Skip main navigation

Military Health System

Clear Your Browser Cache

This website has recently undergone changes. Users finding unexpected concerns may care to clear their browser's cache to ensure a seamless experience.

Need larger text?

Projects test new approaches to improve health care quality, outcomes

Image of Military health personnel wearing a face mask practicing a spinal rotation technique. Physical therapy Assistant Rhonda Dusharm practices applying the spinal rotation technique to a fellow health care professional during a course on the McKenzie Method at Fort Drum, New York, in September 2020. The McKenzie Method is a scientifically proven physical therapy process that allows clinicians to identify the best treatment solution for back, neck and extremity problems (Photo by: Army Staff Sgt. Warren Wright Jr.).

4/15/2021 By: MHS Communications

Share this page

Social Media Links

TRICARE has more than a half-dozen pilots and demonstration projects underway that offer new and innovative medical services, treatments, and approaches, and that have the potential to become part of its permanent health care coverage.

"Many of these pilots are value-based initiatives that seek to reward better health outcomes, enhance beneficiary care experiences, and reduce health care costs over time," said TRICARE Health Plan Deputy Director Curt Prichard. "These include projects for autism care, sexual trauma, and low back pain. These pilots and demonstrations are also looking to improve care through nurse navigators, a referral and appointing center and accountable care organization to make medical care easier for TRICARE beneficiaries."

Air Force Lt. Col. Donald "Del" Lofton, chief, TRICARE Optimization said: "The use of these pilots and demonstrations allows TRICARE to develop and test innovative approaches and services with the broader TRICARE beneficiary population as well as specific services to targeted groups. The goal is always to provide the most effective, high-quality, value-based health care while seeking to improve the overall health care experience for both beneficiaries and those who provide them care."

Here's a look at eight initiatives underway:

Comprehensive Autism Care Demonstration

The Department of Defense's Comprehensive Autism Care demonstration provides reimbursement from TRICARE for applied behavior analysis (ABA) services for beneficiaries diagnosed with autism-spectrum disorder.

Its major goals are to analyze, evaluate, and compare the quality, convenience, efficiency, and cost-effectiveness of ABA services that have not been shown to be proven medical care and are not covered by TRICARE. The pilot, which covers a wide range of TRICARE beneficiaries, began in July 2014 and is scheduled to conclude at the end of 2023.

Sexual Trauma Intensive Outpatient Program Pilot

The Intensive Outpatient Program pilot for sexual trauma aims to treat psychological behavioral health effects of that trauma in active-duty service members (ADSMs) through partnership with public, private, and non-profit organizations in seven locations in the United States.

The pilot is focused on treating ADSMs suffering from post-traumatic stress disorder and other psychological conditions associated with sexual trauma, and determining the feasibility and advisability of using such programs by measuring outcomes and sharing lessons learned. The pilot began last September and is slated to conclude Aug. 31.

TRICARE Select Navigator Pilot

The TRICARE Select Navigator pilot is designed to assess whether providing eligible beneficiaries with one-on-one assistance from nurses identified as health care "navigators" improves health outcomes and the patient experience for those with complex medical conditions.

Those eligible for the pilot must be enrolled in TRICARE Select and have two or more medical conditions requiring coordination of specialties or at least $100,000 in claims per year.

This assistance could lead to reduced use of unnecessary emergency room or urgent care visits due to a beneficiary's lack of understanding of their options. The pilot also will determine the feasibility of incorporating nurse navigators in available support contracts. The pilot is expected to conclude March 31, 2023.

Military health personnel wearing face mask have a discussion Health Benefits Advisor Charlene Johnson (left) talks with a retiree in the TRICARE Operations Department at Naval Hospital Jacksonville Nov. 24, 2020 (Photo by: Deidre Smith, Navy Medicine Readiness and Training Command Jacksonville).

Low Back Pain and Physical Therapy Demonstration

Another demonstration project deals with physical therapy (PT) for lower back pain (LBP). The purpose is to evaluate whether waiving cost-sharing for up to three PT visits increases TRICARE beneficiary use of PT, decreases low-value care, and/or decreases the overall cost of care for treating patients with LBP. The demonstration, available in 10 states, runs through Dec. 31, 2023.

Referral and Appointing Center Pilot

The Referral and Appointing Center (RAC) pilot will create a RAC at one pilot site that will receive all TRICARE Prime referrals written by military medical treatment facility providers in the area. It will determine whether the specialty care will be provided at a Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care facility or will be referred to the TRICARE network. The goal is to determine if using RACs simplifies and improves the process of receiving referrals for specialty care and making appointments for members enrolled in TRICARE Prime.

Accountable Care Organization Demonstration

The Accountable Care Organization (ACO) demonstration offers beneficiaries eligible for TRICARE Prime and TRICARE Select in the Atlanta metro area the chance to enroll in Kaiser Permanente, a TRICARE Prime option. The demonstration is testing the hypothesis that an integrated delivery model will result in higher levels of efficiency, care effectiveness, and beneficiary satisfaction. The demonstration continues through Dec. 31, 2022.

Buckley Prime Service Area Pilot

Another value-based care-driven pilot is in the Buckley Air Force Base, Colorado, Prime service area. Under this population-based capitation pilot, the regional contractor for this region, HealthNet Federal, will provide dedicated, concierge-type service and support to network-enrolled TRICARE Prime beneficiaries in the Denver area. The regional contractor also will target improved quality of care, better experience, and increased satisfaction for both the beneficiaries and providers in the pilot. The goal of the pilot is to determine the effectiveness of a value-based payment model approach versus the current predominantly discounted fee-for-service payment model.

Non-Food and Drug Administration-approved laboratory-developed tests

The final demonstration project is the Defense Health Agency's evaluation of non-Food and Drug Administration-approved laboratory-developed tests (LDTs).

According to regulation, DHA may not cost-share LDTs that are not approved by the FDA under its "substantial equivalence" rules. The goal is to improve the quality of health care services for rare diseases by evaluating the feasibility for DOD review of non-FDA approved LDTs to see if they meet TRICARE requirements for safety and efficacy to become a covered benefit under the demonstration.

The demonstration also extends coverage for cystic fibrosis preconception and prenatal carrier screening when provided in accordance with guidelines.

You also may be interested in...

Policy
Aug 17, 2015

Directive: #DoD Directive 6010.04, DoD Directive 6010.04: Healthcare for Uniformed Services Members and Beneficiaries

This directive reissues DoD Directive (DoDD) 6010.04 (Reference (a)) to update established policy and assigned responsibilities for administering Title 10, United States Code (Reference (b)). It serves as the joint document for administration of healthcare benefits required pursuant to Reference (b), and is issued by the Departments of Defense, ...

  • Identification #: DoD Directive 6010.04
  • Type: Directive
Recommended Content Health Care Administration & Operations Information for Patients: About TRICARE
Policy
Apr 27, 2015

Memorandum: First Call Resolution and Expeditious Reply to Patient Policy

.PDF | 123.07 KB

This policy requires first call resolution for all patients requesting appointments at all National Capital Region Medical Directorate medical treatment facilities. Under this policy, beneficiaries will not be asked to call back for an appointment.

  • Identification #: N/A
  • Type: Memorandum
Recommended Content Health Care Administration & Operations Quality, Patient Safety & Access Information (for Patients)
Policy
Apr 2, 2015

Memorandum: #OTSG/MEDCOM Policy Memo 15-019, First call Resolution and Do Not Call Back Policy

.PDF | 125.00 KB

This Army OTSG/MEDCOM policy identifies responsibilities of MTF commanders, primary care, specialty care and other stakeholders identified in the appointing process to ensure patient satisfaction for our beneficiaries; outlines use of alternative portals such as Army Medicine Secure Messaging, Nurse Advice Line and TRICARE Online; specific procedures ...

  • Identification #: OTSG/MEDCOM Policy Memo 15-019
  • Type: Memorandum
Recommended Content Health Care Administration & Operations Quality, Patient Safety & Access Information (for Patients)
Policy
Mar 17, 2015

Instruction: Air Force Instruction 44-102: Medical Care Management

This instruction implements Air Force Policy Directive (AFPD) 44-1, Medical Operations, and provides guidance for the organization and delivery of medical care. It implements various publications of Department of Defense (DoD), recognized professional organizations, the Joint Commission (TJC), the Accreditation Association for Ambulatory Health Care ...

  • Identification #: N/A
  • Type: Instruction
Recommended Content Quality, Patient Safety & Access Information (for Patients) Health Care Administration & Operations
Report
Feb 28, 2015

Evaluation of the TRICARE Program Fiscal Year 2015 Report to Congress

.PDF | 1.77 MB

The Evaluation of the TRICARE Program: Access, Cost, and Quality, Fiscal Year 2015 Report to Congress is provided by the TRICARE Management Activity (TMA)/Office of the Chief Financial Officer (OCFO)—Defense Health Cost Assessment and Program Evaluation (DHCAPE), in the Office of the Assistant Secretary of Defense (Health Affairs) (OASD/HA).This ...

Recommended Content Health Care Administration & Operations Annual Evaluation of the TRICARE Program
Policy
Jan 21, 2015

Guideline: MEDCOM Regulation 40-49: Medical Services Surgical Counts

This regulation provides guidelines for accountability of items used during operative and other invasive procedures (inclusive of minimally invasive procedures) to ensure they are not retained in a patient. This regulation addresses which items will, at a minimum, be counted, as well as when, how, and by whom the surgical count will be performed.

  • Identification #: N/A
  • Type: Guideline
Recommended Content Quality, Patient Safety & Access Information (for Patients) Health Care Administration & Operations
Skip subpage navigation
Refine your search
Last Updated: July 11, 2023
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on X Follow us on YouTube Sign up on GovDelivery