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Highlights

The Department of Defense (DOD) provides health care through TRICARE--a regionally structured program that uses civilian contractors to maintain provider networks to complement health care provided at military treatment facilities (MTF). In 2004, DOD implemented extensive changes to its TRICARE contracts and regional structure. A committee report accompanying the Ronald W. Reagan National Defense Authorization Act for Fiscal Year 2005 directed GAO to provide information on implementation issues for (1) the new TRICARE contracts and (2) the new regional structure. This report also provides information on the new management tools used to assess (3) contractors' performance and (4) program performance at the MTF and regional levels.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense 1. As DOD considers what further investments are warranted for managing referrals and authorizations, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to determine comprehensive costs for the development and nonavailability of the Enterprise Wide Referral and Authorization System as well as the costs being incurred to develop a solution.
Closed - Not Implemented
We recommended that DOD determine comprehensive costs associated with the initial development and nonavailability of its Enterprise Wide Referral and Authorization System (EWRAS) as well as the costs being incurred to develop a solution. In March 2007, DOD's recommendation tracking system cited the costs associated with the TRICARE contract modifications over $400 million---as the department's completed action for this recommendation. However, this response did not include all costs, such as the costs incurred by the military services as a result of the system's inavailability as well as more definitive costs for the initial development that would include costs incurred by the TRICARE Management Activity and the military services for staffing and other resources expended in conceptualizing and developing system specifications. DOD also did not include the cost of any contracts involved in system development.
Department of Defense 2. To facilitate the TROs' oversight of regional health care delivery, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to clearly define the TROs' contract oversight roles and responsibilities as they relate to other TRICARE Management Activity offices.
Closed - Not Implemented
We recommended that DOD clearly define the TRICARE Regional Offices' (TRO) contract oversight roles and responsibilities as they relate to other TRICARE Management Activity (TMA) offices. In our report, we cited confusion about the TROs' role with contract oversight, which is also a function conducted by one of TMA's offices. In September 2006, this recommendation was deemed "completed" in DOD's recommendation tracking system, which stated that contract surveillance and reporting responsibilities are still shared by the TROs and TMA staff and that the offices' functions have been defined and clarified. However, DOD officials would not provide additional information to corroborate that the recommendation had been fully addressed. Without additional evidence, it is unclear whether changes have actually been implemented.
Department of Defense 3. To facilitate the TROs' oversight of regional health care delivery, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs to establish protocols for how TROs are to collaborate with the military services' MTFs.
Closed - Not Implemented
We recommended that DOD establish protocols for how the TRICARE Regional Offices (TRO)are to collaborate with the military services' military treatment facilities (MTF). In our report, we discuss issues related to TRO collaboration with MTFs--specifically, that the newly established TRICARE Governance Plan did not establish protocols for these collaborations even though the TROs are responsible for helping maximize the use of the military services' direct care system in their respective regions. There had been some instances in which the services' Surgeons General and their staff expressed concern that the TROs had overstepped their authority by directly providing guidance to MTFs on issues such as referral management. In September 2006, DOD's recommendation tracking system cited the TRICARE Governance Plan and a memo about business planning as the completed action for our recommendation. However, as stated in our report, while the business planning process is the primary method of collaboration between TROs and MTFs, it is not the only area for which protocols are needed. Because TROs serve as the health plan managers for their regions, they will sometimes need to collaborate with MTFs on issues that are not directly related to the business plans, such as communication of referral management procedures. Additionally, as cited earlier, the TRICARE Governance Plan does not provide protocols for TRO and MTF interactions.

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