Skip to main content

Military Health System

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.).

Recommended Content:

Information for Patients: About TRICARE | Health Care Administration & Operations | TRICARE Health Plan | TRICARE 101

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 SelectTRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate.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 Direct 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 SelectTRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate.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...

TRICARE Answers Your Questions About Baby Formula

Article
5/23/2022
Baby smiling

The shortage of baby formula is having an impact on millions of families including military families. Here are a few questions and answers about the shortage to help.

Recommended Content:

Information for Patients: About TRICARE | Children's Health

MHS Video Connect Offers Convenience, Efficiencies for Providers

Article
2/16/2022
Army Lt. Col. (Dr.) Ryan Brennan

MHS Video Connect provides a safe and effective platform to virtually engage with patient “face-to-face”.

Recommended Content:

Health Care Technology | Health Care Technology | MHS Video Connect | Information for Providers | Health Care Administration & Operations | Military Hospitals and Clinics

'Open Notes' Approach Builds Stronger Provider-Patient Relationships

Article
1/4/2022
Open notes offer many evidence-based advantages through mutual communication, understanding, and collaboration.

'Open notes' enable two-way communication and feedback that encourages providers and patients to feel that they are not just on the same page, but in the same boat on a shared journey.

Recommended Content:

MHS GENESIS: The Electronic Health Record | Health Care Administration & Operations | Information for Providers | MHS GENESIS

Access to TRICARE Online Patient Portal Materials Just Got Easier

Article
12/20/2021
Beneficiaries may access outreach materials by clicking the Patient Portal Outreach option on the menu.

TRICARE Online Patient Portal (TOL PP) outreach materials will be accessible without login on TOL PP

Recommended Content:

Information for Patients: About TRICARE | Secure Patent Portals

Connected Health Hosts DHA Digital Health Virtual Summit

Article
11/22/2021
MHS providers discuss the new MHS Video Connect at the second Digital Health Virtual Summit

The second Digital Health Virtual Summit occurred on Nov. 9 to educate attendees about the Defense Health Agency’s new standard telehealth solution: MHS Video Connect.

Recommended Content:

MHS Video Connect | Health Care Administration & Operations

New MHS Video Connect increases convenient access to care for patients

Article
11/4/2021
Air Force Lt. Col. John A. DaLomba

The MHS is rapidly expanding the number of facilities using MHS Video Connect, with all continental United States-based hospitals and clinics expected to have the capability by the end of 2021.

Recommended Content:

Health Care Technology | Health Care Administration & Operations | MHS Video Connect | Military Hospitals and Clinics

Don't Hesitate: Vaccinate Today for School

Article
8/13/2021
A boy gets the COVID-19 vaccine

Back to School Means Vaccine Time

Recommended Content:

COVID-19 Vaccine Efforts | Coronavirus & the MHS Response | Immunization Healthcare Division | Vaccine-Preventable Diseases | Vaccine Recommendations | Children's Health | Immunizations | Information for Patients: About TRICARE

Delivering Readiness: The Evolution of TRICARE

Article
7/1/2021
A picture of a laptop

The mission of TRICARE is to deliver exceptional medical and dental care to eligible beneficiaries and their families.

Recommended Content:

Information for Patients: About TRICARE | Information for Providers | TRICARE 101 | TRICARE Health Plan

MHS’s four tips for patient-centered digital health

Article
5/5/2021
Picture of Robert Ciulla with the words "Four Tips for Patient-Center Digital Health"

The MHS is taking the lead at the enterprise level by expanding existing digital health systems and partnerships and rolling out new ones.

Recommended Content:

Health Care Technology | Health Care Administration & Operations
Showing results 1 - 9 Page 1 of 1
Refine your search
Last Updated: March 10, 2022
Follow us on Instagram Follow us on LinkedIn Follow us on Facebook Follow us on Twitter Follow us on YouTube Sign up on GovDelivery