By Annette M. Boyle
WASHINGTON— The Defense Health Agency (DHA) launched two programs this summer to ease access to care and improve communication between military and civilian healthcare providers. The Urgent Care Demonstration enables TRICARE Prime beneficiaries to receive medical care at civilian urgent care centers for the first time, while the Virtual Lifetime Electronic Record simplifies medical record sharing.
The three-year pilot urgent care program, mandated by the 2016 National Defense Authorization Act, allots patients up to two urgent care visits per year without requiring prior authorization or referral, or incurring deductibles or co-pays. TRICARE Overseas enrollees do not face a cap on the number of visits to domestic urgent care facilities.
The program aims to keep TRICARE members out of the emergency department (ED) when they could be more quickly—and less expensively—treated elsewhere. “We recognize there are some times when our patients don’t really need an emergency room, but they do need access to urgent care,” said Vice Admiral Raquel Bono, director of DHA.
Previously, visits to civilian urgent care clinics required authorization, while care provided in an ED did not. The program “will reduce the burden for beneficiaries who need medical care after-hours or while traveling,” explained Shane Pham, a member of the DHA Policy and Operations Directorate.
For servicemembers based overseas, “it’s a huge benefit. They had such a problem getting a primary care manager referral when they came back to the U.S.,” Pham added.
In 2014, TRICARE spent $4.9 million on primary care provided through EDs, compared to many times that for actual emergencies. “That’s not much, compared to the $6 billion in patients seen,” said Regina Julian, MHA, MBA, DHA’s chief of Patient-Centered Integrated Care, Experience and Access.
“People had an idea that a lot more of our patients were going to network emergency rooms than actually were. Based on industry standards, we found that our patients do a good job of not going to the emergency room when not warranted in a prudent layperson’s opinion,” she noted.
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