The Primary Care Computer Simulation: Optimal Primary Care Manager Empanelment.
Abstract
Commanders of Military Treatment Facilities (MTFs) throughout the Military Health Services System (MHSS) face a common dilemma as TRICARE Managed Care Support (MCS) Contracts are implemented: How many beneficiaries should the Facility empanel per Primary Care Manager (PCM)? Leaders at Evans Army Community Hospital at Fort Carson, Colorado decided to study this problem using MedModel Computer Simulation Modeling Software due to its quality graphical animation capabilities and its ability to simulate the hundreds of simultaneously occuring events of a primary care setting. Several incentives exist for Commanders to enroll the maximum number of eligible beneficiaries in MTF Prime. Most significantly, the Department of Defense will allocate future budget authorizations based on a capitated methodology tied to enrollment. Hospitals face several incentives to avoid over-enrollment to include failure to meet Congressionally mandated access standards and patient dissatisfaction. Dissatisfied patients, and reimbursement for their care, will migrate to MCS Contractors. On the other hand, under-enrollment could also be devastating to the MIF. DoD funding will follow the flow of patients away from the MTF and to the contractor through the Bid-Price- Adjustment process.
Document Details
- Document Type
- Technical Report
- Publication Date
- May 01, 1997
- Accession Number
- ADA372305
Entities
People
- James B. Montgomery
Organizations
- Academy of Health Sciences