Tricare Regional Contracts Update

Posted: April 30, 2012 in Uncategorized

Some beneficiaries in Tricare’s western region may need to start looking for a new doctor. The Department of Defense has changed the contractor that creates the network of civilian health care providers for Tricare beneficiaries in the West region. The contract was originally awarded to Truest Healthcare Alliance, but the DOD re-opened the bidding process after UnitedHealth Military & Veterans Services filed a protest. In September, TriWest was ordered to pay a $10 million fine to settle a whistleblower lawsuit. TRICARE Management Activity (TMA) announced on March 16, 2012 that the TRICARE Managed Care Support Contract (MCSC) for the West Region was awarded to UnitedHealth Military & Veterans Services. The contractor provides administrative support and helps Tricare operate the health system, said Austin Camacho, a Tricare spokesman. The change should not affect most beneficiaries, he said. “It shouldn’t have any impact on our beneficiaries directly,” Camacho said. “We expect it to be a pretty much invisible process.” Still, he said, some providers who work with TriWest don’t have arrangements with UnitedHealth. If those providers don’t make the switch, the beneficiaries will have 10 months to find a new provider.
Tricare’s West region includes Alaska, Arizona, California, Colorado, Hawaii, Idaho, Iowa (except the Rock Island Arsenal area), Kansas, Minnesota, Missouri (except the St. Louis area), Montana, Nebraska, Nevada, New Mexico, North Dakota, Oregon, South Dakota, areas of west Texas, Utah, Washington and Wyoming. There are about 2.9 million Tricare beneficiaries in the West region, according to a Tricare news release. The contract is for the third generation of MCSC, referred to as “T-3.” The instant obligation on the award is $10,000,000. The total potential contract value, including the approximate 10-month base period and five one-year option periods for health care delivery, plus a transition-out period, is estimated at $20,462,202,594.It is important for beneficiaries enrolled in the TRICARE West Region to know the new T-3 contract and MCSC will not officially take over the TRICARE West Region until 1 APR 2013. In the meantime, the current T-NEX TRICARE contract will remain in place with TriWest Healthcare Alliance through the transition process to make sure beneficiaries continue to receive quality health care and maintain customer service. There will be a yearlong seamless transition as TMA moves forward into the new TRICARE T-3 contract.
TriWest is protesting DoD’s decision to award the contract to another bidder, saying the process was not fair. They were told they had submitted the lowest bid, but the decision was based on best value for the work. But company representatives went to a debriefing with the government about the process and learned “disturbing information about how the process itself was conducted.” First, the government did not account for several hundred million dollars' worth of discounts that was included in TriWest's bid. Second, the government did not fully examine UnitedHealth's track record. As part of the bid process, companies are required to submit their five largest accounts which serve as references. TriWest also included other information about its record, including the whistleblower lawsuit, and “were told that they had rated the highest category of past performance. However, TriWest contends that the bid evaluators only checked UnitedHealth's five largest accounts and did not probe any deeper into their history. Had they done an appropriate and reasonable buyer's check, the outcome may have been very different. A simple Google search, revealed “massive fines” levied against United Health and doctors have contacted TriWest, “expressing significant concern about the behavior and track record of [UnitedHealth] in the marketplace.” TriWest filed its protest 26 MAR, and this type of dispute is generally adjudicated within 100 days. Inall transition activities will be put on hold while the protest the interim is examined. [Source: & Stars and Stripes Jennifer Hlad articles 17 & 27 Mar 2012 +]


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