Summary of Pediatric Care Developments within Defense Health Agency (DHA) Summer 2016

These developments are the direct result of the Tricare for Kids legislation and subsequent implementation advocacy of the Tricare for Kids Coalition. These summary points are pulled from recent presentations by DHA at a Pediatric Advocacy Forum and the Military Family Readiness Council.

Developments include:

• An internal working group of pediatric clinical experts in the MHS has been chartered to focus on consistent provision of safe and effective pediatric care:

• Five studies are underway to gain greater understanding of the military children with complex medical needs population and their health care. Study topics were chosen to align with elements of the Pediatrics Report to Congress.
• FY 2016 TRICARE evaluation grouped Pediatric metrics for quality under a Pediatrics heading to clarify the data collected at the MHS level for children.

• Intensive Outpatient Programs will soon be covered by Tricare (regulations promulgated awaiting finalization).  This is an issue specifically advocated for since around 2010.

• Onerous certification requirements for residential and substance abuse treatment centers will be streamlined (upon finalization of proposed regulations).

• Implementing a telehealth pilot program for mental and behavioral health. Currently only with Johns Hopkins US Family Health Plan but would include any providers within that network which could include CHOP and CNMC connected physicians.

• Tricare is reporting a 43% improvement in wait times for pediatric appointments since the Tricare for Kids report in July 2014. Presenters were not able to describe any specifics of either the baseline or improvement line.  A key issue for us as advocates is to ensure that Tricare utilizes meaningful data and comparisons and is transparent about it. Obviously we still have far to go.

• Pediatric project team created as a result of Tricare for Kids legislation. The internal group was charged with analyzing the gaps or areas for clarification. The group’s report was not made available to stakeholders (or Congress even though it was requested by Congressional committees) but some points were shared. One of the positive outcomes was an intent to “clarify” TRICARE policy coverage, and contractor application of policy to decrease variation between professional societies’ recommendations and the Affordable Care Act (ACA) for well child care, Medical Nutritional Therapy, and habilitative care benefits, among others.

• The Department plans to hold regular meetings such as one in April to discuss pediatric issues with stakeholders. Again, while not an earth shattering development, it definitely improves accountability, something we have long advocated for.

The detailed DHA presentations can be found under Resources tab.