FALLS CHURCH, Va. (AFRNS) -- The new managed care support contracts were awarded July 21. The East Region contract goes to Humana Government Business, Inc. of Louisville, Kentucky, and the West Region contract goes to Health Net Federal Services, LLC of Rancho Cordova, California.

The new regional contracts are the fourth generation of managed care support contracts since 1994. As with each generation of managed care support contracts, the Military Health System seeks to improve the delivery, quality, and cost of health care services from previous contracts. 

MHS officials report these new contracts will provide: a solid foundation for future initiatives; a more cost-effective and efficient managed care contract; and improvements to enable better health care benefit administration.

One of the two key changes in the new contracts is improved integration across the MHS.  The MHS consists of direct care and purchased care.  Direct care refers to military hospitals and clinics, also known as military treatment facilities, or MTFs. The TRICARE Health Program is often referred to as purchased care. It is the services "purchased" through the managed care support contracts.

Officials state that to enhance each beneficiaries' experience of care, the new contract improves integration between direct care and purchased care by requiring the managed care support contractors to:

-- Process referrals electronically resulting in decreased wait times for beneficiaries to get specialty care, and less administrative burden for military hospitals and clinics

-- Share more data across the enterprise resulting in improved beneficiary care coordination and access to care, plus real time access to data on utilization and medical management.

-- Increase the use of analytics and standardized metrics to ensure fewer gaps in care and improved clinical quality and patient safety

Another key contract change is turning three TRICARE regions into two in the United States.  The East Region merges the current North and South Regions, while the West Region remains the same.  Officials believe the two-region concept supports consistency in benefit administration by reducing administrative variation across regions, reducing administrative cost, and providing seamless support to a mobile TRICARE beneficiary population.

There is a nine-month transition period between the contracts. For more information, visit the TRICARE website and sign-up for email alerts about the new contracts.  (Courtesy of TRICARE)