Initial Response: “Study on Health Care and Related Support for Children of Members of the Armed Forces”
On July 15, the Under Secretary of Defense for Personnel and Readiness, the Honorable Jessica L. Wright, submitted a Report analyzing pediatric health care coverage under TRICARE to the House and Senate Armed Services Committees. The Report, commonly referred to as the “TRICARE for Kids (TFK) Report,” was a requirement of Section 735 of the Fiscal Year 2013 National Defense Authorization Act (NDAA), directing the Secretary of Defense to conduct a comprehensive review and analysis of health care provided to dependent children of members of the Armed Forces.
The TRICARE for Kids Stakeholders Coalition, consisting of pediatric provider organizations, military and veterans’ service organizations, disability groups and military families, has been working since January 2013 for the purposes of providing input to the Department of Defense (DoD) on its provision of healthcare to our military children and coordinating next steps. The Coalition appreciates that its feedback and recommendations were included for consideration in the TFK Report and has asked Secretary of Defense, the Honorable Chuck Hagel, to also incorporate the feedback into the recently directed 90 day review of the military health system.
While each organization has its own perspective and priority issue areas, in order to provide an easy-to-reference summary and response to the TFK Report, the Coalition has compiled the following from analyses, concerns and reactions collected from partner organizations and military families.
The TFK Report concluded that the Military Health System (MHS) is meeting the needs of children in its care—including those with special health care needs—as specifically addressed under each of the nine elements listed in Section 735. This overall finding is not surprising, as this Report was an internal review conducted by the Defense Health Agency (DHA), which administers the TRICARE program.
Although the Report concluded that TRICARE was meeting the needs of children, it also acknowledges in every element of the study that there are significant “gaps,” “areas for clarification” and considerable deficiencies in data collection, utilization and analysis. These findings might be better described as “areas in need of improvement.” These gaps and findings align with many of the areas identified and recommendations made by Coalition partners to the DoD for consideration in preparing the Report. Those areas are ripe for and in need of immediate attention. TFK stakeholders are pleased that the Report acknowledges areas of concern and urges action in a timely and collaborative manner.
An overarching theme woven throughout the Report is the lack of data and meaningful utilization of data, or inability to collect data, which then limits the analysis in many of the elements examined. Many areas, such as specialty care, the Extended Care Health Option (ECHO) program, care management and the Exceptional Family Member Program (EFMP), lack sufficient data to support the DoD’s conclusion that it is providing adequate care and support, particularly to military families with special needs. This lack of data and appropriate analysis is consistent with a recent New York Times article “In Military Care, a Pattern of Errors but Not Scrutiny,” published on June 28, 2014. The Coalition aligns itself with the comments of Dr. Jonathan Woodson, the Assistant Secretary of Defense for Health Affairs, in a follow-up to the New York Times investigation:
“The people we serve expect us to improve. The American public expects us to improve. We expect ourselves to improve.” Woodson called for greater attention to patient safety and more openness about problems in treatment. “In moments like these, it can be easy to close down,” he said. “We need to do the opposite. We need to become even more transparent.”
In each of the nine areas of the Report, the TFK Coalition identifies substantial opportunities for the DHA and the DoD to work with the Congress and stakeholders to collect better data, increase transparency, enhance safety and institute changes to improve TRICARE for one of our most valuable resources, our military children.