CHRISTUS - Uniformed Services Family Health Plan

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CHRISTUS HEALTH UNIFORMED SERVICES FAMILY HEALTH PLAN As one of the top ten Catholic health systems in the United States, CHRISTUS Health is an international health care provider committed to delivering high-quality, accessible care. CHRISTUS is a leading provider of uncompensated care among not-for-profit health care systems and operates in states with some of the highest rates of uninsured, including Texas, Louisiana, and New Mexico. We employ more than 30,000 individuals and treat more than three million patients annually through almost 350 facilities, including more than 50 hospitals and long-term care facilities, 175 clinics and outpatient centers, and dozens of other health care ministries.

Demonstrated Value of the USFHP Program The Uniformed Services Family Health Plan (USFHP) program offers a TRICARE Prime health insurance plan through the U.S. Department of Defense (DOD) to retired service members, their families, and the families of active-duty service members. The USFHP managed care plan is available through six non-profit health care providers in six regions across the country as a type of TRICARE Prime benefit, limited to service areas defined by Zip Code. The USFHP plan achieved a member satisfaction rating of 92.5 percent in 2013, and it has surpassed the satisfaction rates of other managed care plans for 19 consecutive years. CHRISTUS Health has been a designated provider within the USFHP program since 1981. The plan made available through CHRISTUS Health serves 11,604 beneficiaries in southeastern Texas and 256 beneficiaries in western Louisiana. The USFHP network of hospitals includes St. Joseph Medical Center in Houston, Houston Methodist St. John Hospital in Clear Lake, Houston Methodist St. Catherine Hospital in Katy, CHRISTUS St. Mary Hospital in Port Arthur, and CHRISTUS St. Patrick Hospital in Lake Charles. The USFHP program offers unique benefits through an integrated managed care approach that focuses on wellness and provides innovative health care techniques to ensure quality of care. A recent Milliman analysis of the USFHP program found that inpatient utilization for TRICARE Prime members was 50 percent higher and emergency room utilization was almost 40 percent higher when compared to a similar USFHP population. Proposals to eliminate TRICARE Prime and move beneficiaries into TRICARE Standard would negatively affect patients’ health outcomes and satisfaction.

SEPTEMBER 2014

www.ChristusAdvocacy.org

The Recent GAO Report is Incomplete and Inaccurate The Government Accountability Office (GAO) spent 16 months preparing a report that examined only a very narrow set of attributes of the USFHP program. By its own admission, GAO failed to consider patient health outcomes or the benefits offered by the USFHP designated providers, but it nonetheless recommended that the program be eliminated. Assertion (p.9): “The USFHP contracts are expected to cost approximately $6.4 billion over 5 years.”

Fact Check: The USFHP program’s designated providers do not negotiate or propose rates; rather, the ceiling rates are based on government data.

Assertion (p.10): “The USFHP’s role within the current MHS [military health system] is duplicative because it offers military beneficiaries the same TRICARE Prime benefit that is offered by the MCSCs [managed care support contractors] across much of the same geographic service areas and through many of the same providers.”

Fact Check: The MCSCs are not a part of the direct care system – they are part of contracted care, just like the USFHP Program. The USFHP program is a capitated, managed care model, not fee-for-service, and it is a completely different approach to providing care to beneficiaries. The GAO acknowledges that “the MCSCs are not ‘at risk’ for their beneficiaries’ health care costs as are the designated providers under USFHP.” Unlike the MCSCs, the USFHP designated providers have a built-in incentive to control costs and improve patients’ outcomes.

Assertion (p.11-12): “In general, because all of the beneficiaries who are eligible for the USFHP are also eligible for TRICARE Prime offered by the MCSCs, USFHP enrollees in these areas would likely be able to maintain their TRICARE Prime benefits through the MCSC if the USFHP did not exist.”

Fact Check: The GAO’s assertion is completely speculative, and the data in the report actually show that many enrollees would not be able to do so.  In fact, only 57 percent of CHRISTUS Health’s assigned Zip Codes as a USFHP designated provider actually overlap with the TRICARE MCSC (see Table 1, p. 11). GAO has not assessed the ability of USFHP enrollees to maintain TRICARE Prime benefits if the program were eliminated.  If TRICARE Prime were not available to beneficiaries who previously chose to participate in a managed care plan, GAO’s recommendation would effectively force those enrollees into an unmanaged care system.

Assertion (p.21): “Eliminating this statutorily required program would … eliminate unnecessary costs and inefficiencies ….”

Fact Check: The GAO report mistakenly assumes that DOD would save money by eliminating the USFHP program. In fact, current USFHP enrollees would have to seek care elsewhere within the DOD health care system if the USFHP program did not exist. The potential administrative cost savings to DOD would be negligible in light of the increased administrative costs incurred under other programs due to the influx of new enrollees.

The USFHP program represents an important care management model, because the designated providers are incentivized to control costs and improve care for patients. It should remain a cornerstone of the DOD health care program, and potentially, a model for broader reform.

SEPTEMBER 2014

www.ChristusAdvocacy.org