By Jennifer Barnhill, Navy Spouse
See this article inside the December issue of Military Spouse Magazine.
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 resources 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.”
“For families who do notice a difference…we need to make sure they understand what they need to do to get their problems resolved.”
Karen Ruedisueli, Government Relations Deputy Director, National Military Family Association