Government Estimates in the Tricare Managed Care Support Contracts
Government Estimates in the Tricare Managed Care Support Contracts

Author: Michael Evi Jonasson

Publisher:

Published: 2001-08-01

Total Pages: 101

ISBN-13: 9781423527503

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In 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."

Defense Health Care
Defense Health Care

Author: United States. Government Accountability Office

Publisher:

Published: 2019

Total Pages: 27

ISBN-13:

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DOD contracts with private sector companies—referred to as managed care support contractors—to deliver health care services to its TRICARE program beneficiaries through networks of civilian providers. In July 2016, DOD awarded its fourth generation of TRICARE contracts, referred to as T- 2017, for management of civilian providers in its two regions (East and West). For new TRICARE contracts, DOD provides a transition period— usually 9 to 12 months—for the incoming and outgoing contractors. During this time, the incoming contractors must take specific steps to prepare for health care delivery. This report examines (1) how the requirement to implement TRICARE Select affected the transition, (2) challenges DOD experienced executing the T-2017 transition process, and (3) how DOD addressed problems after the start of health care delivery. GAO is making three recommendations to improve future contract transitions, including that DOD improve the specificity of its transition guidance and have subject matter experts review oversight requirements.

Defense Health Care
Defense Health Care

Author: United States Government Accountability Office

Publisher: Createspace Independent Publishing Platform

Published: 2017-12-16

Total Pages: 38

ISBN-13: 9781981758067

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Defense Health Care: Acquisition Process for TRICARE's Third Generation of Managed Care Support Contracts

An Evaluation of Resource Sharing Within Tricare's Managed Care Support Contracts
An Evaluation of Resource Sharing Within Tricare's Managed Care Support Contracts

Author: Martin D. McCue

Publisher:

Published: 1996-09-01

Total Pages: 146

ISBN-13: 9781423583011

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To help reduce the overall cost of health care in the Military Health Services System, Managed Care Support Contracts include a provision known as Resource Sharing. Resource Sharing Agreements allow the contractor to provide personnel, equipment, or supplies to a military treatment facility to improve its capability to deliver health care. After reviewing civilian managed care programs, this thesis examines the Military Health Services System and its new managed care program known as TRICARE. Then the concept of Resource Sharing is examined and the process for identifying, evaluating, and using cost effective Resource Sharing Agreements is discussed. Case studies of different types of agreements are used to illustrate the complexity and importance of cost and workload estimates and key contract factors in understanding the agreements. The findings suggest that the contractor's and government's performance data and assumptions underlying the agreements should be continuously monitored to ensure the cost-effectiveness of the agreements.

Defense Health Care
Defense Health Care

Author: United States. General Accounting Office

Publisher:

Published: 1997

Total Pages: 23

ISBN-13:

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To help contain health care costs, the Department of Defense (DOD) in 1993 initiated TRICARE, its nationwide managed health care program for military personnel. By mid-1998, DOD expects to have implemented seven TRICARE managed care support contracts at an estimated cost of $17 billion. Since the award of the first TRICARE contract in 1994, 357 change orders have been made to the five TRICARE contracts now in place. Cumulatively, these change orders have increased tasks and overall costs. DOD has settled 134 of the orders at a cost of about $336,000. DOD estimates costs for the 223 orders that are yet to be settled at $38 million. However, DOD's initial cost estimates differ markedly from contractor estimates. GAO found that although there have been many change orders, DOD has not adequately managed the process. For example, rather than separately budgeting for the costs of individual change orders, DOD has used funds budgeted for other Defense Health Program activities to pay for them--an approach that could potentially create a need for supplemental funding. In addition, DOD's initial cost estimates for new orders have not been sound. As a result, DOD has not developed a reliable estimate of the total federal liability for the contract changes.