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.