United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office Health, Education, and Human Services Division author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 1999-09-30 monographic deposited born digital 28 p. GA 1.13:HEHS-99-168 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-168 P0b002ee18038569f f:he99168 DGPO 2010-08-12 2011-03-23 GAOREPORTS-HEHS-99-168 machine generated eng fdlp REPORT GAOREPORTS-HEHS-99-168 HEHS-99-168 Customer service Health services administration Health care programs Performance measures Military personnel Health maintenance organizations DOD TRICARE Program DOD Composite Health Care System DOD TRICARE Prime Program DOD Customer Satisfaction Survey Letter Report HEHS

Pursuant to a congressional request, GAO reviewed the Department of Defense's (DOD) administration of its health maintenance organization, TRICARE Prime, focusing on: (1) DOD's performance in scheduling appointments; and (2) possible reasons why Prime enrollees might not obtain appointments within the appointment timeliness goals.<p/>GAO noted that: (1) after correcting definitional discrepancies in DOD data, GAO found DOD has not achieved its goal of scheduling 98 percent of acute and routine appointments within the timeliness standards it established; (2) about 70 percent of appointments for a routine visit at military treatment facilities (MTF) were scheduled within the standard, while between 80 and 97 percent of the appointments for acute care, preventive care, or specialists were scheduled within the relevant standards; (3) DOD's analysis of appointment timeliness is consistent with GAO's findings, and DOD has reported that the MTFs' performance has fallen short of its expectations; (4) there are several reasons why active duty members and other enrollees may not obtain appointments within the standards; (5) GAO found that about 16 percent of the appointment slots were given to nonenrolled beneficiaries; (6) DOD permits nonenrollees to make appointments and obtain care in MTFs because it believes treating these beneficiaries is necessary to support medical readiness and training requirements; (7) DOD has made no analysis, however, of the extent to which this policy adversely affects the ability of the enrolled population to obtain care and treatment or the effect of any resulting shortfall on readiness and training; (8) research by the Congressional Budget Office has shown that instituting a copayment for care provided in MTFs could reduce demand for care and improve appointment timeliness by freeing up appointments for active-duty members and Prime enrollees; (9) DOD's data tools are inadequate for measuring appointment timeliness against the access standards; (10) survey weaknesses include reliance on the beneficiaries' ability to correctly recall details of the appointments, a low response rate, and no analysis of the beneficiaries who do not respond--all of which affect the accuracy of the information on how well appointment standards were met; (11) DOD also has several efforts under way to improve the data contained in the Customer Satisfaction Survey and Composite Health Care System (CHCS) appointment scheduling system; and (12) once implemented, CHCS promises to become a good source of the appointment timeliness information DOD needs to effectively manage and monitor access to care. https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-168/html/GAOREPORTS-HEHS-99-168.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-HEHS-99-168/pdf/GAOREPORTS-HEHS-99-168.pdf GAO/HEHS-99-168 https://www.govinfo.gov/app/details/GAOREPORTS-HEHS-99-168 Letter Report GAO/HEHS-99-168; Defense Health Care: Appointment Timeliness Goals Not Met;; Customer service Health services administration Health care programs Performance measures Military personnel Health maintenance organizations DOD TRICARE Program DOD Composite Health Care System DOD TRICARE Prime Program DOD Customer Satisfaction Survey Title 10 Section 1073 Title 10 Section 1097(c) 10 U.S.C. 1073 10 U.S.C. 1097(c) Public Law 104-106 Public Law 105-261