Defense health officials say they appreciate proposals from the Military Compensation and Retirement Modernization Commission to revamp military medicine, but believe the recommendations would hurt medical readiness and drive up costs if implemented.
In the Defense Department's first formal response to the commission, Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson said the Defense Health Agency already is undertaking reform.
Efforts underway will address some of the panel's biggest concerns, including patient access to care, quality and oversight, according to Woodson.
The Pentagon is taking a six-pronged approach to health care reform: streamlining leadership, increasing partnerships, improving medical competency, modernizing, increasing global health engagement and reforming Tricare.
The changes should provide a "world-class system" that matches the high rate of medical success seen on the battlefields of Iraq and Afghanistan, Woodson said.
"Our leadership team will be relentless in our efforts to be a national leader in our quality and safety," he added.
The commission made several recommendations for overhauling the military health system, to include abandoning the current Tricare structure in favor of privatized health care, creating a four-star command to oversee readiness and improving services for Tricare beneficiaries with special needs.
Commission members argued for a commercial-based health system for the more than 8 million non-active duty Tricare beneficiaries, saying the current structure impedes access to quality care and forces military medical centers and clinics to maintain services that don't contribute to combat readiness.
But Army Surgeon Gen. Lt. Gen. Patricia Horoho said the current hospital structure directly contributed to successes seen in the past 14 years. She said threats other than combat injuries, such as infectious diseases, also threaten the force, and without the educational programs and patients sustained by the current system, readiness would suffer.
"Our hospitals are our readiness training platforms," Horoho said. "The commission's recommendation to establish Tricare Choice would negatively impact the readiness of our entire health care team and present financial challenges to our active duty families and retirees."
DoD in April initiated its next generation of Tricare contracts, a competition that should improve Tricare by rewarding innovation and simplifying the organization, Woodson said.
Under the contract solicitation, the number of Tricare regions would narrow from three to two, which would reduce administrative costs and improve transition for beneficiaries as they move across regions.
The next generation of Tricare contracts is expected to be awarded in 2017 and could be worth up to $55 billion over five years.
Woodson said the Pentagon needs Congress's support in implementing some of its proposals as well as flexibility to adapt its programs to streamline operations and improve care.
Rep. Tom MacArthur, R-N.J., said he initially was intrigued by the commission's Tricare Choice proposal as well as its other recommendations, but has been swayed in the past several months to improve Tricare from within.
He asked Woodson and the service chiefs to work closely with lawmakers as they work to improve the military health system and Tricare.
"I worry, as we look at the next iteration of Tricare, how do we create a self-evolving Tricare — something that doesn't require an act of Congress every time you want to change something?" MacArthur said. "We want a program that will keep pace with the marketplace."
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
