tricare area office europe

1. TRICARE Area Office Europe Thank you RADM Mayo, for a thoughtful and stimulating opening to our meeting. We are thrilled to have you here, along with our other guests from the States, Dr. Tornberg, Mr. Ford, and LTG Peake. We’re honored to have you all here and look forward to telling you about all that we do here in Europe to support the misison and our patients, and look forward to your counsel and advice as we move forward. This is BG Granger’s last TEC meeting, and I’d like to ask us all to stand and give him a round of applause to thank him for two wonderful years of leadership in a tumultous time. I’d also like for us all to stand for just one minute of silence in honor of all those who have sacrificed during OIF and OEF, with their lives, limbs, eyesight, emotional status, or family difficulties. And in honor of those who serve them as part of the greatest military health system in the world. -----------------------------Like RADM Mayo said, TRICARE Europe has been in action for 10 years in this unique theater, one of the youngest TRICARE Regions, and one of the last to stand up operations.Thank you RADM Mayo, for a thoughtful and stimulating opening to our meeting. We are thrilled to have you here, along with our other guests from the States, Dr. Tornberg, Mr. Ford, and LTG Peake. We’re honored to have you all here and look forward to telling you about all that we do here in Europe to support the misison and our patients, and look forward to your counsel and advice as we move forward. This is BG Granger’s last TEC meeting, and I’d like to ask us all to stand and give him a round of applause to thank him for two wonderful years of leadership in a tumultous time. I’d also like for us all to stand for just one minute of silence in honor of all those who have sacrificed during OIF and OEF, with their lives, limbs, eyesight, emotional status, or family difficulties. And in honor of those who serve them as part of the greatest military health system in the world. -----------------------------Like RADM Mayo said, TRICARE Europe has been in action for 10 years in this unique theater, one of the youngest TRICARE Regions, and one of the last to stand up operations.

2. Just over 317,000 beneficiaries reside within our region. Among the approximately 246,000 beneficiaries eligible to enroll in TRICARE Prime, 98% (or about 241,000) have done so. Air Force and Army MTFs have formally implemented the retiree TRICARE Plus program at their facilities. Navy facilities are not participating in this program as their MTFs report they see almost all of the retirees and their family members on a space available basis. In most facilities overseas access to healthcare is quite good. The population served is primarily AD and ADFMs. However, unlike stateside facilities, the region also serves a large number of civilians now able to access care on a fee-for-service basis while stationed overseas. The retiree population over age 65 is relatively small (2.4%) when compared to the overall population.Just over 317,000 beneficiaries reside within our region. Among the approximately 246,000 beneficiaries eligible to enroll in TRICARE Prime, 98% (or about 241,000) have done so. Air Force and Army MTFs have formally implemented the retiree TRICARE Plus program at their facilities. Navy facilities are not participating in this program as their MTFs report they see almost all of the retirees and their family members on a space available basis. In most facilities overseas access to healthcare is quite good. The population served is primarily AD and ADFMs. However, unlike stateside facilities, the region also serves a large number of civilians now able to access care on a fee-for-service basis while stationed overseas. The retiree population over age 65 is relatively small (2.4%) when compared to the overall population.

3. An Average Day at Our MTFs52 Clinics, 11 Hospitals, 1 MEDCEN

4. Medical Facilities in AOR 52 medical treatment facilities-30 A, 10 N, 12 AF 11 Hospitals-3 A, 4 N, 4 AF 59 dental treatment facilities CENTCOM: 4 (1A, 1 N, 2 AF) EUCOM: 55 (35 A, 8 N, 12 AF) 49 TRICARE Service Centers Hospitals: 11 (3 A, 4 N, 4 AF) Clinics: 41 (27 A, 6 N, 8 AF) Available for TRICARE Prime Remote enrollees Augmented by an 850+ member provider network 59 dental treatment facilities CENTCOM: 4 (1A, 1 N, 2 AF) Bahrain is the only permanent DTF EUCOM: 55 (35 A, 8 N, 12 AF) Augmented by 800+ host-nation providers 49 TRICARE Service Centers Hospitals: 11 (3 A, 4 N, 4 AF) Clinics: 41 (27 A, 6 N, 8 AF) Available for TRICARE Prime Remote enrollees Augmented by an 850+ member provider network 59 dental treatment facilities CENTCOM: 4 (1A, 1 N, 2 AF) Bahrain is the only permanent DTF EUCOM: 55 (35 A, 8 N, 12 AF) Augmented by 800+ host-nation providers 49 TRICARE Service Centers

5. Facilitate market area coordination means to identify areas where overlap between MTF markets occurs, and facilitate tri-service means to address improved coordination. A good example of that is the contract modfication proposal work you’ll hear about during this meeting to attempt to enhance host nation provider credentials processes and host nation inpatient management. Another example is facilitating discussions among the Italy MTF commanders about ways they can better optimize health care by enhanced cooperation.Facilitate market area coordination means to identify areas where overlap between MTF markets occurs, and facilitate tri-service means to address improved coordination. A good example of that is the contract modfication proposal work you’ll hear about during this meeting to attempt to enhance host nation provider credentials processes and host nation inpatient management. Another example is facilitating discussions among the Italy MTF commanders about ways they can better optimize health care by enhanced cooperation.

6. Remote sites 156 TRICARE Global Remote Sites –TGRO (International SOS) 91 countries (CENTCOM and EUCOM) 13 Time Zones 250 POCs (Points of Contacts) Remote non-TGRO

7. Average Monthly Outpatient Visits You can see that there has been little change in the proportion of all outpatient visits in Europe that takes place downtown, compared with our direct care military clinics since before September 11th. I also want you to notice that 4 out of every 5 outpatient visits in our theater takes place in a military facility; we do our best to take care of our own, unless we simply don’t have the capability or capacity. You can see that there has been little change in the proportion of all outpatient visits in Europe that takes place downtown, compared with our direct care military clinics since before September 11th. I also want you to notice that 4 out of every 5 outpatient visits in our theater takes place in a military facility; we do our best to take care of our own, unless we simply don’t have the capability or capacity.

8. Average Monthly Admissions On the inpatient side, there has also been very little increase in the proportion of all admissions that are host nation compared with military hospital admissions, increasing only from 42% to 44% since FY 2000. You’ll notice however, that the total number of admissions has increased by 14% since then, largely reflecting the OIF and OEF missions European military hospitals have accrued. The next slide will show that in more detail. The yellow box reflects early FY04 data, which is a bit too early to use for comparisons yet.On the inpatient side, there has also been very little increase in the proportion of all admissions that are host nation compared with military hospital admissions, increasing only from 42% to 44% since FY 2000. You’ll notice however, that the total number of admissions has increased by 14% since then, largely reflecting the OIF and OEF missions European military hospitals have accrued. The next slide will show that in more detail. The yellow box reflects early FY04 data, which is a bit too early to use for comparisons yet.

9. TAO-Europe Challenges Day-to-day beneficiary/MTF/POC assistance and claims management Transformation in the European theater Host Nation Services test project

11. TRICARE PACIFIC COL Art Wallace, AN, USA Director, TRICARE Area Office – Pacific TRICARE Conference 24 January 2005

13. TRICARE Pacific - Resident Population Supported

14. WESTPAC Enrolled (Top 10) Dec 04 18th MEDCOM/121 Gen Hosp: 42, 981 NH Okinawa: 26,164 NH Yokosuka: 22,201 Kadena (18th MDG) 18,363 NH Guam: 12,117 Yokota (374 MDG) 9452 Andersen (36 MDG) 9376 Osan (51st Med Grp): 8804 BMC Sasebo 5185 Kunsan (8th Med Grp): 3065

15. ValueValue

16. Overflight Destinations – Pacific10 Nov 03 – 8 Jul 04 NNMC, San Diego 60 Wilford Hall, San Antonio 15 MAMC, Tacoma 7 WRAMC, Washington D.C. 7 Travis, Sacramento 5 Brooks AFB, San Antonio 4 UCLA 3 BAMC, San Antonio 3 NNMC, Bethesda 3 Stanford Childrens 2 Palo Alto VA TBI/SCI 2

17. Reasons for OverflightN=138 Closest Capable 82 MEB/Rehab Near Family 24 Service Not Available 22 Continuity of Care 5 Compassionate 3 Credentialing 2

18. TGRO Enrolled Population – Oct 04The TOP FIVE Australia: 281 + 466 = 747 Am. Samoa 30 + 569 = 599* Singapore 183 + 321 = 504 Thailand 116 + 210 = 326 N. Mariana 3 + 192 = 195* Non-TGRO: Diego Garcia = 476 AD

19. Remote Pacific Referral HospitalsThe Top 5 Gleneagles, Singapore – 21% Bumrungrad, Bangkok –20% Mt. Elizabeth, Singapore 15% Gleneagles, Kuala Lumpur – 4% BNH, Bangkok – 3% Total TGRO admissions CY04: 274

20. Issues & Developments (2004) Growth of commercial ticket program OIF/OEF/Tsunami impacts on MTF capabilities TRICARE Next Generation transition 1. Loss of Lead Agent Established WESTPAC Medical Services Directory Website

23. Issues & Developments (2004) Projected force realignments and reductions Discontinued HCIL, HEAR, and funded outpatient retiree medical travel TGRO modifications: Diego Garcia, remote (non-catchment) Japan, MSC? TRICARE Pacific relocation to Okinawa

24. Future Challenges and Issues Think JOINT! Force structure, organization, and interoperability in common areas of medical and dental services. Growth of host nation networks at smaller MTFs – TRICARE Europe pilot. Consensus on theater outcome metrics –share with operational community!

25. Future Challenges and Issues Increase in Reserve Component family members impacting Guam & Hawaii. CHCS connectivity between service MTFs in the same country. Continue to emphasize OCONUS medical screening for DOD contractors/civilians. Fraud, waste, and high cost of retiree costs in Philippines.

26. WPS CLAIMS PAIDPhilippines vs. WESTPAC Region

27. Future Challenges and Issues Educate line leaders on consequences and risks associated with unaccompanied and/or non-command sponsored family members bypassing OCONUS medical/EFMP screening. Impacts of reduced mental health (active duty & child/adolescent), GI, dermatology & EDIS programs.

28. QUESTIONS?

29. TRICARE in Latin America & Canada CAPT Paul W. Lund, MSC, USN Director for TRICARE Latin America & Canada January 2005

30. TLAC Overview Playing Field and Regional Snapshot Health Plans Concept of Operations Challenges Wish List

31. Our Playing Field ... Our world is indeed different with a playing field of nuances and at times, constraints -- each of you I’m sure lives this slide everyday so I will not preach to the choir Our world is indeed different with a playing field of nuances and at times, constraints -- each of you I’m sure lives this slide everyday so I will not preach to the choir

32. Regional Snapshot 42 Countries -- North to South Pole -- 12 Million Square Miles 59,000 Beneficiaries MHS / Line Infrastructure Limited -- Puerto Rico -- Guantanamo Bay -- JTFB- Honduras -- Military Groups and Attache Offices Last TRICARE region to “stand-up Operate mostly in remote locations; do not have the MHS infrastructure found in CONUS and other OCONUS regions - Pacific: 12 MTFs - Europe: 52 MTFs Because of this lack of infrastructure, we obviously have different demands and more reliance on the host nation health care system Last TRICARE region to “stand-up Operate mostly in remote locations; do not have the MHS infrastructure found in CONUS and other OCONUS regions - Pacific: 12 MTFs - Europe: 52 MTFs Because of this lack of infrastructure, we obviously have different demands and more reliance on the host nation health care system

33. TLAC “Health Plans” Canada -- Canadian Forces Health Facilities & National Plan “Remote” Areas -- TGRO Contract Puerto Rico -- Limited MTF With Contractor Augmentation Guantanamo Bay -- Direct Care Implementation of TRICARE benefit different among our 5 health plans Our focus and concern of course is on our Remote Health Plan which is executed in partnership with International SOS Implementation of TRICARE benefit different among our 5 health plans Our focus and concern of course is on our Remote Health Plan which is executed in partnership with International SOS

34. Concept of Operations TRICARE Area Office (TAO) -- Beneficiary Assistance, Referral Coordination, Clinical Oversight, Program & Contract Management, Enrollment, Marketing Partners -- SAIC: TSC Operations and TAO Support, Enrollment, Education & Marketing -- HMHS: Puerto Rico -- International SOS: TGRO -- TRICARE POCs OCONUS regions are not supported by a single Managed Care Support Contractor (MCSC) - the Lead Agency serves in this capacity We are not a Travel Agency Medical Necessity Medical Indicated Covered Benefit Not for scar revisions, nose jobs, breast enlargement, hair removal or transplant or tummy tucks Lead Agent executes MCSC-like responsibilities via partnerships shown - In Puerto Rico, SAIC and McKesson HBOC are our main contractors - In Remote Latin America, International SOS provides our managed care system OCONUS regions are not supported by a single Managed Care Support Contractor (MCSC) - the Lead Agency serves in this capacity We are not a Travel Agency Medical Necessity Medical Indicated Covered Benefit Not for scar revisions, nose jobs, breast enlargement, hair removal or transplant or tummy tucks Lead Agent executes MCSC-like responsibilities via partnerships shown - In Puerto Rico, SAIC and McKesson HBOC are our main contractors - In Remote Latin America, International SOS provides our managed care system

35. Dental Care TLAC Dental Consultant Dental Readiness Variations Host Nation Care Variations

36. Challenges TRICARE Complexity Inconsistent Overseas Screening Exceptional Family Member Cases Long Term TDY Assignments Fraud Immigration Risk Management Crisis in Puerto Rico For those who do not know, we implemented a travel benefit 1 Feb 01 For those who do not know, we implemented a travel benefit 1 Feb 01

37. Our Wish List . . . TRICARE Simplicity Improve Personnel Program Compliance -- Overseas Screening -- EFMP Standardize Readiness Requirements Keep TLAC and Contractors Apprised of Anti-fraud Activities

38. Preguntas y Comentarios