Provider Acceptance And Beneficiary Access Under TRICARE's PPO Health Plan

Area of Science:

• Health Services Research
• Military Health Systems
• Healthcare Access

Background:

• TRICARE provides health benefits to over nine million military beneficiaries.
• Complaints regarding civilian provider access in TRICARE's PPO plan prompted congressional action.
• TRICARE PPO plans require provider networks in areas offering the TRICARE Prime (HMO) option.

Purpose of the Study:

• To assess beneficiary access and utilization of TRICARE PPO plans.
• To evaluate provider participation in TRICARE PPO networks.
• To compare PPO plan performance in Prime and non-Prime markets.

Main Methods:

• Analysis of beneficiary and provider survey data from 2012-2015.
• Assessment of perceived access to care by beneficiaries.
• Evaluation of provider acceptance of TRICARE patients.

Main Results:

• Most providers participate in TRICARE PPO networks; most users utilize network providers.
• Beneficiary access and provider acceptance were slightly better in non-Prime markets.
• Areas with low access and acceptance were identified for further study.

Conclusions:

• TRICARE PPO networks generally maintain provider participation and beneficiary utilization.
• Market characteristics, particularly the presence of the Prime option, influence access and acceptance.
• Targeted investigations in underserved markets are recommended to improve TRICARE PPO performance.