Looming Changes to Military Medical Care Cause Uncertainty

Stan Smith / December 08,2019
Looming Changes to Military Medical Care Cause Uncertainty

By Jennifer Barnhill, Navy Spouse

See this article inside the December issue of Military Spouse Magazine.

Looming Changes to Military Medical Care Cause Uncertainty

With the threat of losing 18,000
uniformed medical billets over the next few years,
frustrations at the lack of
health care continuity may be exacerbated for military families. Couple this
cutback with a lack of program clarity, and many beneficiaries feel as though
their care might suffer. 

Uncertainty in Change

On a good day, trying to negotiate the intricacies of a
public or private health care system can be irritating. Dealing with one when
you are mid-Permanent Change of Station or in a health crisis can result in
chalkboard-scratching, hair-pulling frustration.

Military families are among the
most vulnerable when it comes to continuity of care related issues. Moving
every two to three years requires families to start over, searching for new
health care providers, homes, schools, jobs, and friends.

In December 2016, Congress passed
the FY2017 National Defense Authorization Act, the driving force behind
numerous changes to TRICARE and the Military Health System (MHS). Changes
already in effect include increased pharmacy copays and civilian-style open
enrollment period restrictions.

More change is brewing. With the
mandate to reduce and refocus uniformed medical billets to prioritize military
lethality over civilian care, many families wonder how this will translate to
their beneficiary experience.

“It’s an opportunity to
standardize care across the system and standardize the patient experience. The
whole point of bringing everything under (Defense Health Agency) DHA is to
ensure that we’re not going to experience the same variability we have had in
the past with quality or patient experience,” said Dr. Terry Adirim, the deputy
assistant secretary of defense for Health Services Policy and Oversight.
Despite this lofty goal, many seasoned military families know change is often
felt by the beneficiaries.

Communication Gaps

For better or worse, military members and their families
often depend upon military-specific corporate knowledge spread through word of
mouth. The military also heavily relies upon this unofficial communication
channel.

“You don’t know what you don’t know. We are blindly trying to exchange information on social media or trying to do quick Google searches…It’s frightening to a certain degree,” said Michelle Norman, 2019 Armed Forces Insurance Navy Spouse of the Year, co-founder of Parents for Free Appropriate Public Education and military children education advocate. We don’t want to make the wrong decisions (in choosing providers) for our families and we want to make sure the continuity of care is the same, but there is an incredible stress for us to get it right. The implications if you don’t get it right can affect our children, our families, our readiness and our retention.”

Families depend on
TRICARE-contracted administrators in call centers to guide them to new
providers. They rely upon those individuals being well-versed in policy, able
to provide insights into a confusing system, to be understanding of extenuating
circumstances and, when appropriate, empowered to elevate concerns.

“One of our criticisms of the communications plan that took place was that it relies on pull communication rather than push communication. If you sign up for TRICARE’s Facebook page or if you had gone to Tricare.mil for email alerts, you would have been aware that this (policy change) was coming. We felt there was not sufficient effort made to push the information out to families,” said Karen Ruedisueli, government relations deputy director for National Military Family Association.

Growing pains go hand in hand
with an organizational change. However, when patient care is on the line,
having a clear path forward can mitigate frustration.

Waiting with Anticipation

Murphy’s law typically hits military spouses hard when
their military member is deployed. Children smash heads on coffee tables at
bedtime. Fingers are cut while cooking dinner. As many military spouses know,
one does not have to have a medically complex story to be thrust into a
medically complex situation. They juggle. They survive. Reliable care should be
the easy part.

These billet cuts will happen.
Management of MHS will be transferred to DHA. But the details are still hazy.

“We (military advocacy groups)
have not been fighting these cuts; we are fighting the speed of these cuts. We
are strongly encouraging the DHA, the services and Congress to make sure that
all risks to the beneficiary are assessed and mitigated before these cuts go
into place,” said Ruedisueli. “We have not seen the level of analysis that you
would think would be necessary to make sure families in rural areas (have)
adequate medical res in the community to absorb the care (lost by the
reduction in billets).”

Where the cuts will be felt is
something determined by each branch of service. According to Adirim, “We are
not involved with those types of personnel decisions. It’s a (branch of)
service issue. They determine their uniform provider needs.”

Military families don’t get to
choose where they live. They don’t always get to choose the care they receive.
You follow orders. You don’t question orders. Within that framework, families
might feel trapped. But military families do not have to resign themselves to
the idea that “you get what you get and you don’t throw a fit” mentality. 

“For families who do notice a
difference … we need to make sure they understand what they need to do to get
their problems resolved,” Ruedisueli said.

“Periodic updates on the
transition are shared with the public on sites such as health.mil, and concerned individuals
should check there for updates. Individuals can sign up for Military Health
System email updates at health.mil/subscriptions. They can also connect with the
DHA on Facebook and Twitter at facebook.com/DefenseHealthAgency and twitter.com/DoD_DHA. As always, if a patient feels
that their care has changed at any military hospital or clinic, they should
reach out to that facility’s patient representative or patient advocate for
assistance,” according to DHA spokesperson Kevin Dwyer via email.

As surveys into the privatized
military housing crisis have uncovered, many military family issues bottleneck
at low levels, with Interactive Customer Evaluation (ICE) complaints unopened,
paper surveys collecting dust in a digital world, until they explode onto the
national stage. Norman believes without proper oversight and accountability,
changes to the military health care system could become “a huge issue impacting
readiness and retention.”

She added, “At some point military families will say enough is enough. We need to take care of our families and this career path is not allowing us to do that.”

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