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New Regional Contracts to Administer the TRICARE Benefit

The new regional contracts are the fourth generation of Managed Care Support Contracts since 1994. As with each generation of Managed Care Support Contracts, the Military Health System (MHS) seeks to improve the delivery, quality, and cost of health care services from previous contracts. 

New Contracts Awarded: July 21, 2016

The new regional contracts awarded on July 21, 2016. The East Region contract goes to Humana Government Business, Inc. of Louisville, Kentucky, and the West Region contract goes to Health Net Federal Services, LLC of Rancho Cordova, California. These contracts will provide a solid foundation for future initiatives, a more cost-effective and efficient managed care contract, and improvements to enable better health care benefit administration.

GAO Uphold Contract Awards: November 11, 2016

The Government Accountability Office announced the results of its review of the protests filed against the TRICARE 2017 Managed Care Support Contracts awards on November 11, 2016.

Two Key Changes

Improved Integration across the MHS

The MHS consists of Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care and Purchased CareThe TRICARE Health Program is often referred to as purchased care. It is the services we “purchase” through the managed care support contracts.purchased care. To enhance our beneficiaries’ experience of care, the new contract improves integration between direct care and purchased care by requiring the Managed Care Support Contractors to:

Change Resulting in ...
Process referrals electronically
  • Decreased wait times for beneficiaries to get specialty care. 
  • Less administrative burden for military hospitals and clinics
Share more data across the enterprise
  • Improved beneficiary care coordination and access to care. 
  • Real time access to data on utilization and medical management.
Increase the use of analytics and standardized metrics
  • Fewer gaps in care. 
  • Improved clinical quality and patient safety.

Reduction of Three TRICARE Regions to Two

There are currently three TRICARE regions in the United States: North, South, and West. The new contract reduces the number of regions to two.

  • East Region (merges current North and South Regions)
  • West Region (same as the current West Region)

Image showing change from three TRICARE regions to two.

The two-region concept supports consistency in benefit administration by reducing administrative variation across regions, reducing administrative cost, and providing seamless support to a mobile TRICARE beneficiary population.

What You Can Do Now

There is a 9-month transition period between the contracts. To make sure you are prepared for the transition, you can:

For more information, please visit the TRICARE website.

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On Jan. 1, 2018, the current three U.S. TRICARE regions consolidate into two. New regional contractors will administer the TRICARE benefit for the East (Humana Military) and West (Health Net Federal Services, LLC) Regions. Due to these changes, it’s possible that your primary care manager (PCM) will no longer be in network.

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This video spot describes how the three TRICARE regions are changing to two.

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Changes are coming to your TRICARE benefit beginning January 1, 2018. These changes will give you more benefit choices, improving your access to care and simplifying cost shares. The best way to prepare is to update your information in DEERS, sign up for TRICARE benefit updates, and visit the TRICARE Changes page.

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