Projects test new approaches to improve health care quality, outcomes

Military health personnel wearing a face mask practicing a spinal rotation technique

4/15/2021 By: MHS Communications

Share this page

Social Media Links

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...

Policy Memorandum to Establish 2012 Monthly Premium Rates for TRICARE Reserve Select and TRICARE Retired Reserve

Policy

Identification #: 11-013
Date: 8/24/2011
Type: Memorandums
Topics: Information for Patients: About TRICARE | Rates and Reimbursement

Air Force Instruction 44-119: Medical Quality Operations

Policy

This instruction outlines military treatment facility (MTF) roles and responsibilities in the area of clinical performance improvement (PI), explains patient safety and risk management (RM) programs, PI/accreditation/self-inspection requirements, credentials and privileging processes, and scope of practice in order to provide optimal healthcare delivery.

Identification #: N/A
Date: 8/16/2011
Type: Instructions
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients)

Navy BUMED Instruction 6010.28: Healthcare Resolutions Program

Policy

This instruction establishes Navy Medicine strategic policy for the promotion of organizational transparency and full disclosure following unanticipated or adverse outcomes of care; to assist the enterprise in "doing the right thing" when there are unanticipated outcomes of care, treatment and services; to train and coach providers in disclosure techniques and to resolve complex healthcare issues at the earliest opportunity, outside a legal venue, with equitable resolutions for patients, providers, and the organization.

Identification #: N/A
Date: 5/23/2011
Type: Instructions
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients) | Patient Safety

TRICARE Policy for Access to Care

Policy

This memorandum rescinds and replaces several previously-issued Assistant Secretary of Defense (Health Affairs) (ASD[HA]) policy memoranda regarding TRICARE policy for access to care. To the extent practicable, this policy applies to overseas locations and to the TRICARE Overseas Program contractor with consideration that overseas/foreign locations often present unique circumstances.

Identification #: HA Policy: 11-005
Date: 4/26/2011
Type: Memorandums
Topics: Health Care Administration & Operations

Clear and Legible Report Process 02-2011

Policy

The purpose of this Policy Memorandum is to document unifonn business rules for managing the Clear and Legible Report (CLR) process and incorporate these business rules as standard operating procedures at all Referral Management Centers (RMC).

Identification #: N/A
Date: 2/4/2011
Type: Memorandums
Topics: Information for Patients: About TRICARE

Army Regulation 40-68: Clinical Quality Management

Policy

This consolidated regulation prescribes policies, procedures and responsibilities for the administration of the Clinical Quality Management Program. It includes DoD and statutory policies addressing medical services quality management requirements. In addition, it implements DoD 6025.13 – R, DoDD 6000.14 and other DoD guidance.

Identification #: N/A
Date: 5/22/2009
Type: Federal Regulations
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients)

Mandatory Use of Full Patient Name and Date of Birth for Patient Identification

Policy

This memorandum requires military treatment facilities to use a patient's full name and date of birth for patient identification to standardize the patient identification process.

Identification #: N/A
Date: 3/27/2007
Type: Memorandums
Topics: Quality, Patient Safety & Access Information (for Patients) | Health Care Administration & Operations

Standardized "Do Not Use" Medical Abbreviations List

Policy

This memorandum established a list of standardized "do not use" medical abbreviations for all handwritten orders and medication-related documentation, including free-text computer entries and pre-printed forms.

Identification #: N/A
Date: 3/27/2007
Type: Memorandums
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients)

Military Health System (MHS) Clinical Quality Assurance (CQA) Program Regulation

Policy

This Department of Defense (DoD) Regulation (6025.13-R) identifies the various components comprising the DoD's efforts to ensure that beneficiaries receive quality care.

Identification #: N/A
Date: 6/11/2004
Type: Directives
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients)

Navy BUMED Instruction 6010.18A: Participation in the National Practitioner Data Bank

Policy

This instruction requires all military and civilian practitioners who are assigned to, employed by or contracted to the Department of the Navy to participate in the National Practitioner Data Bank.

Identification #: N/A
Date: 2/14/2003
Type: Instructions
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients)

Navy BUMED Instruction 6010.23: Participation in the Military Health System Patient Safety Program

Policy

This instruction requires all shore-based commands providing medical and dental services, providing care, or participating in the health care delivery system to support the MHS Patient Safety Program.

Identification #: N/A
Date: 12/18/2002
Type: Instructions
Topics: Health Care Administration & Operations | Quality, Patient Safety & Access Information (for Patients) | Patient Safety

Debt Collection Assistance Officer Program to Assist Service Members with TRICARE Claims Collection Problems Memorandum

Policy

Identification #: N/A
Date: 6/27/2000
Type: Memorandums
Topics: Information for Patients: About TRICARE

Navy BUMED Instruction 6010.21: Risk Management Program

Policy

This instruction establishes policy and assigns responsibility for organizational risk management activities. It defines minimal requirements for proactive and reactive responses in naval medical and dental treatment facilities.