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GAO denies protests, clears way for new Tricare contracts

November 16, 2016 (Photo Credit: Petty Officer 1st Class James Stenberg/Naval Hospital Pensacola)
Defense health officials are starting the transition to the new Tricare contracts – deals they say will shorten some wait times and close coverage gaps, among other improvements – following the Government Accountability Office’s decision to deny a protest from a current contracted provider. 

Defense Health Agency officials expect the transition to be completed in late 2017, according to an announcement Tuesday. The biggest change: North and South regions will merge to become a new East region, a move that officials have stressed will not require any immediate action by patients. 

With the change to two regions, officials said, Tricare patients will get more support particularly when they move, and also if they are a family with special needs. 

The transition process should be transparent for Tricare patients, with the new contracts resulting in some improvements – shorter wait times for specialty care appointments, an easier referral process, and improved communication between patients’ military and civilian health care providers, according to defense officials. The new contracts will increase the use of standardized metrics and analytics, officials said,  which will mean fewer gaps in health care, improved clinical quality and improved patient safety.

On Nov. 9, the GAO upheld the Defense Health Agency contract awards to Humana Government Business Inc.,of Louisville, Kentucky, for the East region, and Health Net Federal Services of Rancho Cordova, California, for the West region. Humana now manages the South region, and Health Net manages the North region.  

UnitedHealthCare, which manages the West region, submitted proposals for both the East and West regions, and filed a formal protest with the GAO on Aug. 1, after the new regional contracts were awarded July 21. GAO's decision to reject the protest didn't include details on why it was denied because it is covered under a protective order

“I am pleased our new Tricare contracts are moving forward,” said Dr. Karen S. Guice, acting assistant secretary of defense for health affairs, in a statement announcing the GAO decision.

Both deals have nine-month transition periods and five one-year options. The East region deal could be worth up to $40.5 billion overall, with the West region contract worth up to about $17.7 billion. 

“We’ve added new controls to provide a more seamless transition to the new contracts,” Guice said in the statement. “We’ll work very closely with our new partners to test their systems and ensure a smooth handoff of care for all of our beneficiaries.”  

In a statement provided to Military Times, UnitedHealthcare officials said the company "remains fully committed to serving the health care needs of our country's military service members, retirees and their families in the Tricare West region, including a successful transition," adding that they "will continue to look for opportunities to support the government and bring quality and innovative solutions to meet the health care needs of our nation's military families and veterans."

Under the new regional contracts, the East region includes Alabama, Arkansas, Connecticut, Delaware, the District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (Rock Island area), Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (St. Louis area), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (excluding El Paso area), Vermont, Virginia, West Virginia and Wisconsin. 

The West region includes: Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (excludes Rock Island area), Kansas, Minnesota, Missouri (except St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, Texas (southwestern corner including El Paso), Utah, Washington and Wyoming. 
 
Patricia Kime contributed to this report.

Karen Jowers covers military families, quality of life and consumer issues for Military Times. She can be reached at kjowers@militarytimes.com .


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