Defense Health Care:

Operational Difficulties and System Uncertainties Pose Continuing Challenges for TRICARE

HEHS-98-136R: Published: Apr 10, 1998. Publicly Released: Apr 10, 1998.

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Pursuant to a congressional request, GAO responded to follow-up questions on its testimony on the Department of Defense (DOD) TRICARE Program.

GAO noted that: (1) while some contractors and regions met their TRICARE enrollment goals, program-wide, DOD has fallen short of its enrollment expectations; (2) while DOD collects some data on beneficiary access to care, it does not use the data to measure TRICARE's performance in improving beneficiary access against DOD's standards; (3) it cannot report on how well the access standards are being met because the TRICARE Management Activity is not reporting data on the timeliness of appointments and it did not collect such data itself; (4) recent sustained protests against TRICARE contract awards indicate that some problems with bid evaluations continue; (5) DOD is simplifying the TRICARE procurement process while incorporating private-sector best practices; (6) since physicians continue to treat military beneficiaries and accept discounted Civilian Health and Medical Program of the Uniformed Services maximum allowable charge (CMAC) rates, it does not appear that the CMAC structure needs to be modified; (7) DOD is placing less reliance on resource sharing with its recently awarded TRICARE contracts and it plans not to include a resource sharing feature in its future TRICARE 3.0 contracts; and (8) because DOD has made such little progress with resource sharing and is phasing it out of future contracts, GAO expects that resource sharing will have a very limited impact on TRICARE's ability to contain costs and increase access.

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