Schaettle Paul R, Kaplan Robert S, Lee Vivian S, Parkinson Michael D, Gorman Gregory H, Browne Michael-Anne
Knowesis, Inc, Fairfax, VA 22031, USA.
Harvard Business School, Boston, MA 02163, USA.
Mil Med. 2022 Jan 4;187(1-2):12-16. doi: 10.1093/milmed/usab271.
The U.S. Military Health System spends about $50 billion annually to provide care to 9.6 million active duty service members, retirees, and their families through its TRICARE health plans. TRICARE follows the predominant payment model in the USA-fee-for-service-although the Department of Defense (DoD) and Congress encourage and mandate a move toward alternative payment models-mainly, fee-for-value. For the next TRICARE contracts which will begin in 2023, the DoD asked its health-focused federal advisory committee, the Defense Health Board (DHB), to recommend how best to assess and prioritize leading value-based healthcare initiatives identified from private, public, and employer-based health plans. The November 2020 report, 'Modernization of the TRICARE Benefit', specifies a rubric to evaluate these value-based care initiatives not only in traditional measures of effectiveness but also in terms of the Defense Health Agency's Quadruple Aim with its focus on readiness. The goal of TRICARE's move toward value-based care is to leverage its size and focus on prevention of disease and injury to maintain the readiness of the U.S. Armed Forces in addition to delivering great outcomes and value to the DoD's nearly 10 million beneficiaries. The DHB emphasizes that TRICARE's size and focus on providing quality care at lower cost will incentivize providers to participate in the shift toward value-based care despite the potential challenges in transitioning to this system. This shift also aims to motivate other large government and private payors to accelerate the adoption of value-based care through TRICARE's example.
美国军事医疗系统每年花费约500亿美元，通过其特里卡尔医疗计划为960万现役军人、退休人员及其家属提供医疗服务。特里卡尔遵循美国主要的付费模式——按服务收费，尽管国防部和国会鼓励并要求转向替代付费模式，主要是按价值付费。对于将于2023年开始的下一轮特里卡尔合同，国防部要求其以健康为重点的联邦咨询委员会——国防健康委员会（DHB），就如何最好地评估和优先考虑从私人、公共和雇主型健康计划中识别出的领先的基于价值的医疗保健举措提出建议。2020年11月的报告《特里卡尔福利现代化》规定了一个评估这些基于价值的医疗保健举措的准则，不仅包括传统的有效性衡量标准，还包括国防卫生局的四重目标，其重点是战备状态。特里卡尔向基于价值的医疗保健转变的目标是利用其规模并专注于疾病和伤害的预防，以维持美国武装部队 的战备状态，同时为国防部近1000万受益人提供出色的结果和价值。国防健康委员会强调，尽管向该系统过渡可能存在挑战，但特里卡尔的规模和专注于以较低成本提供优质医疗服务的特点将激励医疗服务提供者参与向基于价值的医疗保健的转变。这一转变还旨在通过特里卡尔的例子激励其他大型政府和私人付款人加快采用基于价值的医疗保健。
