DoD Awards $136B TRICARE Managed Care Contracts

The T-5 MCS Contracts launch in 2024.

  The U.S. Department of Defense has awarded $136 billion for the "next generation" of TRICARE Managed Care Support Contracts that launch in 2024.

The T-5 MCS Contract maintains the requirement for two TRICARE regions in the United States – East and West.  In addition, six states -- Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin with 1.5 million beneficiaries -- managed in the East Region will transfer to the West Region for a more equitable balance of the beneficiary population.

The $70.9 billion East Region T-5 MCS Contract was awarded to Humana Government Business of Louisville, KY. In the West Region the $65.1 billion T-5 MCS Contract was awarded to TriWest Healthcare Alliance of Phoenix, AZ.  The new contracts will replace the T-2017 managed care contracts that provide care for the military and their dependents beginning in 2024.

"I am pleased that our new T-5 TRICARE contracts will continue to focus on enhancing the experience of care and great healthcare outcomes for our service members, retirees and their families," said Lt Gen. Ronald Place, director, Defense Health Agency.  

The new contracts will continue to provide for the delivery of healthcare, customer service, claims processing and other administrative services to the estimated 9.6 million TRICARE beneficiaries. The new contracts do not change the TRICARE benefit and offer all the same TRICARE options.

"TRICARE is moving into a new era, making use of the lessons learned in the first three contract phases," Place says. "Defense Department leadership and the incumbent managed care support contractors are dedicated to managing a smooth transition to the new managed care support contractors, with minimum disruption to our beneficiaries."

The new contracts mandate improved integration between military medical facilities and the T-5 private sector care, with an emphasis on increasing interoperability with MHS GENESIS through Health Information Exchanges.

With T-5, beneficiaries can transfer care referrals when they move, whether their orders take them to a new duty station within their current region or to the other region.  The DHA says that improving customer service also will be emphasized, with both regions required to reduce the average speed of answer calls to 20 seconds, matching general healthcare sector standards. In addition, the contract holders are mandated to improve call center resolutions and call backs, and first-call resolution requirements to align with industry standard for 85% of initial calls."

"We listened to our beneficiaries about what impacts their experience of care and address many of those concerns in T-5," Place says.

After the yearlong transition to T-5, military hospitals and clinics will have real-time access to medical management data, which increases data-sharing and promoting standardize care between civilian and military venues.   

Blue Cross Blue Shield of Arizona says it will provide support for TriWest Healthcare Alliance’s new contract to administer the 26-state TRICARE West Region.  

The U.S. Department of Defense's reconfigured "T-5" TRICARE program provides coverage for about  active-duty service members, their families, National Guard and reserves and their families.