Defense Health Agency Industry Forum - Value Based Incentives. We are pleased to announce an upcoming Defense Health Agency (DHA) Industry Forum. We invite commercial health plans to share an industry perspective about value based provider incentive programs. This includes, but is not limited to the CMS Value Based Purchasing Program. You may provide your input at one-on-one meetings with the DHA or in writing. One-on-one meetings will allow full disclosure in an environment that protects information shared. • Where : Defense Health Headquarters in Falls Church, VA • When : August 17-18, 2015 • How to Respond : If you wish to schedule a one-on-one meeting, please contact us via email at
[email protected] to indicate your preferred date and time (AM or PM). Please include the name and contact information of a Point of Contact so that we can provide you with additional information regarding your visit. We encourage you to request your one-on-one meeting as soon as possible, but no later than August 10, 2015. Or, you may submit written input to
[email protected] no later than August 15, 2015. Please note that this is neither a notice of intent to issue a solicitation, nor is it intended to serve as a market research tool, as that term is defined in the Federal Acquisition Regulation. Any information provided may or may not become a requirement of future government efforts. The Government will not reimburse any respondent for any costs associated with information submitted in response to this notice. Specific Areas of Interest Please refer to the attached question set for more information about DHA's specific areas of interest regarding value based incentives. Overview This overview discusses: • A summary of the TRICARE Program. • The reimbursement processes for private sector care providers. • Our interest in value based provider incentive programs and their potential applicability to TRICARE. About the Defense Health Program The DHP includes direct care and private sector care. • Direct care is provided by Department of Defense (DoD) personnel at military hospitals and clinics. • Private sector care is provided by Managed Care Support Contractors. We strive for a fully integrated health care delivery and financing system. This is to benefit all Military Health System beneficiaries. To accomplish this, sources and contractors must: • Provide all services needed to fully support DoD's primary wartime readiness mission. • Supplement the services provided through DoD owned or operated health care facilities. The TRICARE Program TRICARE Program provides three basic health care options. TRICARE Prime • Similar to a health maintenance organization • Includes a point of service option • Requires beneficiaries to enroll • Care is managed by a primary care manager TRICARE Standard • Fee-for-service option • Beneficiaries can use any TRICARE authorized provider • Enrollment not required TRICARE Extra • Beneficiaries use providers from the contractor developed network • Reduced cost sharing for each episode of care from a network provider • Not restricted to the network • Enrollment not required You can learn more about TRICARE on the TRICARE About Us page ( http://www.tricare.mil/about ). Reimbursement Process for Private Sector Care Providers We generally base our reimbursement for TRICARE private sector care providers on Medicare methodologies. TRICARE does not currently use any value based incentive programs similar to the CMS Value Based Purchasing Program. Payment Reform Discussion of Value Based Incentives We're seeking information from you about industry best practices and initiatives. We want to learn how industry implements value based incentives that align provider incentives with desired behaviors and outcomes. Your perspective will help us decide if we could: • Implement alternative payment methodologies and incentives in TRICARE. • Base reimbursements to private sector care providers on quality of care - not on the volume of services they provide.