On this Fourth of July, the US Family Health Plan Alliance celebrates the independence of our great nation and pays tribute to all our men and women in uniform, retirees and military family members. The selfless service and sacrifices of these brave men, women and families must always be appreciated and honored, and the Fourth of July is a fitting occasion to reflect upon and commemorate all they do to keep America free and secure.

The US Family Health Plan programs are grateful for the privilege of providing high-quality healthcare to our uniformed services family members and retirees, and we wish everyone a safe and enjoyable Fourth of July.

September is Pain Awareness Month, a time to promote better understanding of pain and pain management issues.  While retired military populations are likely to endure substantial pain after service and many may require physical therapy, military retirees are less likely than other populations to seek help for managing aches and pains.

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Recent research shows that service members and their families can be hesitant to divulge minimal aches and pains to their medical care providers.  Unfortunately, minor injuries and aches and pains often become chronic conditions that can adversely affect job performance and daily living.

Preventive healthcare is critical to preventing illness and injury and to slowing the progression of minor ailments into more serious conditions. The member organizations of the US Family Health Plan program recognize the importance of keeping our military family members healthy so they can live their lives to the fullest.

We encourage family members to participate in their own care, and we believe preventive healthcare is an investment in their future wellbeing.

Because the US Family Health Plan has provided high quality care to military families for over 30 years, our member organizations understand military culture, in addition to the unique healthcare needs of military families and retirees.

Academic research has shown that cultural understanding is key to providing the most effective health care for military populations.  Because we understand the culture, we are better able to focus on population health, prevention programs and disease management.  Our aim is to keep everyone healthy and well, rather than just treating individual episodes of disease when they occur.

By knowing who our patients are, understanding their needs, and clearly communicating their care and treatment options, the US Family Health Plan member organizations are better able to effectively care for chronic conditions like diabetes.  Our value-based model of care also results in fewer emergency room visits, reduced utilization of inpatient services, and achieves better health and wellness outcomes. We strive to ensure our member patients get appointments when they need them and receive sustained and reliable access to care through a 24-hour nurse help line, in-home monitoring and other advanced approaches to care delivery.

Some tips to stay healthy are:

• Get regular checkups. Visit the doctor regularly and get regular screenings for chronic diseases or illnesses to which you may be predisposed. Frank discussions with providers about your health needs helps you stay healthy and increases the chances diseases will be detected early.
• Eat nourishing foods. A balanced diet that includes protein, grains, fresh fruits and vegetables helps nourish the body.  Avoiding processed foods is ideal.  Foods high in antioxidants also can help reduce the risk of cardiovascular disease.
• Exercise regularly. Going for a walk, playing on a sports team or engaging in other physical activities helps keep your body and mind healthy.
• Take good care of your bones. Bone density is important as we get older.  Be sure to eat enough foods high in calcium and vitamin D in order to keep your bones strong.

Congress is one step closer to a makeover of the Military Health System (MHS) and TRICARE that will feature the model of care, values and performance objectives already provided by the US Family Health Plan.

In the recently-passed conference bill and report on the National Defense Authorization Act for Fiscal Year 2017 (NDAA), Congress establishes objectives and expectations for improving military health care beginning in 2018, focusing on quality, value-based care and an improved experience and access to care for beneficiaries. Specifically, in the report Congress calls for the Department of Defense (DOD) to pursue several strategic improvements to military health services, including:

• Improved access to health care
• Improved health outcomes
• Improved quality of health care
• Enhanced beneficiary experience in receiving health care
• Lowered per capita costs of health care

Congress urges DOD to focus on value-based reimbursement for the companies that provide care to military beneficiaries and better health outcomes for these patients. The member organizations of the US Family Health Plan Alliance are pleased and encouraged by Congress’ approach to military health care reform because the US Family Health Plan program has consistently provided high quality care, easy access to care, improved health care outcomes, and very high beneficiary satisfaction for many years. We have set and maintained the standard for military health care through a value-based approach to care that continually yields the highest quality and beneficiary satisfaction marks in TRICARE.

As highlighted below, the conference report’s strategy guidance to DOD includes specific goals, which the US Family Health Plan already achieves.

NDAA Conference Report Objective: Value-based incentive programs to shift financial risk to health care providers and managed care support contractors—

The conference agreement between the House and Senate requires the Secretary of Defense to develop and implement value-based incentives as a part of any contract awarded to provide health care to military beneficiaries. Along with these incentives, a new acquisition strategy for managed care is also required

The US Family Health Plan is currently TRICARE’s only value-based, capitated model of health care, and the US Family Health Plan Alliance is gratified that Congress is embracing the value-based model of care. This model of care rewards delivery of appropriate and necessary care, based on the population of patients and their likely medical needs, ensuring that the contractors have the burden of keeping healthy patients healthy and achieving positive health outcomes. As results from the US Family Health Plan have already demonstrated, Congress’ direction to DOD to incorporate value-based care into the managed care support contracts should yield better health outcomes for more patients and cost savings over the long term.

“The US Family Health Plan is the model of care that the Department of Defense should emulate,” said Linda Marzano, chair of the US Family Health Plan Alliance’s board of directors and CEO of Seattle-based Pacific Medical Centers. “This program has consistently provided the high quality care military patients deserve, better health outcomes, high patient satisfaction and at a reasonable cost for taxpayers.”

NDAA Conference Report Objective: Incentives that emphasize disease prevention and wellness and encourage patient participation in medical and lifestyle intervention programs—

The NDAA conference agreement requires DOD to use prevention and wellness incentives to encourage beneficiaries to seek health care services from high-value providers. The bill also requires the use of incentives to encourage certain beneficiaries to engage in medical and lifestyle intervention programs.

As a value-based care program, the US Family Health Plan member organizations already incorporate health prevention, wellness, and disease management programs into the regimen of care afforded to beneficiaries. Through the use of predictive, population-based modeling, specialized care protocols are tailored to the needs of individual patients. This modeling permits better use of preventative and lifestyle management care, especially for those with chronic conditions. We also encourage our members to participate in the management of their own health care, another feature of the US Family Health Plan that other contractors would do well to adopt. Patient participation in their own care ultimately yields improved efficiency, better health outcomes and higher patient satisfaction because they are invested in their own care.

NDAA Conference Report Objective: Maximize flexibility in network design and configuration and develop high-performing networks—

Another positive aspect of the fiscal year 2017 NDAA conference bill is that it encourages partnerships between military treatment facilities and high performance military-civilian integrated health delivery systems. This objective would be accomplished through the use of memoranda of understanding and contracts with local or regional health care delivery systems, including HMOs, health care centers of excellence and other similar organizations.

The member organizations of the US Family Health Plan Alliance commend Congress for directing the Department of Defense to work with high performance health care delivery organizations like us. US Family Health Plan beneficiaries overwhelming report high levels of satisfaction with the care they receive, earning the US Family Health Plan high marks for both quality care and patient satisfaction that outpace the rest of TRICARE and private sector health care. The National Committee for Quality Assurance (NCQA) recently awarded top national ratings to our member organizations, including Johns Hopkins and Martin’s Point Health Care in Maine, both of which earned 5 out of 5 ratings for customer satisfaction, prevention and treatment. These ratings are important because NCQA considers results from the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS®) survey. This survey regularly ranks US Family Health Plan among its highest performers. For example, in 2015, CAHPS gave the US Family Health Plan a 91.5 aggregate member satisfaction rating – more than 25 percentage points higher than the national average for commercial health plans.

The bottom line is that the US Family Health Plan program already provides many of the features, benefits and performance objectives that Congress is directing the Department of Defense to pursue. The US Family Health Plan Alliance offers its support for the reforms outlined in the NDAA legislation and is eager to work with Congress and DOD as a partner to improve the Military Health System and improve the health care that our military beneficiaries so richly deserve.

We recently sat down with Linda Marzano, the new chair of the board of directors for the US Family Health Plan Alliance. Linda will lead the Alliance as Congress is exploring reforms to TRICARE and considering the recommendations made by The Military Compensation and Retirement Modernization Commission in February 2015. Linda, the CEO of Pacific Medical Centers, shares with us her views about the value of the US Family Health Plan program:

 

Q: Your responsibilities at PacMed include overseeing a US Family Health Plan (USFHP) that serves the Pacific Northwest. What were some of your first observations about working with TRICARE and the military healthcare system?

A: What stands out immediately is the commitment to and trust of PacMed by our patients, some of whom have been with us for 15 to 20 years and have wonderful partnerships with their physicians. Many USFHP beneficiaries have had long-term relationships with us—some since the 1980s, before the Plan’s inception, and others who have been with us since Congress created the USFHP and later designated it as a TRICARE program in the 1990s.

I’ve also noticed that unlike some other patient populations I’ve encountered, our patients really listen to their doctors and follow their professional advice. I attribute that, at least in part, to a respect for authoritative expertise forged by their military backgrounds. Our military health patients are also very open to giving us feedback about their interactions with our staff—from how they were greeted to the processes in our clinics—which allows us to continually improve. I very much appreciate that two-way relationship.

 

Q: What is the USFHP approach to working with a patient?

A: We place a lot of value on the relationship between patient and provider. The aggregate patient satisfaction score for all US Family Health Plan programs is substantially above the average for the Department of Defense. We work very hard on patient access initiatives. When a member joins our Plan, our concern is not just about what the member comes to see us for on one particular day. We take a comprehensive approach, considering everything else going on in their lives. What is their family situation? What about their job? What geographic area do they live in? By working with our patients holistically, there is a much better relationship between the patient and the healthcare provider and ultimately better health outcomes. If a patient wants to come in on a given day, we will get them in on that day. It’s always about the patients, all the time.

 

Q: How is technology helping innovate the way USFHP offers its service?

A: Innovative uses of Technology lets us put healthcare on the patient’s terms. Patients can’t always come to the doctor’s office. If it is 10 p.m., your husband or wife is deployed and you have a sick child, it is not manageable. Technology provides an alternative to packing everyone up and heading to the emergency room. We have to be able to use technology in different ways to support healthcare and the demands of the people.

 

Q: USFHP focuses on improving patients’ abilities to manage their own healthcare, which is especially pertinent for management of chronic diseases like diabetes. How is USFHP using preventive care programs to address chronic disease?

A: One of the biggest trends in the healthcare industry right now is a desire by patients to have more control of their healthcare. At USFHP, we are embracing that. When we take a collaborative approach to managing chronic diseases, we can reduce the rate of hospitalization and doctor visits and can also avoid prescribing additional medications that may be required if a condition is not caught early enough. We also focus a great deal on screening and prevention. Take for example our colon screening and all of our cancer screening initiatives. We channel time and energy into our outreach because we want to catch those things early and keep those patients healthier. 

Truly effective preventive care requires attentiveness to patients’ degrees of risk. Our care managers and case managers are trained nurses and social workers who conduct regular outreach to patients. We evaluate all of our patients and identify those we consider high-risk who would benefit from more frequent follow-ups. Once those patients are identified, we work with them on a regular basis to share helpful information related to their health through mail, phone calls and even group meetings.

 

Q: Why has USFHP invested so much in preventive medicine?

A: We know that keeping patients healthy and putting these prevention measures in place helps patients lead better lives. We identify problem areas through evidence-based medicine. We put these programs in place because of our belief in patient-centered medical home and chronic disease management and evidence-based medicine. We want to keep people healthy, we don’t believe in only seeing patients when they’re sick. We want to keep them out of the doctor’s office and out of the hospital, so that’s what led to developing the infrastructure to do the outreach when the patients need it and do outreach to help patients not even need that care.

 

Q: Does the capitated model encourage this type of investment?

A: Absolutely. In a fee-for-service model, a provider is paid when the patient walks through the door, which encourages illness instead of prevention and wellness. With a capitated model, like USFHP features, there is an incentive to institute cost-saving measures. If a plan is able to reinvest in staff or new technology it can operate more efficiently with fewer costs. One example is USFHP predicative modeling, which we use to determine a patient’s risk factor, this helps us prevent problems and keep patients healthy.

 

Q: What lessons have you learned from working with USFHP?

A: We have taken away some great lessons from USFHP and applied them at PacMed, so our commercial patients are enjoying the same benefits. USFHP has a unique capitated model, and we are constantly reinvesting in the program’s infrastructure to support the highly effective case management programs and personnel we have in place (e.g. the social workers, the outreach and the chronic disease management programs).The approach is so effective that we now apply the same care model to our commercial patients at PacMed. Since adopting the new model from USFHP, we’ve lowered our costs by 10 to 15 percent, and our healthcare outcomes are in the top quartile on the Washington Health Alliance website.