Overview ofThe Military Health System,

TRICARE, and Navy MedicineCAPT James Chun, MC, USN

LCDR Eric A. Polonsky, MSC, USN

LT D. Todd Uhlman, NC, USN

November 4, 2011

MHS Mission

Patient Care, Sustain Skillsand Training

Promote & Protect Health of the Force

Deploy toSupport the Combatant

Commanders

to and

In Peace & War

Manage Beneficiary Care

Deploy A Healthy Force

Manage Beneficiary Care

Deploy A Healthy Force

Deploy Medical Force

Manage Beneficiary Care

How Do We Support Changein the Right Direction?

• Readiness– Pre- and post-deployment– Family health – Behavioral health – Professional competency/currency

• Population Health– Healthy service members, families, and retirees– Quality health care outcomes

• A Positive Patient Experience– Patient and family centered care, Access, Satisfaction

• Cost– Responsibly managed– Focused on value

Balanced Approach to Quadruple Aim

What Is TRICARE?

TRICARE is…

… the health care program for active duty service members, National Guard and Reserve members, retirees, family members, survivors, and certain former spouses worldwide.

… a network of military and civilian health care professionals working together to foster, protect, sustain, and restore health for those entrusted to their care.

TRICARE - Who We Are

• 9.6 million beneficiaries – 3.7 million TRICARE Prime enrollees

Direct care system – 1.6 million TRICARE Prime enrollees

Contractor networks – Remainder

• TRICARE Standard/Extra• TRICARE for Life• TRICARE Reserve Select

• Military Treatment Facilities (MTFs)– 59 Hospitals & Medical Centers– 364 Health Clinics

• Over 380,000 network providers

• Over 60,000 retail pharmacies

TRICARE Prime Options

TRICARE Prime is a managed care option, meaning most of your care will be provided by a primary care manager dedicated to your care.*

Benefit Information

Program Description

TRICARE Prime Available to active duty service members (ADSMs) and their families, retired service members and their families, survivors, certain former spouses, and others living near a military hospital, clinic, or another area with an established TRICARE network

TRICARE Prime Remote (TPR) and TPR for Active Duty Family Members (TPRADFM)

Available to ADSMs who live and work in remote locations (more than 50 miles or a one-hour drive from a military treatment facility) and family members residing with them

US Family Health Plan(USFHP)

A TRICARE Prime option available in six service areas across the country; not available to ADSMs

* ADSMs must enroll in a TRICARE Prime option, other than USFHP.

Other TRICARE Programs

Other TRICARE programs work more like fee-for-service plans, allowing you to see any TRICARE-authorized provider for care.

Benefit Information

Program Description

TRICARE Standard and TRICARE Extra

Option for active duty family members (ADFMs), retired service members and their families, survivors, certainformer spouses, and others who are not eligible for TRICARE Prime based on location or prefer additional freedom to choose their provider

TRICARE Young Adult (TYA) Option for qualified, unmarried dependents who have not yet reached age 26

TRICARE For Life (TFL) Medicare-wraparound coverage for beneficiaries who are entitled to premium-free Medicare Part A and have Medicare Part B* (these beneficiaries should generally follow Medicare guidelines for accessing care)

TRICARE Reserve Select (TRS) Option for members of the Selected Reserve of the Ready Reserve, their eligible family members, and qualified survivors

TRICARE Retired Reserve (TRR) Option for qualified Retired Reserve members, their eligible family members, and qualified survivors

* In most cases, TRICARE is the last payer after other health insurance (OHI), including Medicare.

TRICARE Pharmacy ProgramBenefit Information

Prescription drug coverage is the same regardless of your beneficiary category or which health plan option you are using. There are four ways to have your prescriptions filled:

• At any military treatment facility pharmacy

• Through TRICARE Pharmacy Home Delivery

• At any TRICARE retail network pharmacy

• At a non-network pharmacy (highest cost)

TRICARE has partnered with Express Scripts, Inc. to provide home delivery and retail network pharmacy services. For more information, visit Express Scripts, Inc. at www.express-scripts.com/TRICARE or call 1-877-363-1303.

Dental Program OptionsOther Benefit Information

• Active Duty Dental Program (ADDP)– Available to ADSMs– Care through military dentist referrals and remote access– For more information, visit www.addp-ucci.com

• TRICARE Dental Program (TDP)– Available to eligible ADFMs and National Guard and Reserve

members and their families– For more information or to enroll online, visit

www.TRICAREdentalprogram.com• TRICARE Retiree Dental Program (TRDP)

– Available to retired service members and their families, retired National Guard and Reserve members, survivors, and others

– For more information or to enroll online, visit www.trdp.org

A Week in the Life of TRICARE

• 2.5 million prescriptions– 923,000 direct care– 1.39 million retail pharmacies– 202,000 home delivery

• 179,300 behavioral health outpatient services– 46,100 direct care– 133,200 purchased care

• 21,800 inpatient admissions– 5,000 direct care– 16,800 purchased care

• 1.6 million outpatient visits – 737,000 direct care – 876,400 purchased care

• 2,300 births – 1,000 direct care– 1,300 purchased care

• 3.5 million claims processed

• 12.6 million electronic health record messages

Behavioral HealthOutpatient Visits

Per Year

Who We Are – Education and Training

• Uniformed Services University of the Health Sciences – Doctoral, Masters, Graduate Medical Education – residencies, fellowships, nursing, out service training, etc.

• Technical Training/METC(2010) – medics, corpsmen, technicians (lab, X-ray, pharmacy, pulmonary, preventive medicine, veterinary, physical therapy, orthopedic, surgical, etc.)

• Defense Medical Readiness Training Institute - joint medical readiness

Who We Are – Research

• Uniformed Services University of the Health Sciences

• 36 Medical Research Laboratories• 18 Clinical Investigation Programs

(Army, 8; USAF, 6; Navy, 3; USUHS, 1)

• Over $2B in research funding is devoted to DoD biomedical research

13

The Core Mission: Readiness

Observed vs. Predicted Survival Rate(Battle Wounds in Operations Enduring/Iraqi Freedom)

75%

80%

85%

90%

95%

100%

2007 2008 2009

Predicted Survivors Observed Survivors

• THEATER CARE• Next-generation, quick clotting hemostatic

bandages

• En-route care during air transportation from theater (ICU on a plane)

• Negative Pressure Wound Therapy in Combat-Related Injuries to promote wound healing

• 31 clinical practice guidelines as a result of Joint Theater Trauma System (JTTS)

• MEDICAL EVACUATION• Total Global Patient movements1 137,100

• Total Evacuated2 73,290 (13,478)3

• Return to CONUS as quickly as 72 hours

• PREVENTIVE AND PRIMARY CARE MEDICINE

• Disease Non-Battle Injury per Week

• Operation Joint Guardian (Kosovo) – 8.1%

• Desert Shield/Storm – 6.5%

• OIF – 4%

• Observed vs. Predicted Survival Rate• Battle Wounds in Operation Enduring/Iraqi Freedom

• Global Patient Movements1 Since 9/11/01• (000s)

Readiness MissionBenefit Mission

Warrior & Family Centered Care. . . .Anytime, Anywhere

OperationalFleet

& Fleet Marine

Forces

Casualty Receiving

& Treatment

Ships &

Medical Battalions

ExpeditionaryMedical Facilities

TRICARENetwork

HospitalShips

&Smart Power

US OverseasHospitals Hospitals

& Research

Labs

Navy Medicine

Who are we?

Navy Medicine

Maritime Strategy:A Cooperative Strategy for 21st Century

Seapower – Core Capabilities

• Forward Presence • Deterrence • Sea Control • Power Projection • Maritime Security • Humanitarian Assistance and Disaster

Response (Smart Power)

Mission: Expeditionary Care

Provide direct medical support

around the world from the

deckplates to the battlefield

For the first time ever, HA/DR is now a core capability of the Navy

Mission: Humanitarian Assistance/ Disaster Response

Navy Medicine is often the face of our national humanitarian assistance/ disaster response efforts around the world

Mission: Garrison Health CareNavy Medicine supporting medical readiness, providing health care to the warfighter and their families

Questions