A look at network participation in TRICARE's PPO plans

veteran health care
A new study looks at TRICARE's PPO networks. (Rawf8/Getty Images)

A new study examines the network participation of TRICARE’s preferred provider organization plans—and the results, for the most part, are positive. 

The report, published in the August issue of Health Affairs, stratified regions into three tiers, with the top group performing best on provider acceptance of TRICARE and on beneficiaries’ perceptions of access. Most regions fell in the middle, indicating there's room for improvement but no yawning access gaps.

Nationally, about 67% of general practice physicians accept TRICARE, compared to about 95% that accept private plans, 86% that take Medicare and 65% that accept Medicaid, according to the study. 

However, on patient-reported measures, such as perceived access to specialty care and satisfaction with their physician, TRICARE members were in line with those in private plans. 

“On those particular measures, TRICARE’s PPO plan compares favorably to similar commercial plans,” Yonatan Ben-Shalom, Ph.D., a senior health researcher at Mathematica and the study’s lead author, told FierceHealthcare. 

RELATED: TRICARE families report worse access to care than commercially insured, uninsured, study finds 

That said, notable regional variations cropped up in the study. In some parts of Texas, New Mexico, Washington, Alaska and Hawaii, network acceptance and access were lower for primary care, for example, putting them in the bottom tier. These same regions also struggled with access to specialty care and mental health care, according to the study. 

“Areas in which low access and acceptance coincide, or in which multiple access measures indicate problems, may be fruitful sites for in-depth investigation, both to understand these interrelationships and to focus efforts on improving access by encouraging provider participation,” they said in the study. 

Findings like these should also prompt the Department of Defense to dig more into why a provider would choose not to accept TRICARE coverage and adjust to ease those barriers and improve access, according to the study. Changes to attract additional providers in underserved TRICARE segments could lead to improvements in more high-functioning regions, too, the researchers said. 

Suggested Articles

CMS will cut federal money to states that don't fully inspect nursing homes for infection control and boosts penalties for nursing homes.

Change Healthcare continues to build up its pharmacy technology business with the acquisition of PDX.

HHS' federal watchdog collected $1.51 billion from fraudsters over a six month period from October to March.