
DATE: Tuesday, November 18, 1997            TAG: 9711180279

SECTION: FRONT                   PAGE: A1   EDITION: FINAL 

SOURCE: BY TERRI WILLIAMS, STAFF WRITER 

                                            LENGTH:   85 lines

MILITARY HEALTH INSURANCE GIVEN TO PRIVATE FIRM

Starting in the spring, all 400,000 military personnel, retirees and their families in Hampton Roads will get their health insurance through a private company rather than through the government.

And that, say military officials, should mean a more streamlined system that's easier for patients to navigate.

The Department of Defense has awarded an Indiana company a five-year contract to operate the Tricare military health insurance program for the region that includes Hampton Roads. It's one piece of a national effort to shift the insurance to the private sector.

Anthem Alliance for Health Inc. of Indianapolis will take over Tricare services May 1 for most of Virginia and all of North Carolina, an area that serves about 1.1 million members of military families.

The change will benefit the economies of two Hampton Roads cities.

In downtown Portsmouth, Anthem expects to open a Hampton Roads service center at 801 Water St. With a staff of about 100, the office will handle patients' phone calls about appointments, benefits and claims problems. Positions will include registered nurses, case managers and administrators.

In Hampton, a new regional headquarters will have responsibility for Virginia and North Carolina.

``We think it's a great opportunity to expand our work force downtown,'' said Matthew James, Portsmouth's economic development director.

The Defense Department wants Anthem to encourage eligible people to choose a managed-care plan over conventional insurance. In general, managed-care plans save money while emphasizing good health and preventive care.

One factor driving the retooling of military health care is the need for more doctors and facilities, said Cmdr. Gene Barron, director of managed care for the Portsmouth Naval Medical Center.

Since 1987, 35 percent of military hospitals around the United States have closed, and there's been a similar drop in the number of doctors, nurses and technicians. During the same period, the number of people eligible for care declined by only about 9 percent.

Tricare says most military families in Hampton Roads should notice little difference in their care under the new management.

The goal, said Don Deliz, director for Tricare service centers in the Virginia-North Carolina region, is to improve service. Planned features include:

A new phone system to eliminate a common complaint among patients: busy signals when they call for appointments.

A mail-order pharmacy.

Uniform benefits, meaning that if a patient requires health care in another Tricare region, his co-pay typically would be the same.

Better access to civilian doctors for retired military personnel under 65, who have had difficulty getting appointments.

Tricare offers three health insurance options in Hampton Roads:

Tricare Standard, formerly known as CHAMPUS. This is a fee-for-service health insurance plan in which the patient sees any doctor, then bills the insurer. There is an annual deductible, and the insurer typically pays 80 percent.

Tricare Extra, what is often called a ``preferred provider'' network of doctors. This offers many of the same freedoms as a standard plan, but there are financial incentives to see a doctor approved by the insurance company.

Tricare Prime, a health maintenance organization that first came to Hampton Roads in 1992 as a demonstration project. Sentara Health System, under a contract that expires in three years, operates several Tricare Prime clinics for about 100,000 local enrollees.

Members pay nothing for office visits to their primary care doctors, but there are more restrictions on, for example, how often they can change doctors.

Because preventive care is important in HMOs, mammograms, vision screening and child immunizations will be encouraged. Case managers will work closely with patients who have chronic illnesses such as diabetes or asthma.

Anthem Alliance for Health is a subsidiary of Anthem Inc., an Indianapolis-based company. MEMO: Staff writer Marie Joyce contributed to this story. ILLUSTRATION: PLANNED FEATURES:

A new phone system to schedule appointments.

A mail-order pharmacy.

Uniform benefits for all Tricare regions.

Better access to civilian doctors for some participants.

TO LEARN MORE

For information about Tricare, contact the Tricare Service Center at

677-6000. The military also posts a comprehensive site on the World

Wide Web at http://www.ochampus.mil