FRA 367 Mail List: Brief on the Philippines Tricare Closed Network (Manila and Angeles meetings)

Posted on: November 1st, 2012 by admin No Comments

TRICARE Demonstration Project for the Philippines Limited Briefings

Meeting attendance in Manila 9, in Angeles 20 and in Olongapo 7, which covered Orion as well.

Presenters:

Mr. Mick Frewen Vice President Operations, TRICARE Asia Pacific at International SOS

Mr. Mark Zimmerman TRICARE Regional Program Director Asia Pacific at International SOS

Mr. Thomas Halliwell TRICARE Area Office – Pacific, Chief, Hawaii Satellite Office

I personally attended both Manila and Angeles meetings. The general consensus among the attendees and local facilitators for why there was such low attendance was:

  • Beneficiaries don’t believe what TRICARE puts out anymore.
  • They have been promised new and better process in the past only to find most or all of their claims denied.
  • TRICARE does not listen to their concerns.
  • Nothing will really change.
  • Many have given up entirely and no longer submit claims and some have stopped Medicare Part B with the intent of using the premiums to pay for care that they are convinced TRICARE will not pay for.

Apparently TRICARE expects attendees to educate the rest of the population based on the slides and their notes; no recording allowed. This is an issue since the majority of the beneficiary population lives outside these demo areas and is spread throughout hundreds of islands. At present there appears to be almost no specific information on the websites or literature available. Certainly most of what was put out in the briefings is not available to the vast majority of the beneficiary population that is being affected by this mandated program. We were told the slide presentation would be posted on the web but without explanations to accompany the slides.

Some general questions asked observations or impressions take away from the meeting.

As the presentations progressed it was very apparent that the TRICARE Management Activity (TMA) and the contractor excluded the stakeholders during the development of the demo and that many important issues were not thought of or even known by those that created the program. It appeared the designers based the plan on how a typical U.S. PPO would be developed. This was shown by the lack of understanding and answers regarding the local customs, practices and policies and how the network is designed to look and feel much like a typical network in the U.S. which works against its success in a foreign country. Most of the issues addressed could have been tackled and resolved early on as the stakeholders would have anticipated issues that are obvious to them but not TMA or the contractor.

I suggested, even at this late date, TMA and the contractor consider a stakeholders panel where issues and changes to the program would be discussed with all the parties involved in order to maximize the chances to correct the current issues and improve chances of success. We were told by the contractor they would take it back to TMA for consideration.

Contractor has a stake in making this demo work as the contract will be terminated if it fails. But many of TMA’s policies and requirements seem to work against success.

Most of the attendees would also like to see the network work but have concerns about quality of providers, access to providers and the viability of how it is designed.

The contractor will train providers in the claims processing system requirements such as forms, authorized benefits, how and where to send claims, etc. But they will not train them in the unique

U.S. billing and coding system. This has been the major point of failure of previous attempts by local hospitals and physicians in the past and is likely to be a significant issue again.

I suggested that the program accept two addresses, local for whatever reason the program needs it and FPO to send EOBs. Sending EOBs to local addresses will involve up to 8 weeks and result in a high percentage of loss. I pointed out the VA, embassy and most major businesses don’t use the local mail system for these reasons.

It appears almost all ancillary services, lab and x-ray, will be hospital based. This will generally mean increased cost to the taxpayer and the beneficiary since local hospitals generally charge higher rates than dedicated services.

The point was made that making this program optional would remove much of the anxiety and concern from beneficiaries who have historically found new programs and requirements not as they were presented to them in the past. If it is a viable program beneficiaries would flock to it on their own initiative. This did not receive any positive response from the presenters.

The slide presentation follows with interspaced comments and or explanations.

James Houtsma

U.S. Military Retirees of the Philippines Group

Email: us_mil_ret_of_the_pi@123mail.org

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