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VICE PRESIDENT'S MESSAGE

Next Generation of TRICARE

Provider Contracts Forthcoming

Defense Health Agency n Minimize Transition Disruptions — TRICARE
(DHA) is in the final process contractor transitions have a history of issues of
of development of a Request delayed referrals, claims processing, and customer
for Proposals (RFP) for the service. We have urged DHA and Congress to
fifth-generation of man- ensure minimal disruptions due to the changes.
aged-care support contracts for
Michael P. Hughes, the TRICARE health services n Shield Beneficiaries from Higher TRICARE Costs
OSC, USNR (ret) program. This is commonly — There are concerns that the new T- 5 construct
NERA Vice President known as T-5. These contracts could, at least in the short term, result in signifi-
are particularly important as cant cost increases for TRICARE. Rising costs are
legislatively-directed military medical facility restructur- historically a main reason used to justify TRICARE
ing and medical billet cuts proposed by the services are fee increases. NERA and the TMC are adamantly
likely to move many beneficiaries to the civilian sector for opposed to shifting health care costs to beneficiaries,
care through TRICARE. particularly if the increases are a result of contract
changes.
The latest RFP will deliver health care services for military
personnel, retirees and dependents enrolled in TRICARE n Maintain Robust Provider Networks — With each
in the United States. Healthcare for those overseas will be contract transition we have already seen reduced
provided through a separate contract. Separate contracts provider networks in certain geographic areas as
will be issued for the East and West TRICARE regions. contractors have cut provider reimbursements to
They must be separate and distinct contractors and one compete. This has resulted in less timely care and
contractor can not be awarded both contracts. The con- extreme wait times in some specialty care areas.
tracts are proposed to be for eight one-year options. NERA and the TMC have expressed concern that
DHA and Congress ensure that the new manage
The current TRICARE West contract is held by Health care support networks in TRICARE remain viable
Net Federal Services, LLC, a subsidiary of Centene to maintain access to care and provide high qual-
Corporation. The TRICARE East contract is held by ity providers.
Humana Military Health Services Inc., a subsidiary of
Humana Inc. Both current contracts are for shorter peri- n Improve Access to Mental Health Care — An
ods than the new eight year contracts. August 2020 DoD Inspector General (IG) report,
Evaluation of Access to Mental Health in the
NERA and our partners of The Military Coalition Department of Defense, confirmed reports from
(TMC) support the intentions to improve access to care, TMC member organizations of significant barriers
health outcomes, the quality of care and patient outcomes for beneficiaries access to mental health services.
through these new contracts, but based on previous expe- We are recommending that DHA and Congress
rience with TRICARE contract transitions there are con- ensure the recommendations of the IG report are
cerns and risks which we have forwarded to the appropri- carried out.
ate congressional oversight committee chairs and ranking
members. Following is a brief synopsis of these concerns:

If you have concerns or issues you would like NERA to address please let me
know. My email is [email protected] and my cell is 443-812-9591 or you can send
mail to my attention at NERA national headquarters. I welcome all suggestions.

The Naval Enlisted Reserve Association 5