The Military Health System (MHS) places significant priority on ensuring our service members and their families have constant, reliable access to the health care services they need. In surveys and in meetings with beneficiary organizations, the issue of timely access to care is often raised first.
For that reason, TRICARE Prime publishes specific access to care standards: One day for urgent care, seven days for routine care, and 28 days for referrals to a specialist or for a wellness visit. These access standards are among the most specific and stringent standards in the health care sector.
And these standards come with a promise: If a TRICARE Prime enrollee cannot be seen by his or her provider within those access standards, TRICARE will authorize the care to be delivered by another provider in the network.
This article explains the first access to care standard: one day for an urgent medical issue. How does DoD perform on this standard? How is the measure calculated? And what alternatives do TRICARE Prime enrollees have when the standard cannot be met?
The MHS publishes Access to Care performance on Health.mil.
Beneficiaries can review the performance of the MHS as a whole, an individual Service, or a specific medical treatment facility. Overall, the trends are favorable, with many MTFs providing appointments in less than one day. The overall system shows a good trend toward more timely appointments.
The MHS determines Urgent Care wait times by identifying when the “third next available appointment” is open. This is the most widely used measure of timely access in the civilian health community. The “third next available appointment” is used rather than the “next available” appointment because it is considered a more accurate depiction of appointment availability by eliminating the chance an appointment opening comes from a cancellation or other unique event.
During the last two years, military medicine has introduced and expanded access points. These alternatives include: a Nurse Advice Line that provides 24/7 toll-free access to nurse advice and is integrated with the appointment system so that an appointment can be made by the nurse team for the next day if needed; secure messaging that allows patients to communicate directly with their provider online; a TRICARE Online Web portal that allows enrollees to directly book appointments online; continuous expansion of telehealth (or “virtual health”) capabilities; and the introduction of an Urgent Care demonstration that allows patients to use Urgent Care clinics twice per year without an authorization. When the “urgent” issue is really an emergency, patients should proceed directly to the nearest emergency room.
Timely access to health care is an important driver of both satisfaction and quality. Leaders of the MHS understand that, which is why they encourage all DoD beneficiaries to view the MHS access to care performance and encourage feedback from beneficiaries on how this system is best supporting them and their families.
This is the first in a series of articles that describes important performance measures available on www.health.mil to help beneficiaries with their health care choices.