Details of Humana’s TRICARE Contract
The Defense Health Agency awarded Humana Government Business, Inc. a $45 billion TRICARE Managed Care Contract for East Region. The East Region serves approximately 5.9 million TRICARE-eligible beneficiaries residing in 32 states/districts[i]. This contract provides for an average care reimbursement of $7,627 for each TRICARE-eligible beneficiary.
The Defense Health Agency awarded the contract to Humana based on its review of the following factors:
- Network Management
- Referral Management
- Medical Management
- Beneficiary Satisfaction/Customer Service
- Claims Processing
- Program Planning & Control
- Transition
- Cost & Pricing Data
- Financial Viability of Contractor
TRICARE Contract Award Process
Each Managed Care Support Contractor (MCSC) must submit a proposal detailing how their service offering meets or exceed all TRICARE program requirements. MCSCs are encouraged to include technical enhancements highlighting how their service and support provide value to the government, in the form of cost savings, improved patient outcomes, and better customer service.
Under TRICARE, Private Healthcare Access Is Limited
The Defense Health Agency runs the Department of Defense’s TRICARE program. TRICARE provides government-supported health care to approximately 8.8 million active-duty troops, military retirees, military children, and other program beneficiaries.
The TRICARE program has two tiers, TRICARE Prime and TRICARE Select. TRICARE Prime is a managed care plan, which requires treatment at military facilities or through approved network providers. TRICARE Select offers a fee-for-service plan with more provider and facility options for enrollees.
TRICARE patients that do not live near a military base rely heavily on treatment by civilian physicians. Access to care for TRICARE members is not always easy. Many physicians decline to accept new TRICARE patients due to low compensation and reimbursement delays. A 2011 study by the General Accountability Office (GAO) found that over 50% of physicians in California and Texas turned away TRICARE patients.
[i]Alabama, Arkansas, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa (partial coverage), Louisiana, Maine, Maryland, Massachusetts, Michigan, Mississippi, Missouri (partial coverage), New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, Tennessee, Texas (partial coverage), Vermont, Virginia, WestVirginia, and Wisconsin.
