Care Support Contracts (MCSCs) is Resource Sharing. Resource sharing is a system to reduce the government's health care costs by recapturing the TRICARE workload This thesis explores if Resource Sharing Agreements (RSAs) are cost-effective and how they are being monitored and evaluated by the Lead Agent and MTFs. After conducting a literature review, interviews and performing data analysis, this thesis examined the reported cost analysis, retrospective analysis, and workload of RSAs in Health Services Region 10 as they are used under the MCSC for that region. A case study of RSAs, comparing forecasted and reported savings, was also conducted to understand RSAs and their role in controlling military health care costs. The analysis found that the RSAs are reducing government costs, but not at the predicted rate. This case study found that only 67 percent of the estimated government savings were realized. Decreasing workload is a key factor explaining this shortfall.
Download or read book Defense Health Care written by Government Accountability Office and published by . This book was released on 2017-08-25 with total page 36 pages. Available in PDF, EPUB and Kindle. Book excerpt: "DOD offers health care coverage-medical and pharmacy services-to eligible beneficiaries through its TRICARE program. DOD contracts with managed care support contractors to provide medical services, and separately with a pharmacy benefit manager to provide pharmacy services that include the TRICARE mail-order pharmacy and access to a retail pharmacy network. This is referred to as a carve-out contract structure. DOD's current pharmacy contract ends in the fall of 2014. DOD has been preparing for its upcoming contract through acquisition planning, which included identifying any needed changes to contract requirements.Senate Report 112-173, which accompanied a version of the NDAA for fiscal year 2013, mandated that GAO review DOD's health care contracts. For this report, GAO examined: (1) how DOD identified changes needed, if any, to requirements for its upcoming pharmacy services contract; and (2) what, if any, assessment DOD has done of the appropriateness of its current contract structure. GAO reviewed DOD acquisition planning documents and federal regulations, and interviewed officials from DOD and its pharmacy services contractor."
Download or read book Defense Health Care written by United States Government Accountability Office and published by Createspace Independent Publishing Platform. This book was released on 2017-09-16 with total page 72 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Department of Defense (DOD) provides health care through its TRICARE program. Under TRICARE, beneficiaries may obtain care through a managed care option that requires enrollment and the use of civilian provider networks, which are developed and managed by contractors. Beneficiaries who do not enroll may receive care through TRICARE Standard, a fee-for-service option, using nonnetwork civilian providers or through TRICARE Extra, a preferred provider organization option, using network civilian providers. Nonenrolled beneficiaries in some locations have reported difficulties finding civilian providers who will accept them as patients. The National Defense Authorization Act (NDAA) for fiscal year 2004 directed GAO to provide information on access to care for nonenrolled TRICARE beneficiaries. This report describes (1) how DOD and its contractors evaluate nonenrolled beneficiaries' access to care and the results of these evaluations; (2) impediments to civilian provider acceptance of nonenrolled beneficiaries, and how they are being addressed; and (3) how DOD has implemented the NDAA fiscal year 2004 requirements to take actions to
Download or read book Substance Use Disorders in the U S Armed Forces written by Institute of Medicine and published by National Academies Press. This book was released on 2013-03-21 with total page 350 pages. Available in PDF, EPUB and Kindle. Book excerpt: Problems stemming from the misuse and abuse of alcohol and other drugs are by no means a new phenomenon, although the face of the issues has changed in recent years. National trends indicate substantial increases in the abuse of prescription medications. These increases are particularly prominent within the military, a population that also continues to experience long-standing issues with alcohol abuse. The problem of substance abuse within the military has come under new scrutiny in the context of the two concurrent wars in which the United States has been engaged during the past decade-in Afghanistan (Operation Enduring Freedom) and Iraq (Operation Iraqi Freedom and Operation New Dawn). Increasing rates of alcohol and other drug misuse adversely affect military readiness, family readiness, and safety, thereby posing a significant public health problem for the Department of Defense (DoD). To better understand this problem, DoD requested that the Institute of Medicine (IOM) assess the adequacy of current protocols in place across DoD and the different branches of the military pertaining to the prevention, screening, diagnosis, and treatment of substance use disorders (SUDs). Substance Use Disorders in the U.S. Armed Forces reviews the IOM's task of assessing access to SUD care for service members, members of the National Guard and Reserves, and military dependents, as well as the education and credentialing of SUD care providers, and offers specific recommendations to DoD on where and how improvements in these areas could be made.
Download or read book Selecting a Health Care Option for Military Beneficiaries that Minimizes Health Care Costs While Maintaining Personal Desires for Choice written by Norman H. Pallister and published by . This book was released on 1997-03-01 with total page 94 pages. Available in PDF, EPUB and Kindle. Book excerpt: Tricare, the triservice, triple-option, managed care plan for the uniformed services, incorporates a managed care support contract to complement Military Treatment Facilities. Currently being implemented throughout the CONUS, Tricare provides more equitable health care service to all military beneficiaries, improved access to care, a reduction in health care costs, and provides beneficiaries with an expanded choice of medical-care providers. This thesis examines the Tricare program and reviews relevant health care literature, both military and civilian. Using these inputs, the author presents a deterministic decision analysis model that allows a military beneficiary to select a health care option that minimizes his or her annual out-of-pocket costs while maintaining personal desires for choice among health care providers. Using several carefully selected examples that span the pool of military beneficiaries, the results of this study are presented. Every individual faced with the Tricare decision, approximately six million people, will gain insight from this thesis. While individual impact may only be on a scale of thousands of dollars, the impact for the entire pool of beneficiaries ranges well into the millions.
Download or read book Managed Care Contracting written by Wendy Knight and published by . This book was released on 1997 with total page 392 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides physician executives and medical group managers with a 'next generation' reference on the managed care contracting process. This handbook will educate health care providers about managed care contracting: how the contracting process works, what a standard practice contract looks like and why certain provisions are included, what questions to ask and how to evaluate a capitation rate. Provides pertinent information from professionals in the field.
Download or read book Defense Health Care written by DIANE Publishing Company and published by DIANE Publishing. This book was released on 1995-07 with total page 69 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Department of Defense Authorization for Appropriations for Fiscal Year 2005 written by United States. Congress. Senate. Committee on Armed Services and published by . This book was released on 2005 with total page 524 pages. Available in PDF, EPUB and Kindle. Book excerpt:
