Triferral Model: A Case Study

Assignment 1 Page 1 I am a spouse of an active duty Staff Sargent who is in the United States Army. We have a HMO that is called Tricare prime. With Tricare prime, we are assigned a primary care manager just as any civilian HMO plans have. Our care is given first and foremost by military treatment facilities if it is available. Our primary care manager is responsible for all our primary care. The military has started a new kind of health care called the patient centered medical home or PCMH. The PCMH is a team-based model based on the premise that the best healthcare begins with a strong primary care foundation, accompanied
The first problem I find is the referral process. With Tricare Prime, you are required to have a referral if you need to see a specialty doctor for any reason. In my case, I see a cardiologist on a regular basis. We moved to California in June and when I first seen my primary care doctor, I asked for a referral to establish a new cardiologist here in California. A referral was placed in June, this is now September and I have yet to get a referral. The primary care doctor keeps messing up the referral and because of this I have gone without my cardiac medicine which is a must to maintain a normal heart rhythm. The
The military providers are rarely physicians. The providers are Physicians assistants. I have some serious medical problems and with that said, I feel more at ease if I could see a medical doctor instead of physician assistants. There are so many patients assigned to a provider that appointment waits are very long at a military treatment facility. There are good things with Tricare such as no health care premiums for active duty soldiers and their families. If we use a health care facility at a military treatment facility, there is no fee’s for medications or co-pays for a provider. If we have to see a civilian provider, the fees are very small and my husband, who is active duty, does not have a fee at all. If we need to go to the emergency room, we can go without having to worry about big hospital bills and things not being covered. Overall Tricare prime has better pros than cons in my opinion. With the rising health care cost’s today, it really doesn’t impact our family in anyway. Being a military wife is very stressful and having good health care can make my life a little