11

TRICARE SOUTH RESERVE/GUARD ADVISORY

COMMITTEE MEETING

November 20, 2008

22

OVERVIEW

• Welcome

• Due Outs From Last Meeting

• TRICARE Programs Overview

• TRICARE Education

• Behavioral Health Programs

• Open Discussion

• Closing Comments

3

DUE OUTS

• TRICARE Reserve Select Data to Command - Updating TRS POC Listings - Sending Monthly - some glitches have been reported

• Notification of receipt of TRICARE Reserve Select Enrollment Form - HMHS will support if phone numbers are on enrollment form - RA unable to populate phone numbers in Guard/Reserve Portal

3

44

TRICARE Programs Overview

55

TRICARE PROGRAMS OVERVIEW

• TRICARE Reserve Select (TRS) - Numbers

• Problem Areas - Disenrollments For Non-payment - DEERS/Access to Portal - Early TRICARE Eligibility

6

TRICARE RESERVE SELECT POPULATION

6

Region South TRS

Population by Military Service

MHS-Wide TRS

Population by Military Service

Region South TRS

Population by State

Sponsor Military Service

AffiliationOct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08

Percent of Total for Most Recent

Month

Air Force 6,413 10,456 11,652 13,351 14,003 13,938 15,402 15,988 16,375 16,915 17,806 17,736 23.3%Army 20,826 27,944 30,850 33,392 35,613 35,755 40,065 42,038 42,371 43,752 45,652 45,377 59.6%

Coast Guard 534 702 768 852 935 937 1,073 1,059 1,072 1,132 1,211 1,224 1.6%Marine Corps 1,239 1,554 1,799 1,983 2,095 2,035 2,197 2,236 2,257 2,313 2,396 2,428 3.2%

Navy 3,285 4,660 5,329 6,089 6,625 6,618 7,529 7,965 8,510 8,995 9,340 9,433 12.4%

Total 32,297 45,316 50,398 55,667 59,271 59,283 66,266 69,286 70,585 73,107 76,405 76,198 100%

Sponsor Military Service

AffiliationOct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08

Percent of Total for Most Recent

Month

Air Force 1,726 3,090 3,808 4,314 4,526 4,584 5,096 5,303 5,424 5,555 5,829 5,743 22.8%Army 6,222 8,894 10,460 11,320 11,993 11,782 13,147 13,878 13,855 14,594 15,295 14,934 59.4%

Coast Guard 186 242 268 311 336 357 385 384 396 429 461 464 1.8%Marine Corps 336 451 583 672 705 696 764 768 764 769 799 790 3.1%

Navy 929 1,463 1,761 1,991 2,223 2,227 2,502 2,733 2,935 3,099 3,236 3,221 12.8%

Total 9,399 14,140 16,880 18,608 19,783 19,646 21,894 23,066 23,374 24,446 25,620 25,152 100%

Beneficiary State

Oct-07 Nov-07 Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08Percent of Total for Most Recent

Month

Alabama 550 914 1,184 1,311 1,394 1,388 1,574 1,628 1,714 1,792 1,925 1,892 7.5%

Arkansas 319 492 623 709 775 766 879 973 1,071 1,090 1,125 1,093 4.3%

Florida 1,410 2,295 2,886 3,150 3,381 3,293 3,654 3,940 4,047 4,215 4,384 4,328 17.2%

Georgia 947 1,415 1,774 1,990 2,118 2,077 2,374 2,427 2,490 2,636 2,780 2,709 10.8%

Louisiana 602 1,075 1,437 1,535 1,624 1,587 1,850 1,978 2,005 2,074 2,158 2,059 8.2%

Mississippi 664 1,061 1,337 1,439 1,483 1,472 1,533 1,603 1,633 1,747 1,864 1,822 7.2%

Oklahoma 402 656 811 943 1,086 1,139 1,248 1,312 1,271 1,323 1,361 1,312 5.2%

South Carolina 788 1,146 1,397 1,564 1,652 1,739 1,941 2,031 2,099 2,183 2,272 2,187 8.7%

Tennessee 1,047 1,447 1,722 1,805 1,840 1,761 1,883 2,020 1,979 2,043 2,122 2,128 8.5%

Texas 1,860 2,940 3,709 4,162 4,430 4,411 4,933 5,124 5,041 5,327 5,619 5,613 22.3%

Total 8,589 13,441 16,880 18,608 19,783 19,633 21,869 23,036 23,350 24,430 25,610 25,152 100%

Note: Minor changes in total numbers between State and

South Region tables are due to some beneficiaries having

incomplete or invalid state codes in DEERS.

7* TRS Data is not yet available by region defined states. Some very small geographic areas of some states within the South region are actually within the West or North Region

Region SouthTRICARE Reserve Select

(Active Plans as Sep 08) by State *

8

TRICARE Reserve Select Individual & Family Plans

Reasons for Disenrollment or Termination (Sep

2008)

99

TRICARE PROGRAMS OVERVIEW

DEERS/Access to Guard/Reserve Portal

- Number one eligibility/enrollment problem is inaccurate DEERS information.

- If members are not able to access the Guard/Reserve portal - They are ineligible (no longer selected

reserve) - DEERS is incorrect

- Covered under another TRICARE program

10

TRICARE PROGRAMS OVERVIEW

Early TRICARE Eligibility

• This early eligibility program is totally dependent on the service member's personnel units updating the Defense Enrollment Eligibility Reporting System (DEERS) with this delayed effective date order information.

• Some RC members/families are unaware of this program and are not being identified by their components in DEERS. Recommend education at all levels of the personnel community.

10

11

National Guard* & Reserve* Purchased Care Data

Medical Services** During FY 2008***

*Includes Active Duty (AD) and AD Family Members. **See breakout of Medical Services types next slide *** Oct 2007 thru Aug 2008; Sep not complete.11

Medical Services 2008 Trend

12

National Guard Purchased Care Medical Services

12

13

Reserve Purchased Care Medical Services

13

14

Purchased Care Medical Services FY 2008*

Type of Service National Guard Reserve Total

Medical Care 472,162 424,067 896,229

Surgery 199,867 149,033 348,900

Diagnostic Laboratory 180,164 160,430 340,594

Other Medical Service 149,965 163,773 313,738

Physical/Occupational Therapy 139,198 149,381 288,579

Diagnostic/Therapeutic X-Ray 118,986 103,296 222,282

Mental Health Care 23,021 24,251 47,272

Ambulance 21,104 15,305 36,409

Consultation 11,787 12,174 23,961

DME Rental/Purchase 9,554 11,646 21,200

Anesthesia 10,525 10,269 20,794

Speech Therapy 4,152 4,582 8,734

Maternity 4,240 3,638 7,878

Radiation Therapy 2,180 2,049 4,229

Assistance at Surgery 913 824 1,737

Total 1,347,818 1,234,718 2,582,536

*Oct 2007 thru Aug 2008; Sep not complete

15

Other Places of Service Not Listed in Chart

Place of Service National Guard

Member

Reserve member

Rural Health Clinic 625 241

Comp Outpatient Rehab Facility 393 460

State/Local Public Health Clinic 732 107

Community Mental Health Center 285 109

Psych Facility Partial Hospitalization 68 120

School 59 11

Comp Inpatient Rehab Facility 37 32

Mobile unit 11 51

Federally qualified health center 29 7

Nursing Facility 24 8

End Stage Renal Disease Trt Fac 15 13

Tribal 638 Free Standing Facility 4 4

Birthing Center 2  

Non-residential substance abuse 2  

Assisted living facility   1

Purchased Care Places of Service for Reserve and National Guard Members (Oct 2007 thru Aug

2008)

15

16

16*Oct 2007 thru Aug 2008; Sep not complete.

.

  Primary Diagnosis (Reason for Visit) Air Force Army Total % of Total

1 ROUTINE INFANT OR CHILD HEALTH 4,483 24,026 28,509 10.22%

2 ACUTE UPPER RESPIRATORY INFECTIONS 911 5,290 6,201 2.22%

3 CARE INVOLVING PHYSICAL THERAPY 959 4,036 4,995 1.79%

4 LUMBAGO (PAIN IN MID/LOWER BACK) 713 4,228 4,941 1.77%

5 ACUTE PHARYNGITIS 725 4,050 4,775 1.71%

6 OTITIS MEDIA 577 3,771 4,348 1.56%

7 ALLERGIC RHINITIS 538 3,456 3,994 1.43%

8 PAIN IN JOINT INVOLVING LOWER LEG 899 2,997 3,896 1.40%

9 ACUTE SINUSITIS 585 3,003 3,588 1.29%

10 ALLERGIC RHINITIS DUE TO POLLEN 873 2,576 3,449 1.24%

11 CERVICALGIA (PAIN IN NECK) 575 2,809 3,384 1.21%

12 EXAMINATION OF EYES AND VISION 712 2,559 3,271 1.17%

13 INFLUENZA VACCINATION, INFLUENZA 575 2,568 3,143 1.13%

14 ROUTINE GYNECOLOGICAL EXAM 501 2,539 3,040 1.09%

15 ATTENTION DEFICIT DISORDER 474 2,481 2,955 1.06%

16 ACUTE BRONCHITIS 387 2,220 2,607 0.93%

17 MYOPIA 374 1,817 2,191 0.79%

18 FEVER 356 1,829 2,185 0.78%

19 PAIN IN LIMB 360 1,659 2,019 0.72%

20 LACK OF NORMAL PHYSIOLOGICAL DEV 837 1,181 2,018 0.72%

21 ADJUSTMENT DISORDER W/ MIXED ANXIETY 321 1,642 1,963 0.70%

22 CHEST PAIN, UNSPECIFIED 331 1,603 1,934 0.69%

23 JOINT PAIN-SHLDER 454 1,473 1,927 0.69%

24 HEADACHE 245 1,660 1,905 0.68%

25 URINARY TRACT INFECTION 247 1,567 1,814 0.65%

  Primary Diagnosis (Reason for Visit) Air Force Army Total % of Total

1 LUMBAGO (PAIN IN MID/LOWER BACK) 1,955 9,162 11,117 6.24%

2 JOINT PAIN-L/LEG 1,006 9,219 10,225 5.74%

3 CARE INVOLVING PHYSICAL THERAPY 873 7,613 8,486 4.77%

4 JOINT PAIN-SHOULDER 905 7,549 8,454 4.75%

5 CERVICALGIA (PAIN IN NECK) 471 3,443 3,914 2.20%

6 PAIN IN LIMB 416 2,648 3,064 1.72%

7 LUMBAR DISC DISPLACEMENT 425 2,596 3,021 1.70%

8 ROTATOR CUFF SYND NOS 195 2,655 2,850 1.60%

9 SPRAIN ROTATOR CUFF 638 1,920 2,558 1.44%

10 TEAR OF MEDIAL CARTILAGE OF KNEE 300 2,069 2,369 1.33%

11 CHEST PAIN, UNSPECIFIED 337 1,542 1,879 1.06%

12 JOINT PAIN-ANKLE 74 1,755 1,829 1.03%

13 SPRAIN OF CRUCIATE LIGAMENT OF KNEE 67 1,482 1,549 0.87%

14 JOINT PAIN-PELVIS 195 1,320 1,515 0.85%

15 PLANTAR FIBROMATOSIS 232 1,283 1,515 0.85%

16 POSTTRAUMATIC STRESS DISORDER 6 1,489 1,495 0.84%

17 LUMBOSACRAL NEURITIS NOS 180 1,285 1,465 0.82%

18 ACUTE SINUSITIS, UNSPECIFIED 226 1,084 1,310 0.74%

19 LUMB/LUMBOSAC DISC DEGENERATION 205 1,026 1,231 0.69%

20 SHOULDER REGION DISEASE 135 1,076 1,211 0.68%

21 BACKACHE 138 1,061 1,199 0.67%

22 CHONDROMALACIA PATELLAE 280 911 1,191 0.67%

23 CARPAL TUNNEL SYNDROME 223 960 1,183 0.66%

24 BENIGN HYPERTENSION 131 1,046 1,177 0.66%

25 ESSENTIAL HYPERTENSION, UNSP 170 953 1,123 0.63%

Top 25 Diagnoses for National Guard Purchased Care Visits FY 2008* Active Duty Family Member Active Duty

17

17*Oct 2007 thru Aug 2008; Sep not complete.

Top 25 Diagnoses for Reserves Purchased Care Visits FY 2008* Active Duty Family Member Active Duty

  Primary Diagnosis (Reason for Visit)Air

ForceArmy

Coast Guard

Marines Navy Total% of Total

1 JOINT PAIN-L/LEG 633 7,684 49 1,599 1,959 11,924 6.85%

2LUMBAGO (PAIN IN MID/LOWER

BACK)1,561 6,802 316 1,042 2,074 11,795 6.78%

3 JOINT PAIN-SHLDER 828 6,442 16 776 1,129 9,191 5.28%

4 CERVICALGIA (PAIN IN NECK) 650 3,916 76 238 1,078 5,958 3.42%

5CARE INVOLVING OTHER

PHYSICAL557 2,943 3 732 805 5,040 2.90%

6 JOINT PAIN-ANKLE 142 2,137 73 869 578 3,799 2.18%

7 PAIN IN LIMB 292 1,205 18 224 441 2,180 1.25%

8 ROTATOR CUFF SYNDROME 413 1,344 1 59 252 2,069 1.19%

9 LUMBOSACRAL NEURITIS 131 1,049 29 346 394 1,949 1.12%

10 SPRAIN CRUCIATE LIG KNEE 521 960 21 153 294 1,949 1.12%

11 TEAR MED MENISC KNEE-CUR 208 1,147 1 330 184 1,870 1.07%

12 CHONDROMALACIA PATELLAE 209 1,133   243 255 1,840 1.06%

13 SPRAIN ROTATOR CUFF 59 1,554 9 1 190 1,813 1.04%

14 CHEST PAIN, UNSPECIFIED 263 1,082 2 41 274 1,662 0.96%

15 ROTATOR CUFF RUPTURE 125 1,210   278 45 1,658 0.95%

16 PLANTAR FIBROMATOSIS 119 762 8 117 534 1,540 0.88%

17OTHER SHOULDER REGION

DISEASE45 936   222 250 1,453 0.83%

18 SUPERIOR SHOULDER LESION 29 628   316 447 1,420 0.82%

19 BRACHIAL NEURITIS NOS 278 465 143 12 393 1,291 0.74%

20 SPRAIN OF ANKLE NOS 91 506 50 215 345 1,207 0.69%

21 JOINT PAIN-PELVIS 75 784 2 108 221 1,190 0.68%

22 CARPAL TUNNEL SYNDROME 129 663 1 30 355 1,178 0.68%

23 LUMBOSACRAL SPONDYLOSIS 147 397 54 311 247 1,156 0.66%

24 LUMBAR DISC DISPLACEMENT 139 552 7 265 193 1,156 0.66%

25 ACHILLES TENDINITIS 4 778 159 37 176 1,154 0.66%

  Primary Diagnosis (Reason for Visit)Air

ForceArmy

Coast Guard

Marines Navy Total% of Total

1 ROUTINE INFANT OR CHILD HEALTH 2,353 14,129 336 3,946 8,876 29,640 11.63%

2 ACUTE URI NOS 414 2,220 42 542 1,455 4,673 1.83%

3LUMBAGO (PAIN IN MID / LOWER

BACK)558 1,928 65 412 976 3,939 1.55%

4 EXAMINATION OF EYES/VISION 544 1,857 38 203 1,114 3,756 1.47%

5 JOINT PAIN-L/LEG 345 2,621 6 199 534 3,705 1.45%

6 ACUTE PHARYNGITIS 302 1,709 43 306 984 3,344 1.31%

7 CERVICALGIA (PAIN IN NECK) 311 2,017 25 196 664 3,213 1.26%

8 PHYSICAL THERAPY (OTHER) 626 1,538 69 186 781 3,200 1.26%

9 ALLERGIC RHINITIS 336 1,622 24 216 795 2,993 1.17%

10 RHINITIS DUE TO POLLEN 245 1,690 17 192 728 2,872 1.13%

11 OTITIS MEDIA 324 1,199 17 327 980 2,847 1.12%

12 SPEECH DISTURBANCE 553 1,362 5 227 650 2,797 1.10%

13 INFLUENZA VACCINATION 177 1,285 19 276 919 2,676 1.05%

14 ROUTINE GYNECOLOGICAL 274 1,365 35 291 705 2,670 1.05%

15 ATTENTION DEFICIT DISORDER 293 1,312 1 201 812 2,619 1.03%

16 ADJUSTMENT DISORDER 296 1,090 7 169 777 2,339 0.92%

17 JOINT PAIN-SHLDER 618 1,041 114 24 456 2,253 0.88%

18 MYOPIA 230 1,221 35 151 467 2,104 0.83%

19 ACUTE SINUSITIS 232 1,044 8 206 556 2,046 0.80%

20 FEVER 254 890 28 223 623 2,018 0.79%

21 ACUTE BRONCHITIS 181 1,040 26 213 537 1,997 0.78%

22 ROUTINE GENERAL MED EXAM 220 1,105 18 134 447 1,924 0.75%

23 ASTHMA UNSPEC 173 944 33 157 495 1,802 0.71%

24 CHEST PAIN, UNSPECIFIED 203 1,024 60 120 361 1,768 0.69%

25 LACK OF NORMAL DEV 134 1,120   39 399 1,692 0.66%

18

TRICARE EDUCATION

INITIATIVES

18

19

TRICARE EDUCATION INITIATIVES

• Education Initiatives

• Yellow Ribbon Campaign

• HMHS Informational CD and Web Site

20

CY 08 RESERVE/GUARD UNIT EDUCATION BRIEFINGS

0

10

20

30

40

50

60

70

Briefings Requested 29 35 45 61 56 30 28 30 30 26

Briefings Completed 29 35 44 60 56 30 28 30 30 26

Briefings Completed Year to Date 29 64 108 168 224 254 282 312 342 368

Number of Attendees 3227 3600 6126 12667 5728 4273 2895 4531 5344 3413

Number of Attendees YTD 3227 6827 12953 25620 31348 35621 38516 43047 48391 51804

Percentage Completed 100.0% 100.0% 97.8% 98.4% 100.0% 100.0% 100.0% 100.0% 100.0% 100.0%

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

21

TRICARE Outreach Initiatives

• Education

– 52 Family Day Events = 27,356 – 30 Conferences = 19,749 – 368 Unit Briefings = 51,804

Total = 98,909

• Web Site– Redesign– 8 Module Video– 4,893 hits on NGR web page in 6 months

22

• Customer Service

– 25,146 calls received on HMHS dedicated Guard/Reserve 800 line

• Outreach

– 76 Visits to Senior Guard and Reserve Staff• State Adjutant Generals• Reserve Command Commanders• Family Program Directors• Transition Assistance Advisors

TRICARE CUSTOMER SERVICE/OUTREACH

INITIATIVES

23

TRICARE OUTREACH INITIATIVES

• Yellow Ribbon Program– Reintegration – Post Deployment Health Reassessment– Level of Participation

• HMHS Informational CD and Web Site

– Informational CD• Best Method of Distribution

− Target Date NLT end of Dec 08

– Educational Information on the HMHS Web Site• www.humana-military.com

− National Guard and Reserve Page

24

NATIONAL GUARD AND RESERVE WEB PAGE

http://www.humana-military.com/south/bene/TRICAREPrograms/ngr.asp

25

RESERVE/GUARD CUSTOMER SERVICE LINE

USAGE 1-877-298-3408

14001600180020002200240026002800300032003400360038004000

Calls Received 1747 1875 1976 2029 2202 2194 2870 3064 3348 3841

Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec

26

RESERVE/GUARD WEB PAGE HITS

0

200

400

600

800

1000

1200

1400

1600

Hits 665 869 940 1005 1409 1404

May Jun Jul Aug Sep Oct

27

BEHAVIORAL HEALTH PROGRAM

OVERVIEW

27

28

BEHAVIORAL HEALTH

• Accessing Services

• Behavioral Health Benefits

• Provider Locator and Appointment Assistance Service

• Resources and Tools

29

ACCESSING SERVICES

• Beneficiaries can contact the TRICARE South Behavioral Health Unit for information regarding:

– Benefits and Eligibility– Provider Locating Services– Authorization Request

• 1-800-700-8646• 1-800-444-5445 (select mental health prompt)

30

BEHAVIORAL HEALTH BENEFITS

• Routine Outpatient Care (up to twice per week)• Inpatient Care (up to 45 days per fiscal year)

– Substance use rehabilitation based on 365 day year (one per year, 3 per lifetime)

• Residential Treatment Center (RTC) (up to 150 days per fiscal year)

• Partial Hospitalization Program (PHP) (up to 60 days per fiscal year)

• Substance Abuse (up to 21 days per treatment)• All these limits are based on medical necessity and are

subject to waiver in special circumstances

31

BEHAVIORAL HEALTH AND PROVIDER LOCATOR

ASSISTANCE

• Dedicated Toll-Free Number– 1-877-298-3514

• Implemented December 2007– Over 5,900 calls

• Activated Guard/Reserve Members and enrolled Family Members (to include Prime Remote and Overseas)

32

BEHAVIORAL HEALTH RESOURCES

• www.humana-military.com

• Behavioral Health Portal with web resources, articles and tip sheets related to a variety of behavioral health issues, such as - PTSD - TBI - Bipolar Disorder- ADHD

• Achieve Solutions- Online Employee Assistance Program (EAP) Work/Life

educational resources• 6,000 articles on 200 different topics• Available in both English and Spanish• Implemented in September 2007• Over 111,000 pages viewed

33

ACHIEVE SOLUTIONS

https://www.achievesolutions.net/achievesolutions/en//Home.do

34

BEHAVIORAL HEALTH RESOURCES

• New Enhancements– Teen Life

• Program designed specifically for teens and parents of teens• Broad spectrum of resources from eating disorders and

substance use to finding the right college and financial aid– Life Manager

• Web based program that allows a user to assess their mood, take assessment quizzes and receive a Plan of Action

– Suicide Awareness• Special section highlighting articles, web resources, tip sheets

and education related to Suicide Awareness• 2 videos related to Suicide Awareness and access to a 24/7

behavioral health clinician for users who maybe feeling suicidal

35

ACHIEVE SOLUTIONS

http://volm.harrisrothenberg.net/Default.aspx

36

Non-TRICARE Behavioral Health Resources

• Afterdeployment.org - A mental wellness resource for Service Members,

Veterans and Military Families designed to assist in managing after deployment concerns

• MilitaryOnesource.com or 1-800-342-9647 - both an online and telephonic resource, with representatives available 24/7/365, to assist military members and their families with a variety of issues

37

• OPEN DISCUSSION

• CLOSING COMMENTS

37