THE VIRGINIAN-PILOT
Copyright (c) 1995, Landmark Communications, Inc.
DATE: Sunday, December 31, 1995 TAG: 9512310055
SECTION: LOCAL PAGE: B1 EDITION: FINAL
SOURCE: BY KERRY DEROCHI, STAFF WRITER
LENGTH: Medium: 92 lines
Matthew Gowan was at work when the phone call came.
His 1-year-old daughter was having a seizure. Her body was shaking. Her skin was hot. Her mother didn't know what to do.
Gowan, a Navy journalist, drove home, picked up the infant and headed to a Navy medical clinic a mile from his house.
``The clinic got us in there and taken care of right away,'' Gowan said. ``My daughter left feeling 110 percent better. Everything was just fast and easy.''
And it was free.
That morning, Gowan, a member of the military's new Tricare Prime health care plan, learned what officials have hoped will be a lesson for many of the area's sailors and their families: that Tricare Prime, the Defense Department's version of a health maintenance organization, is cheap and easy to use.
Tricare Prime, started in Hampton Roads in December 1994, is the latest attempt by the military to come to terms with the rising costs of health care.
Instead of sending military dependents into the civilian world for their care, Tricare Prime is designed to bring the family members back into the military health system, where costs are lower and can be contained.
Tricare Prime is set up like most HMOs. Patients are assigned a primary care physician at one of nine clinics at locations ranging from Hampton to Virginia Beach.
This physician is in charge of every aspect of the patient's health. If a specialist is needed, the patient is referred to a network of doctors for a cost of either $6 or $12, depending on pay grade.
``It put an emphasis on preventative care and continuity of care with the same provider,'' said Air Force Lt. Col. Donald C. Edgell, operations officer. ``It was not so different from the country doctor, except now the country doctor is much more trained and qualified.''
There are no deductibles. There is no paperwork to be filed.
Yet the growth, at first, was slow.
Military officials blame the low interest on the confusion surrounding health care plans and the refusal of some families to give up their own family doctor.
It wasn't until September of this year, almost 10 months after Tricare Prime first opened, that the health plan began to spark attention among the eligible dependents.
Over the next three months, the number of enrollees more than doubled to 40,774, partly because of publicity surrounding the opening of nine Tricare Prime clinics by Sentara Health System.
Edgell and others say they expect the growth to continue.
Those who have enrolled represent only 23 percent of the 177,000 military dependents eligible for coverage in Hampton Roads. Edgell said he expects that number will increase to 65 percent in the next three years.
In addition, the military is bracing for an onslaught of applications from military retirees and their families in the coming months. In January, Tricare Prime will be open to retirees for the first time, though they will have to pay an enrollment fee of $230 per year for individual coverage, $460 for family.
``There's going to be a big boom in January, but we anticipate this to level off,'' Edgell said. ``We don't think we'll be overrun by retirees. They'll be integrated into the system.''
In November, Tricare Prime opened its first clinic in Chesapeake, a spacious string of examining rooms and laboratories off Military Highway.
The clinic offers radiology departments for common procedures like mammography exams and routine diagnostic screening.
The facility also has an on-site pharmacy and an adult care center for emergencies.
For Lisa Leask, the Chesapeake clinic has convinced her that the decision to sign up for Tricare Prime was a good one.
She said she was unsure of the plan when she first signed up, because of confusion over which clinic she and her 4 1/2-month-old daughter would be seen at.
``Now that I've gotten the hang of the system, it's working better for us,'' said Leask, whose husband, Noah, is a cryptologist second class. ``It's worth the care that we've gotten. I really enjoy the care that's been provided us out there.''
Gowan, whose wife, Aurea, and their two children have been members since December 1994, said Tricare Prime has given him some peace of mind.
``It really relieves a lot of tension as far as thinking that, hey, if I get the call tomorrow and I'm deploying to Bosnia, I know my family is taken care of,'' said Gowan, a first class petty officer.
``I know the clinic is a mile from my house. I think we're fairly well-off in that area.''
KEYWORDS: HEALTH CARE HEALTH INSURANCE U.S. MILITARY by CNB