Your Military Health System CAPT Edward (Ed) Simmer Deputy Chief & Chief Clinical Officer, TRICARE Health Plan Defense Health Agency August 13, 2019

A Week in the Life of TRICARE 19,021 Inpatient Admissions 2.38 M Prescriptions (~$107M) 13,444 1.73 M 1.98 M Outpatient Visits 174,721 Behavioral Health Visits 0.85 M 108,693 1.83 M 2,081 Births 55,706 Emergency Room Visits 2,230 108,669 3.8 M Claims Processed Sources: TRICARE 2019 Annual Report Kaiser Permanente 2017 Annual Report, 2015 VA patient volume, data.va.gov Data definitions may vary across organizations $287 M Last revised: 02 Apr 2018

TRICARE Compared to Largest Plans by Membership* * Fahad Saleem, Insider Monkey, 10 Largest Health Insurance Companies by Membership (May 10, 2017), available at https://www.insidermonkey.com/blog/10-largest-health-insurance-companies-by-membership-579652/. ** Director, Defense Health Agency (DHA) Memo dated Nov. 3, 2016, “Estimate of Beneficiaries Eligible for Health Care in Fiscal Year 2017 *** Available at https://www.va.gov/health/ 3

TRICARE A Simplistic Definition Today Military Healthcare System (MHS) TRICARE Program Operational Medicine TRICARE Contractors MTF

Military Health System Consolidation 1 OCT 2018 1 OCT 2019 1 OCT 2020 1 OCT 2021 Previously transferred Transferring within phase 7% Facilities 13% MIL/CIV FTEs 12% Enrollees 17% Dispositions 52% Facilities 54% MIL/CIV FTEs 57% Enrollees 55% Dispositions 81% Facilities 93% MIL/CIV FTEs 89% Enrollees 88% Dispositions 100% MHS Enterprise Full Authority to Standardize Policies for all MTFs Health Plan, Pharmacy & Quadruple Aim Performance Plan (QPP) Functional Capabilities Facilities, MEDLOG & Acquisition Functional Capabilities All other Functional Capabilities

Military Health System Reforms Our Goals What Stays the Same Support to the Mission Patient-Centered Care What’s Changing Standardized Appointing & Referrals across System “Market” Orientation Reporting Relationships

Market Orientation Resources closest to health care delivery Local medical leaders with real authority to effectively move money and people to responsibly coordinate patient-centered care Data-driven

NCR Medical Directorate Reporting Relationships – Old Army Operational Units Navy MEDCOM Marine Air Force MAJCOMs CNO CMC BUMED CJCS Secretary of Defense Sec Army Sec Navy Sec CSAF CSA USD(P&R) ASD(HA) Defense Health Agency USUHS Combat Support Agency Responsibilities Policy & Oversight Army SG Navy SG Air Force SG NCR Medical Directorate MTFs

Military Health System – Before FY 2019 Reporting Relationships – New Secretary of Defense CJCS Sec Army Sec Navy Sec Air Force USD(P&R) ASD(HA) CSA CNO CMC CSAF USUHS Defense Health Agency Policy & Oversight Army SG Navy SG Air Force SG Combat Support Agency Responsibilities Air Force MAJCOMs Markets MTFs Army Operational Units Navy Operational Units Marine Operational Units Air Force Operational Units

NDAA 2017, Section 702 TRICARE Implications One of three functional areas identified for enterprise-level transition Common Medical Benefit Across Direct & Purchased Care Referral Management Improvements Streamlined Case Management

Recent TRICARE Enhancements: Mental Healthcare Goals Align TRICARE’s mental health and substance use disorder (SUD) benefit with the principles of mental health parity Expand covered MH and SUD treatment under TRICARE Streamline requirements for institutional providers Develop TRICARE reimbursement and cost- sharing methodologies Final rule published in Federal Register in September 2016, TRICARE manual changes published in June 217 Results 400% Increase in intensive outpatient 78% Decrease in partial hospitalization Helping families and children receive care in the least restrictive environment

TRICARE Changes in 2019: Introducing TRICARE Open Season Starting in 2019 you’ll need to use open season to change plans (Prime and Select) If you like your plan, you don’t need to do anything Changes outside of Open Season with a Qualifying Life Event For more information, go to TRICARE.mil/openseason Military Changes Activating, Deactivating, Moving. Injured on Active Duty, Separating from Active Duty, or Retiring Family Changes Getting Married, Getting Divorced, Having a Baby or Adopting, Moving, Children Going to College, Children Becoming Adults, Gaining/Losing Other Health Insurance, Becoming Medicare Eligible, or Death in Family

TRICARE Changes in 2019: Introducing FEDVIP Open Season Federal Employee Dental and Vision Insurance Program (FEDVIP) New access to FEDVIP dental and vision plans! Dental is available for retirees. Vision is available for most eligible TRICARE beneficiaries, including TRICARE for Life (TFL) Newly eligible or those who have experienced a Qualifying Life Event (QLE) can enroll in FEDVIP now For all others, next opportunity to enroll will be during the 2019 Federal Benefits Open Season which begins the second Monday in November To check eligibility and explore/compare plans go to Benefeds.com

TRICARE Costs and Fees 2019 Go to www.tricare.mil/costs for easy reference to all beneficiary out- of—pocket costs

What comes next? T-5: The next generation of TRICARE contracts Enhanced Readiness Beneficiary Centric Focus on high value care Move toward Industry Standards

TRICARE A Simplistic Definition Today Military Healthcare System (MHS) TRICARE Program Operational Medicine TRICARE Contractors MTF

TRICARE A Simplistic Definition in T-5 Military Healthcare System (MHS) Mu TRICARE Program Markets Operational Medicine Multiple high Value contractors MTFs

Core Attributes of A New TRICARE Contract Fundamental Reorientation Market-oriented Model (not East and West bolt-on solutions) Tailored networks to each market Consideration of national centers of excellence for select procedures (e.g., organ transplants, complex surgery) Value as driver – networks and reimbursements driven by outcomes and performance, not discounts off of Medicare allowable charges Use / offer integrated delivery networks within geographic communities; explicit partnerships with vendor proposed outcome measures Heighten value of ability to accurately move health data to and from MHS GENESIS in a timely manner Data Exchange Investments – ensure integrated system is properly structured to accommodate expanded data exchange requirements Agile – rapid-cycle approach to innovation and aggressive use of demonstration authority for the purpose of evaluating healthcare delivery options

Outcomes & Experience of Care Enterprise Approach Outcomes & Experience of Care Safety & Quality Improve Improve processing time between appointment referrals and appointment scheduling critical patient safety measures Unintended Retained Foreign Objects, Wrong Site Surgery, Hospital Infections Increase patients satisfied with getting care when they need it Transparency of performance at MHS and MTF levels Readiness Efficiencies Reduce the proportion of Service members that are non-deployable due to preventable medical reasons Streamline overhead staffing through the consolidation of headquarters functions Strengthen Standardize the capability of the deployable medical force business, clinical and administrative policies and processes FY18 Savings Reprogrammed Bolster Cybersecurity medical networks and Cyber standards Eliminate duplicative IT Systems

Rosita, Julia, and some guy who crashed the party

TRICARE.mil is The Source of TRICARE Info https://www.tricare.mil

Stay Connected