MHS Leadership July Message - Access to Care Published July 31, 2014 WASHINGTON -- Military Health System Team, Since the TRICARE Prime benefit was first introduced in 1995, the Military Health System has established standards by which we hold ourselves accountable for access to health care. The standards are straightforward. If a patient enrolled to a military Medical Treatment Facility (MTF) needs to be seen within 24 hours, an appointment will be made with their primary care provider in that time frame. For routine care, enrollees must be provided with an appointment in 7 days. For wellness visits or specialty care referrals, patients must be provided an appointment within 28 days (or sooner if their primary care provider deems it necessary). When we are unable to meet these standards, our enrollees are provided with an alternative - they are provided an authorization to get their needed care from other health care providers in our civilian network. Our preferred approach, however, remains to manage and deliver the care within our military system. Since TRICARE Prime was first introduced, we have continuously worked to expand the options by which beneficiaries can connect with their primary care provider. The Patient-Centered Medical Home represents the most ambitious undertaking in the 20 years since TRICARE Prime was introduced, and it has improved patient continuity of care with the MTF primary care team, and reduced the use of emergency and urgent care. Currently, nearly ninety percent of MTF enrollees' primary care needs are managed within the MTFs. There have been several important innovations that support our PCMH model. TRICARE Online (TOL) is a secure portal, which allows MTF enrollees to book appointments and order prescription refills on-line at any time of the day or night. Additionally, the TOL Blue Button feature allows patients to look up their lab results, radiology results, medication lists, previous encounter information, vital signs, immunizations and allergy information. We also introduced secure, patient-provider communications over the last three years. This secure messaging portal allows MTF enrollees to email their provider with medical questions, rather than requiring a face-to-face visit. This communications link is being expanded to include communications with specialists in some locations. Through these initiatives, MTFs are able to create greater capacity through more efficient delivery of the services they offer. This additional capacity will help us realize our MHS strategic goal of recapturing more of our eligible beneficiary population. Earlier this year, we built on these expanded services when we introduced the Nurse Advice Line (NAL) to our all MHS beneficiaries living or traveling in the United States. The NAL is a 24/7, toll-free service that allows beneficiaries to ask a question about their health with a medical professional. The NAL is not a new concept in medicine, but TRICARE's NAL has some valuable features for MTF Prime enrollees that make it stand out --- the nurse can help ensure a next day appointment can be booked with the MTF enrollee's primary care provider. If there are no MTF appointments available, the NAL will help the MTF enrollee find care in the civilian network. Additionally, the MTF enrollee's primary care provider receives a summary of his or her patients who called overnight so that the patient can be contacted for follow-up, if medically necessary. And, our system is recognizing that the NAL is not just about helping manage patients' questions. Over the last several months, we have had a number of calls from patients who were reluctant to seek care - but had a condition that seemed to be worsening. On several occasions, our nurses on-call recognized that the caller had emergent medical matters that required immediate attention - and contacted 911 or other professionals to intervene immediately. This is more than a service that increases satisfaction, or makes the appointment process more convenient. It ensures our patients get the right care at the right time. It is saving lives. The NAL will be fully deployed throughout the US by the end of July 2014. We're proud of these innovations - and know that they are supporting better access and better care and creating an enhanced patient experience in support of our flagship primary care program, the Patient-Centered Medical Home. Sincerely, Jonathan Woodson, M.D. Assistant Secretary of Defense (Health Affairs) Lt. Gen. Patricia Horoho Surgeon General, United States Army Vice Adm. Matthew Nathan Surgeon General, United States Navy Lt. Gen. Thomas Travis Surgeon General, United States Air Force