The latest Tricare pilot program meant to provide better care and reduce costs has come to Atlanta, Georgia as Tricare partners with Kaiser Permanente.
Nearly 1,760 Tricare beneficiaries signed up during open enrollment last year for the health care pilot that will be available for three years. That is about 740 people short of meeting the program's initial goal.
Tricare officials are testing out partnerships like this so they can move to a value-based system instead of a volume-based program that reimburses health care providers by the amount, not quality, of care they provide.
“This model can fragment the delivery of health care and inadvertently reward providers for providing low value tests, services, or procedures that are not correlated with positive health outcomes,” a Tricare document said.
So testing and adding value-based programs pay providers based on “improved health outcomes, enhanced experience of care for the patient, and reduced health care costs over time.”
The pilot program is available to beneficiaries who are eligible for Tricare Prime and are living in one of the 17 counties surrounding Atlanta. Military Health System officials chose the Atlanta metro area because having too many military medical clinics and hospitals in the area would “confound” the program outcomes. The region also has an “ideal population size.”
Kaiser Permenante will match the cost shares as laid out in the Tricare formulary, a Tricare official said. But he did not specify if Kaiser Permenante will provide more or less drug coverage than Tricare.
However, this pilot does offer more health programs to beneficiaries, like no-cost telephone health coaching; free or low-cost in-person health classes; special rates on gym memberships and discounts on acupuncture, chiropractic and massage therapy.
Tricare is footing the enrollment fees for beneficiaries their first year, but it’s not clear what it will cost enrollees the following years.
Meanwhile, the pilot’s size could change throughout the year as beneficiaries join when they have a Qualifying Life Event, such as a move or birth of a child, or be removed if they become ineligible due to changing health needs.
Kaiser Permenante's health system is unique as it's known for providing its own health coverage in addition to delivering medical care. More information about this program can be found at its Tricare webpage here.
-- Dorothy Mills-Gregg can be reached at firstname.lastname@example.org. Follow her on Twitter at @DMillsGregg.