One thing that helped tremen-

dously was Congress eliminating copayments for preventive-care services. Patients over 50 can get a colonoscopy [and] women can get a mammogram or cervical-cancer screening, with no financial barrier. Well-child care also is included. Another thing we’ve achieved is

convenience. This year we brought some immunization capability into retail pharmacies. On a trip to pick up milk and a valentine, you could get a needed immunization for seasonal flu or H1N1. We hope to expand that to additional immunizations.

TRICARE offers, clockwise from top left, well-child care services, TRICARE Mail Order Pharmacy, counseling services for servicemembers and their fami- lies, and behavioral health programs such as smoking cessation classes.

go as expected. To treat in the ER an acute minor condition like a sore throat or bronchitis costs TRICARE about $400. It would be about $90 at an urgent care center.

What is driving higher ER use?

One thing ... is stressors on active duty family members today. They may not have two cars, or they may be a two-career family. Children become ill after school or get picked up at day care with an acute minor illness. Life is very complicated and has so many stressors that the need to get that problem addressed seems much more immediate.

Is higher stress otherwise affecting the medical system?

We have increased utilization of behavioral health and counseling services, but we encourage that.

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Counseling is a great investment in the stability of the individual and family. It allows us to address issues at the first opportunity. If things aren’t going well at home, if there’s excessive loneliness or depression while someone is deployed, if chil- dren aren’t doing well in school, you want to address that before it be- comes a family crisis.

For all the challenges military medicine faces, what are some of the achievements?

Let’s start with preventive care. We like people to take care of their health and prevent illness, if pos- sible. We can show that at least 70 percent of all of our patients, both in direct care and private-sector care, [take] all of their preventive mea- sures. That compares to about 50 percent not too long ago.

Are families surprised tests and immunizations carry no charge?

Pleasantly so, I think. In the first few weeks of the immunization initiative, we had 12,000 people take advantage without a great deal of marketing. An- other thing to note in the prevention area is how we’re doing with smok- ing. This past year is the first that the active duty smoking rate for 18- to 24-year-olds fell below the national norm. Some see tobacco products as an outlet for stress, so it’s been a chal- lenge. We have a new campaign, “Quit Tobacco, Make Everyone Proud,” which focuses on military pride and professionalism to take this important preventive health step.

The next generation of TRICARE support contracts is valued at $55.5 billion over five years. Is this a much more expensive way to deliver care, through civilian provider networks, than through military facilities?

No. We measure per-member, per- month cost and compare those [mea- surements] to average health care costs in other plans. Many would say TRICARE is a very generous benefit. But per-member, per-month cost in the network is reasonable.

PHOTOS: CLOCKWISE FROM TOP LEFT, DEVIN FISHER/FORT SILL CANNONEER/U.S. ARMY; SHUTTERSTOCK; SPC. JAMICA JOHNSON, USN; MASTER SGT. ANDY DUNAWAY, USAF Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68  |  Page 69  |  Page 70  |  Page 71  |  Page 72  |  Page 73  |  Page 74  |  Page 75  |  Page 76  |  Page 77  |  Page 78  |  Page 79  |  Page 80  |  Page 81  |  Page 82  |  Page 83  |  Page 84  |  Page 85  |  Page 86  |  Page 87  |  Page 88