Due to its oversight by the federal government, TRICARE is challenged with limitations that don’t apply to most insurers—one being that they’re not able to offer some of the economic incentives commonly used to push patients to lower-cost care settings. At the same time, the military insurer is held to the same (or higher) standard for keeping costs under control. One strategy its administrators have come up with is a familiar one: Get patients to visit an urgent care centers instead of the emergency room unless they have a truly emergent complaint. Higher copays for ED visits are not an option, as TRICARE members don’t pay for medications or care, and cost sharing for retirees and dependents is capped at $3,500 per year. So, the agency got creative and instead requires a referral for ED visits—but not urgent care visits. Capt. Edward Simmer, chief clinical officer for TRICARE, explained the move in a session on expanding the role of value-based insurance design (VBID) in public payers at the University of Michigan V-BID Center’s annual V-BID Summit. Other tactics Simmer outlined include identifying preferred providers for TRICARE’s 9.5 million military service members, retirees, and dependents and offering premium services for patients who receive preventive care.

TRICARE Offers Nonfinancial Incentives to Push Patients to Urgent Care
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