Government Estimates in the Tricare Managed Care Support Contracts
Author: Michael Evi Jonasson
Publisher:
Published: 2001-08-01
Total Pages: 101
ISBN-13: 9781423527503
DOWNLOAD EBOOKIn 1994, the Department of Defense (DoD) began a journey, to merge the Military Health System (MHS) with the concept of the Managed Care Support Contractor (MCSC). The DoD managed health care program, called TRICARE, includes the competitive selection of contractors to financially underwrite the delivery of civilian health care services with a uniform, stabilized benefit structure, triple option health benefit features, and a regionally-based health care management system. The goals of TRICARE are to maintain medical readiness, improve access to care, provide a secure quality health care benefit, provide a choice of health care options, and contain DOD health care costs. The Managed Care Support (MCS) contracts are fixed-price contracts, with risk-sharing features and a bid price adjustment process designed to periodically substitute projected/estimated health care costs with actual health care costs. MCS contracts are 5 1/2 year contracts, with a 6-month phase-in period prior to start-up of delivery of health care services, followed by 5 1-year option periods. This thesis will explore the bid price adjustment process within the MCS contract, and the Government's methodology used to project/estimate health care costs for use by offerors in the bidding process. Selected as an example for discussion is the Regions 3 and 4 MCS contract. This thesis explores whether the Government, in choosing and engaging a methodology for projecting/estimating health care costs, should have instead chosen another methodology or path; i.e., "the road not taken."
