Quantitative Analysis of the Referral Management Process under the Next Generation of TRICARE Contracts (TNEX)

摘要

The TRICARE Management Activity negotiated the next generation of TRICARE contracts (TNEX) to improve the cost, quality, and accessibility of services for its beneficiaries. The goal for Military Treatment Facility commanders under TNEX is to maximize the utilization of their funds through MTF optimization plans. The purposes of this study were to identify a procedure or service for a cost-benefit analysis that is currently being referred to the local purchase care market and that could be recaptured by the organization, to perform a cost-benefit analysis to determine the best financial location for the delivery of this service (Bayne-Jones Army Community Hospital, Fort Polk, Louisiana, or the purchase care market), to identify statistically significant beneficiary groups associated with this procedure, and to provide recommendations to the command for a best practice referral management model to optimize the referral process and the organization's purchase care resources. The procedure identified for the cost-benefit analysis was diagnostic X-ray. The majority of the X-ray referrals were for magnetic resonance imaging (MRI). The results indicate that the mean cost of MRI procedures for active duty dependent spouses was significantly higher than for sponsors, both active and retired, and their children. Further, the addition of MRI services would provide a positive health care convenience to the prime beneficiary while adding financial and social value to the organization. Finally, by adopting the best practice referral model recommendations, the Referral Management Center can better position the facility for financial success under TNEX.