Active-duty family members, retirees and their family members will have a new option for health care in Atlanta: Tricare Prime provided by Kaiser Permanente, the not-for-profit health care company considered to be one of the pioneers of health-maintenance organization plans.
Humana Military, the company that oversees Tricare’s East Region, has partnered with Kaiser Permanente on a three-year pilot to provide Tricare Prime to eligible residents within 40 miles of Atlanta.
The new agreement, which will run through 2023, could be the first of several similar arrangements as the Defense Health Agency explores new ways to provide “value-based care,” defined as a health system that pays providers based on performance, quality and value as opposed to volume.
Under the fiscal 2017 National Defense Authorization Act, the Pentagon was required to assess using value-based care within Tricare and report the results to Congress.
Atlanta was home to the Army’s Fort McPherson until 2011 when it was closed as part of the Pentagon’s 2005 Base Realignment And Closure effort. At the time of its closure, nearly 30,000 military retirees lived in the Atlanta area, but Georgia has become an increasingly popular retirement state for military service members.
A spokesman for Humana Military said the program will test whether Kaiser Permanente’s style of managed care “can improve health care quality and reduce health care costs for Tricare beneficiaries.”
DoD needs to address gaps in access and quality of health care, researchers say.
Interested patients can enroll in the new option during Tricare open season, which begins this year on Nov. 11 and ends Dec. 9. During this period, all beneficiaries can decide to stay in their current plan by not taking any action or actively enroll in or switch between Tricare Prime or Tricare Select.
Cheryl Brown, manager of corporate communications at Kaiser Permanente of Georgia said Wednesday that new military affiliated patients in Atlanta will “enjoy the same benefits and low cost as Tricare Prime, plus have access to the medical expertise, coordinate care and convenience of Kaiser Permanente.”
“Care is provided by our network of 800 top-notch providers at our 25 convenient medical offices – most with lab and pharmacy,” Brown said.
Tricare Prime enrollees with sponsors no longer on active duty pay an annual enrollment fee and are responsible for cost-shares and copayments if they are enrolled in Tricare Prime but do not receive care at a military treatment facility.
But the Tricare Prime enrollment fee will be waived for the first 12 months for those choosing Kaiser Permanente, as long as they remain enrolled during the time period.
The waiver will apply to any new person who enrolls during the three-year trial period, according to Kaiser Permanente.
In 2020, the annual enrollment fee is expected to be roughly $301 for an individual and $604 for a family, based on a 1.6 percent rise in the cost of living adjustment calculated by the Social Security Administration.
These beneficiaries also pay a $20 copay for a primary care visit, $30 per specialty care or urgent care visit and $61 for an emergency room visit.
Military medical system changes are expected to have a "huge impact"
Tricare Prime through Kaiser Permanente will have the same health care structure as any other Tricare Prime option, other than an MTF, but their prescriptions would be filled at Kaiser Permanente pharmacies in the area.
The 90-day resupply by mail order also will be available, Brown said.
Humana Corporate Communications Lead Marvin Hill said similar pilot programs testing value-based care are in the works. The projects are “helping inform plans for the next generation of Tricare contracts,” which are to begin in 2023.
During open season or another life event when they need to switch health insurance, beneficiaries can contact Tricare for information on their options. Atlanta area beneficiaries interested enrolling in Kaiser Permanente’s Tricare Prime can contact the company for information and assistance.
Editor’s note: This story has been updated to reflect new information on enrollment waivers.