NEWSMAKER: Maj. Gen. (Dr.) Elder Granger
TRICARE Deputy Rates Military Health System C+or B-By Tom Philpott
Spring 2009
Army Maj. Gen. (Dr.) Elder Granger, deputy director of TRICARE Management Activity in Falls Church, Va., leads a staff of 1,800 in planning, budgeting and executing the $18- billion-a-year defense health program. He is responsible for ensuring access to quality health care for 9.2 million beneficiaries.
He spoke recently with Military Money contributing writer Tom Philpott.
How is TRICARE doing today?
I tend to package [my assessment] in what I call the five “Ps,” the first being people. We have worked aggressively to improve customer satisfaction, focusing first on the wounded, ill and injured, as well as expanding our TRICARE [provider] network… We have seen a total of 115,000 [additional] civilian providers accepting TRICARE since 2007. We’ve also been focusing on access to care, reducing time of referral for consults and making sure we emphasize after-hours care.
The second part we work very hard is process – the handoff between DoD and VA, and excellence for psychological help and traumatic brain injury… making sure we improve the entire process from point of injury to our medical centers and into the VA system.
The third “P” is prevention. We just got approval from Congress to start doing some innovative things, such as free colonoscopy screening, flu shots, eliminating barriers to retirees getting immunizations, as well as demonstration programs to incentivize lifestyle changes.
Two of the preventive care initiatives Congress approved are a waiver of TRICARE co-payments for annual physicals, breast exams, rectal and prostate screenings, and a new cost-free smoking cessation program for Medicare-eligible beneficiaries. Will they go into effect soon?
No. We have to put it in black and white and get it over to the Office of Management and Budget. They have to put it out for public comment and determine the price for making the changes. Then we start the process, anywhere from six to nine months and sometimes up to a year. But we’re trying to put these on a fast track.
The fourth “P” is price. In the long run, we must show internally that we’re being very cost-effective, eliminating waste and maximizing our pricing power.
The Bush administration continually sought to raise TRICARE fees on working-age retirees. Will those types of proposals continue to be sent to Capitol Hill to try to get costs under control?
I let our budgeteers work that out. My focus, given the dollars entrusted to us, is on [whether] we are providing accessible care, continuity of care, good outcomes and safety.
Do you personally support the Military Coalition’s argument that military retirees have paid up-front premiums for lifetime care through years of arduous service?
I focus on making sure we manage that entitlement program to the best of our ability… That leads to the fifth “P,” productivity – being efficient and effective with [our] dollars and resources. To do that, we have to make sure we eliminate as many variables in our system as we can and be consistent in answering the telephone, making appointments [and] providing timely access to information through electronic health records.
What kind of grade would you give the TRICARE system in satisfying that productivity goal?
Looking at the entire system, both our military treatment facilities and our purchase care, trying to be a truly integrated delivery system, I would say we perform at about
C+ or B-.
What needs to change to bring it up to
an “A” grade?
We’ve got to focus on access to care, 24-7-365. That means being able to have good contact through our telephone system, continuing to push technology in terms of electronic health records, allowing beneficiaries to do things online, paying for prevention and performance, and having more consistency wherever patients go, whether to an Army, Air Force or Navy facility. Preventive services, the way we do appointments, the way we answer the phone, how far we book out appointments, contact with providers after hours – those all would be consistent.
What do beneficiaries enrolled in TRICARE Prime at military facilities do now if they need their primary care provider after hours?
It varies from place to place. At some places, they will say, “Go to the emergency room.” Some will say, “Call this number.” Some will say, “Call the hospital and get the administrative officer of the day.” It’s not a consistent process, and yet our policy says we must take care of them 24-7-365... We’ve got to get that under control.
You talked about phones in giving the system a C+, B- grade. Why are phones such a challenge?
In our military treatment facilities, you have to call several times to get an appointment. One phone call should lead to an appointment. We need to make sure we’re booking appointments out into the future, so that if we say call back on such and such a date, [that should result in] an appointment. That continues to be a challenge wherever you go.
There has been a steady migration of TRICARE beneficiaries from military facilities to relying on your network of civilian providers. Are you concerned about that shift?
I am concerned, because the backbone of our medical readiness is what we do within our military health care system and in sending our providers and nurses to the civilian sector to get training.
What can be done about it?
[We must] make sure they have the right resources in terms of people trained and providers having the right support and having an [improved] electronic health care record [system]… [We must] make sure we have a consistent approach to access to care in terms of telephones, appointments [and] after-hours care. [We must] continue to refine our systems so that patients want to come see us in our military treatment facilities. We have got to continue to eliminate barriers that sometimes make it difficult.
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Tom Philpott writes “Military Update,” a syndicated weekly news column appearing in more than 40 daily newspapers. It can be read online each week at www.military.com and www.fra.org.
