Q & A REAR ADM. CHRISTINE HUNTER, USN
[Our primary cost growth] is in
retail pharmacies by patients seen in the network. … It’s more expensive for patients, too, because the copay- ment is for a 30-day [supply] rather than a 90-day supply. If we can move some of that business from retail pharmacy to home delivery, we can make an impact on costs.
What’s the potential to shift to home delivery?
The potential is for chronic medica- tions. If a chronic medication is start- ed in a civilian provider’s office and needs to be filled immediately, using a retail pharmacy is appropriate. Get the first 30 days, then allow us to shift your chronic medication so it comes to you at home. It even comes to you automatically if you select the auto- matic refill option. It’s [a savings to the government of ] about $50 to $70 per prescription for a 90-day supply, and there are additional savings to the pa- tient — $6 to $44 a prescription, com- pared to retail pharmacy purchases.
The George W. Bush administra- tion proposed higher TRICARE fees and copayments for working- age retirees. For years, they even
put a hole in their defense health budgets to encourage Congress to enact higher fees. Congress refused. The defense budget for FY 2011 doesn’t propose higher fees, but Defense Secretary Robert Gates says he can’t name another health system that, for the past 15 years, hasn’t raised patient fees. As administrator for TRICARE, do you see higher fees as a way to make TRICARE more efficient?
Fees are a challenging thing. As we study incentives or disincentives to influence behavior, we’ve been most focused on access. We want people to get care. We don’t want to put up barriers. That said, patients can help reduce overall costs by doing the simple things we’ve talked about: going to urgent care or primary care managers instead of emergency rooms; using [mail-order] pharmacy. If patients do those things, it limits the extent to which we have to look to higher fees. You pose an important question about appropriate fees for behaviors not desirable. We haven’t ever looked at fees as a disincentive in the TRI- CARE program. We don’t have any initiatives nor are we contemplating
that now. But it’s an important ques- tion to look at for future plan design.
Are beneficiaries receptive to modest fee increases?
There’s a lot of economic stress out there. People feel any additional cost out of pocket is challenging. Howev- er, they’re very reasonable when we talk about responsibility to sustain this exceptional benefit. So how do we behave as a popula-
tion of TRICARE users? How do we make smart choices so we all con- tribute to responsible cost manage- ment? … To come up with something [on fees] that is equitable and en- courages the right amount of access will be a challenge for us all.
Before the current wars, there was concern military hospitals weren’t being used effectively and too many beneficiaries were receiving care through TRICARE civilian networks. What do current trends show?
Utilization in military treatment fa- cilities went down a little bit in the mid-portions of current wars [in Iraq and Afghanistan] as medical staffs were deployed. But it’s coming back up, the result of adding providers, moving to medical-home-style prac- tices, and cross-leveling between fa- cilities. TRICARE Online now can be used to make appointments, improve access, and decrease the number of no-shows. Every time someone misses an appointment and it goes unused, we hurt twice — that person will need to be rescheduled, and someone else didn’t get in. On the private-sector-care side,
visits are going [CONTINUES ON PAGE 75]
In 2008, then-commander of Naval Medical Center San Diego
Hunter, left, talks to a soldier at a Soldier Ride Golden State Challenge.
PHOTO: SPC. GREG MITCHELL, USN
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