DOD Uses Surveys to Solicit Some Beneficiary Feedback

DOD conducts beneficiary satisfaction surveys—a common private sector health care practice—to measure TRICARE’s performance and reports the results throughout the MHS. Health Affairs currently conducts two such ongoing surveys: an annual systemwide survey of all eligible beneficiaries and a monthly survey of patients’ perceptions of outpatient visits at MTFs.Both surveys are based on widely used private sector survey instruments. While overall satisfaction levels were fairly high, satisfaction with certain aspects of military health care was somewhat lower, according to the 1996 annual survey (see fig. 3). Table 1 shows the survey results for overall satisfaction. DOD Obtains and Processes Beneficiary-Initiated Comments in Varying Ways Across the MHS

DOD documents, analyzes for trends, and reports on TRICARE beneficiaries’ complaints and compliments in differing ways throughout the MHS. Yet, managed care support contractor officials told us that they consider systematically tracked beneficiary feedback and rigorous analysis of the root causes of members’ complaints to be hallmarks of a customer service-oriented managed care plan. He wrote: “Their enthusiasm and sincerity is definitely the right attitude needed to administer a program that has had the military ‘rank and file’ feeling a little uncomfortable.”

	DOD Could Improve Its Feedback Tracking and Reporting by Further Adopting Private Sector Practices

DOD’s efforts to track beneficiary feedback resemble those of the private sector, but opportunities for improvement exist. For example, DOD’s beneficiary surveys are similar to private health plan and hospital surveys. Also, MTFs and other DOD offices use complaints to help identify problems, as is done in the private sector. Currently, no systemwide approach to tracking and reporting exists. The beneficiary feedback currently available to DOD managers provides useful information about aspects of TRICARE’s performance and possible problem areas. If DOD were to make its current survey efforts more complete and to consistently record and aggregate complaint information across the system, DOD managers would have more valuable information with which to measure TRICARE’s success and identify and eliminate recurring, systemic problems. Enhanced feedback would also help DOD make the outcomes-based assessments it seeks for future TRICARE contracts. Also, while DOD does not currently have an MTF inpatient care survey, we support DOD’s plans to develop and conduct such a survey. Recommendations

To position DOD to obtain and make better use of beneficiary feedback, both now and in the future, the Secretary of Defense should direct the Assistant Secretary of Defense (Health Affairs) to follow through in weighing the costs and benefits associated with civilian network and MTF inpatient care surveys that are comparable to DOD’s current monthly MTF outpatient survey and, as appropriate, implement these surveys and collaborate with the TRICARE contractors to identify options for, and weight the costs and benefits of, achieving consistency in recording beneficiary complaints, analyzing trends, and reporting beneficiary complaints and, as appropriate, implement the most practical, financially prudent approach. However, because of the variability of DOD’s recording of beneficiary comments, we could not determine the range, magnitude, or frequency of beneficiary comments, and we did not review the validity of complaints or how complaints were resolved by the military or contractor organizations that received them. Also, wide differences existed in how much the MTFs analyzed beneficiary feedback for trends. Others are referred through other means, such as priority correspondence, which is referred from congressional and other offices.
Why GAO Did This Study

Pursuant to a congressional request, GAO reviewed: (1) whether the Department of Defense (DOD) solicits feedback from beneficiaries of its managed health care program, TRICARE, and, if so, how this is done and what the data show; (2) what other means are available to beneficiaries to provide feedback and what such beneficiary-initiated feedback could reveal about TRICARE's success; and (3) how DOD's approaches to obtaining feedback compare with the private sector's and whether opportunities exist to improve DOD's beneficiary feedback tracking and reporting.

What GAO Found

GAO noted that: (1) DOD obtains and uses TRICARE beneficiary feedback in several ways across the military health system (MHS); (2) DOD conducts a broad annual beneficiary questionnaire survey and a monthly survey of patients' perceptions of military treatment facilities (MTF) outpatient visits--both of which are based on private-sector models--to measure levels of satisfaction with TRICARE; (3) DOD reports the survey results throughout the MHS; (4) DOD does not conduct such surveys of MTF inpatient users or civilian network care users, though DOD officials told GAO that they are now planning to develop an MTF inpatient survey; (5) as TRICARE continues to be phased in across the MHS, DOD's annual surveys are indicating fairly levels of overall beneficiary satisfaction with the program, but lower satisfaction levels with aspects of military care; (6) DOD also tracks and reports beneficiary-initiated feedback--complaints and other comments--in ways that vary throughout the MHS; (7) a wide range exists in how much feedback information is tracked and in how the different levels of units that compose TRICARE--and other DOD offices--do the tracking; (8) beneficiary-initiated feedback reporting throughout the MHS varies as well; (9) because of the variability of DOD's recording of these data, reliably depicting the range, magnitude, or frequency of beneficiary feedback about TRICARE is not possible; (10) private health care managers rely extensively on beneficiary feedback; (11) surveys, which provide data about whole customer populations, and customer-initiated complaints, which show where specific problems have occurred, are used together as key tools to measure plan performance and identify systemic problems; (12) while no direct private-sector parallel to MHS exists, DOD's feedback efforts are somewhat similar to the private sector's, although adopting certain private practices might improve DOD's feedback systems; (13) more reliable beneficiary feedback data would also help DOD to make customer satisfaction an outcome measure in the next round of TRICARE contracts, which DOD is trying to base more on outcomes and less on process; and (14) to improve its beneficiary feedback approaches, DOD will need to consider a number of cost-benefit issues, the varying sophistication levels of beneficiary feedback management throughout MHS, and other matters.