TRICARE Health Plan

The TRICARE Health Plan manages and oversees an integrated health care delivery system in the East and West U.S. TRICARE regions. The THP Director reports to and operates under the authority, direction, and control of the Director, Defense Health Agency. The THP Director has visibility of both the contract and direct care assets, and coordinates with the services to develop an integrated health plan. THP includes:

Objectives

  • Deliver more comprehensive primary care and integrated health services using advanced patient-centered medical home
  • Coordinate care over time and across treatment settings to improve outcomes in the management of chronic illness, particularly for patients with complex medical and social problems.
  • Match personnel, infrastructure and funding to current missions, future missions and population demand
  • Establish more inter-service standards / metrics, and standardize processes to promote learning and continuous improvement.
  • Create enhanced value in military medical markets using an integrated approach specified in five-year business performance plans.
  • Align incentives with health and readiness outcomes to reward value creation

TRICARE Health Plan Functions

We deliver health care to 9.5 million TRICARE beneficiaries through an integrated network comprised of military hospitals and clinics and civilian providers, and ensure consistency of care in accordance with statute via policy and regulations, benefit determination, and benefit design.

The THP manages the TRICARE contracts in each region. This responsibility includes:

  • Ensuring network quality and adequacy; resolves provider issues
  • Monitoring customer satisfaction outcomes
  • Managing customer service issues
  • Coordinating appointing and referral management policies
  • Addressing enrollment issues
  • Contracting and fiscal management functions
  • Establishing and coordinating regional marketing and education functions
  • Overseeing contractor credentialing
  • Developing TRICARE maximum allowable charge waiver packages
  • Approving resource sharing agreements with the regional contractor and military treatment facilities (MTFs)
  • Ensuring contract support for MTF optimization
  • Approving Memorandum of Understanding with the regional contractors
  • Serving as the award fee determination official for Health Care Services and Administration contracts
  • Other delegated functions

THP supports MTF Commanders in their delivery of health care services for MTF-enrolled beneficiaries, for the management of health care services for beneficiaries not enrolled to MTFs, supporting the MTF Commanders in their efforts to optimize health care services in the MTFs, and other assistance as required to support both MTF and remote areas to meet regional strategic planning goals and the annual business plan objectives

THP develops business plans to support all beneficiaries in each region, including non-MTF areas, remote areas, and those areas where the Service Surgeon Generals request THP Director support. Each individual business plan is integrated into a single, regional business plan that's submitted to the DHA Director each fiscal year. 

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