Factors Associated With the Acceptance of New TRICARE and Medicare Patients by Health Care Providers

Anand, Priyanka; Ben‐Shalom, Yonatan; Schöne, Eric

doi:10.1177/1077558720942700

Cited by 6 publications

(16 citation statements)

References 5 publications

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“…The role of the MMHCG in compounding other barriers to accessing mental health services (e.g., provider availability and personal finances) is an important contribution that advances the understanding of beneficiaries' experiences with Medicare. Participants' difficulties finding a Medicareapproved provider were consistent with national data indicating only 36% of mental health providers accept Medicare patients (Anand et al, 2021). This figure stands in stark contrast to the 83% of physicians who accept new Medicare patients (Anand et al, 2021), suggesting concerns about a lack of mental health parity within the Medicare program are valid.…”

Section: Discussionsupporting

confidence: 57%

“…Participants' difficulties finding a Medicareapproved provider were consistent with national data indicating only 36% of mental health providers accept Medicare patients (Anand et al, 2021). This figure stands in stark contrast to the 83% of physicians who accept new Medicare patients (Anand et al, 2021), suggesting concerns about a lack of mental health parity within the Medicare program are valid. This data provides further evidence that becoming eligible for Medicare does not increase beneficiaries' access to mental health services (Rhodes, 2018).…”

Section: Discussionsupporting

confidence: 57%

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The impact of excluded providers on Medicare beneficiaries’ mental health care

Fullen

Dolbin‐MacNab

Wiley

et al. 2021

Jour of Counseling & Develop

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Mental health conditions are relatively common among Medicare beneficiaries. Yet, Medicare provider eligibility was last updated in 1989, raising concerns about beneficiaries' access to mental health care in the United States. Beneficiaries are currently restricted from accessing mental health services provided by licensed professional counselors and licensed marriage and family therapists. Little is known about the impact of this Medicare mental health coverage gap (MMHCG) on Medicare beneficiaries. Hermeneutic phenomenology was used to analyze semistructured interviews with 18 beneficiaries who had attempted to access mental health care but were limited due to the MMHCG. Three themes emerged: (a) exasperating experiences with the MMHCG, (b) the MMHCG compounds barriers to mental health care, and (c) Medicare as a flawed system. These findings suggest current Medicare mental health policy interferes with beneficiaries' access to needed mental health services. Implications for the counseling profession are described. K E Y W O R D Sgerontological counseling (aging), medicare, professional issues (advocacy)

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Section: Discussionsupporting

confidence: 57%

Section: Discussionsupporting

confidence: 57%

The impact of excluded providers on Medicare beneficiaries’ mental health care

Fullen

Dolbin‐MacNab

Wiley

et al. 2021

Jour of Counseling & Develop

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“…Health care professionals outside the TRICARE network are generally reimbursed on a fee schedule similar to Medicare, while civilian in-network professionals receive a lower reimbursement. 5 Health care professional surveys consistently show that less than 40% of behavioral health professionals (including psychiatrists) accepted new TRICARE patients 16 , 17 compared with 60% and 59% of psychiatrists accepting new Medicare and private insurance patients, respectively, in recent years. 34 Other policy examples might include better coordination of care, electronic sharing of deployment and case history, and reduced waiting time for referrals and during visits.…”

Section: Discussionmentioning

confidence: 99%

“…Services accessed at a military treatment facility are automatically covered, while civilian mental health care professionals decide whether to accept TRICARE based on reimbursement rates, their capacity, and other factors. 5 Active duty individuals have $0 copays for care received at military treatment facilities. 6 Service members also have a $0 copay with a referral and preauthorization from their primary care manager to receive care from a civilian mental health care professional who accepts TRICARE.…”

Section: Introductionmentioning

confidence: 99%

Propensity of US Military Personnel to Seek Mental Health Care When Community Psychiatric Capacity Changes

Shen,

Bacolod,

Heissel

2023

JAMA Health Forum

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ImportanceUnderstanding how the active duty military population’s mental health care use is associated with local military and civilian psychiatrist capacity is critical in designing the optimal allocation of mental health resources from both sectors to improve the mental health of military personnel.ObjectiveTo evaluate whether the probability of mental health care visits by military personnel changes when psychiatrist capacity changes in their communities, when capacity is measured separately for military treatment facilities and civilian sectors.Design, Setting, and ParticipantsThis cohort study of active duty US military service members between January 1, 2016, and September 30, 2020, combines data from the Defense Health Agency, the National Plan and Provider Enumeration System, and the US Census. Data were collected and analyzed from June 2022 to July 2023.Main Outcomes and MeasuresThe main outcome was the probability of making at least 1 mental health care visit in a given quarter at military treatment facilities and in civilian settings. Linear probability models with 2-dimensional fixed effects at individual and community levels were implemented to estimate changes in individual outcomes when community psychiatrist capacity changed.ResultsThis study includes 1 958 421 US service members (83% men; mean [SD] age at baseline, 28.4 [8.0] years). Thirteen percent of service members did not have military treatment facility psychiatrists available within a 30-minute driving time, and 66% lived in communities with a psychiatrist shortage (&lt;1 psychiatrist per 20 000 relevant population), while 9% lived in communities with high (&gt;3 psychiatrists per 20 000 relevant population) military treatment facility psychiatrist capacity. Five percent of service members lived in communities with no civilian psychiatrists within a 30-minute driving time, while 66% lived in communities with high civilian psychiatrist capacity. The mean quarterly mental health care visit rates to military treatment facilities and civilian settings were 7% and 2%, respectively. The probability of a mental health care visit to a military treatment facility increased by 0.95 percentage points (95% CI, 0.79-1.10 percentage points; equivalent to 14%) when the individual experienced a change in military treatment facility capacity from no psychiatrist to high capacity. The probability of a mental health care visit to a civilian setting increased by 0.57 percentage points (95% CI, 0.38-0.76 percentage points; equivalent to 32%) when civilian capacity changed from no psychiatrist to high capacity. The magnitude of responses to military treatment facility capacity changes remained similar in communities that already had high civilian capacity.Conclusions and RelevanceThis cohort study of the US military population suggests that active duty military personnel rely largely on military treatment facilities for their mental health care and that there are meaningful responses to military treatment facility psychiatrist capacity changes even in communities with high civilian psychiatric capacity. Realigning military treatment facility psychiatrists across communities with shortages and high-capacity military treatment facilities, as well as addressing nongeographical barriers in the civilian sector, remain critical to achieve the optimal balance between military and civilian care provision.

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“… 20 , 21 While there are technical solutions to improving appointment availability, lack of providers accepting the TRICARE benefit is a continuing challenge. 22 …”

Section: Discussionmentioning

confidence: 99%

Voice of the Customer: Factors Impacting Beneficiary Choice of Programs in TRICARE

Korona-Bailey,

Janvrin,

Juman

et al. 2023

Journal of Patient Experience

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Little is known about how a consumer would choose a health plan if cost was not an option such as in the Military Health System. We sought to identify how to recruit TRICARE beneficiaries into new pilot programs challenged by low recruitment. We developed a semistructured interview guide by adapting a framework established by Klinkman to assess factors in choosing a health plan. Using social media platforms, we recruited TRICARE Prime and Select beneficiaries to participate in key informant interviews from October to December 2022. We conducted inductive thematic analysis to determine key areas of concern. We interviewed a total of 20 TRICARE Prime and Select beneficiaries. The majority were women, above age 40, had a master's degree, a sponsor in the US Army and of senior officer rank. Four overarching themes emerged: (I) patient choice; (II) access to care; (III) quality of care; and (IV) cost. This evaluation of TRICARE beneficiaries explores how to motivate high-quality value-based care in a traditionally fee for service system.

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Factors Associated With the Acceptance of New TRICARE and Medicare Patients by Health Care Providers

Cited by 6 publications

References 5 publications

The impact of excluded providers on Medicare beneficiaries’ mental health care

The impact of excluded providers on Medicare beneficiaries’ mental health care

Propensity of US Military Personnel to Seek Mental Health Care When Community Psychiatric Capacity Changes

Voice of the Customer: Factors Impacting Beneficiary Choice of Programs in TRICARE

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