Report says Tricare management flaws could cause health provider shortage

The Pentagon's method for measuring the ratio of Tricare health providers to beneficiaries is flawed and could result in a shortage of providers in heavily populated areas, according to a new report from the General Accounting Office.

Contractors managing Tricare, the Defense Department's health insurance plan, try to make sure there are enough providers for all the beneficiaries in each region, according to Tricare spokeswoman Jenny Stathis. But according to the GAO report (03-592T), the Defense Department does not always receive complete information on service standards from Tricare contractors managing the regional networks.

For instance, GAO found quarterly reports from contractors in five of 11 Tricare regions that included less than half of the required data that Defense needs to assess whether the health insurance plan is meeting service standards. Under the service standards, beneficiaries should be able to see a doctor for urgent care within a day of requesting an appointment and should not have to spend more than 30 minutes in the doctor's office waiting room for scheduled nonemergency visits. They also should not have to travel more than 30 minutes to reach a doctor's office for routine care.

The report also recommended that the Defense Department set up a centralized system to handle beneficiary complaints. Currently, complaints arrive through a variety of venues and are "often handled informally or on a case-by-case basis," the report said. Because there is no central evaluation process, Defense has difficulty identifying broader access problems, according to GAO.

Stathis said that beneficiaries can relay their concerns to Tricare management through e-mail, letter, fax or phone. The complaints are then filed in a customer service tracking database and are analyzed, she said. Also, Tricare management conducts a beneficiary satisfaction survey and monitors the results closely, Stathis said.

Defense Department managers need to fix these administrative problems associated with Tricare before awarding new contracts for health care providers in June, the GAO report said.

Draft versions of the new contracts would streamline the process for credentialing providers and simplify patient referral procedures, but requirements to file all claims electronically could discourage some providers from participating, the report cautioned. Some providers are unable to file claims electronically: in fiscal 2002, providers filed roughly one quarter of claims electronically, according to the report.

The Defense Department defended the e-filing requirement, saying it would cut claims processing costs.

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
Close [ x ] More from GovExec

Thank you for subscribing to newsletters from
We think these reports might interest you:

  • Sponsored by G Suite

    Cross-Agency Teamwork, Anytime and Anywhere

    Dan McCrae, director of IT service delivery division, National Oceanic and Atmospheric Administration (NOAA)

  • Data-Centric Security vs. Database-Level Security

    Database-level encryption had its origins in the 1990s and early 2000s in response to very basic risks which largely revolved around the theft of servers, backup tapes and other physical-layer assets. As noted in Verizon’s 2014, Data Breach Investigations Report (DBIR)1, threats today are far more advanced and dangerous.

  • Sponsored by One Identity

    One Nation Under Guard: Securing User Identities Across State and Local Government

    In 2016, the government can expect even more sophisticated threats on the horizon, making it all the more imperative that agencies enforce proper identity and access management (IAM) practices. In order to better measure the current state of IAM at the state and local level, Government Business Council (GBC) conducted an in-depth research study of state and local employees.

  • Sponsored by Aquilent

    The Next Federal Evolution of Cloud

    This GBC report explains the evolution of cloud computing in federal government, and provides an outlook for the future of the cloud in government IT.

  • Sponsored by LTC Partners, administrators of the Federal Long Term Care Insurance Program

    Approaching the Brink of Federal Retirement

    Approximately 10,000 baby boomers are reaching retirement age per day, and a growing number of federal employees are preparing themselves for the next chapter of their lives. Learn how to tackle the challenges that today's workforce faces in laying the groundwork for a smooth and secure retirement.

  • Sponsored by Hewlett Packard Enterprise

    Cyber Defense 101: Arming the Next Generation of Government Employees

    Read this issue brief to learn about the sector's most potent challenges in the new cyber landscape and how government organizations are building a robust, threat-aware infrastructure

  • Sponsored by Aquilent

    GBC Issue Brief: Cultivating Digital Services in the Federal Landscape

    Read this GBC issue brief to learn more about the current state of digital services in the government, and how key players are pushing enhancements towards a user-centric approach.


When you download a report, your information may be shared with the underwriters of that document.