The Military Health System in Transition: Revisiting Avoidable Hospitalizations (Fiscal Years 2021-2024)

The Military Health System (MHS) has faced multiple changes and challenges over the last decade including the Defense Health Agency (DHA) merger, deployment of MHS GENESIS, military treatment facility (MTF) realignment, and the COVID-19 pandemic. We sought to understand the impact of these events on MHS beneficiary care by comparing Agency for Healthcare Research and Quality (AHRQ) Prevention Quality Indicators (PQIs) for avoidable hospitalizations between beneficiaries with a designated direct care primary care manager (PCM) and those with a designated private sector PCM.

We used the MHS Data Repository to conduct a cross-sectional study of TRICARE Prime beneficiaries aged 18 to 64 years during fiscal years 2021-2024. Crude and adjusted risk ratios were used to determine risk by PCM type for each AHRQ PQI. Logistic regression models were used to estimate unadjusted and adjusted odds ratios for admissions for any of the PQIs. This study was found exempt by the Institutional Review Board of the Uniformed Services University of the Health Sciences.

We identified a total of 490,236 hospital admissions by patients in the MHS with a designated primary care manager (PCM) during the study period. Of the total admissions, 2.85% were associated with PQIs, 2.70% by direct care PCM at a military treatment facility, and 3.75% by a private sector PCM. Rate of admission for several of these conditions on a scale per 1,000 hospitalizations showed lower rates of avoidable hospitalizations in patients with a direct care PCM, but adjusted analysis showed lower overall risk of avoidable hospitalizations for patients with a private sector PCM. Additionally, several individual characteristics, including Black race and comorbidities had higher odds of avoidable hospitalization.

Our findings show that beneficiaries with a private sector PCM had lower odds of an avoidable hospitalization, supporting existing concerns that current staffing shortages have impacted direct care capabilities. With the push to increase force lethality, MHS stabilization is needed to rebuild a ready medical force that can support a medically ready force.