§1073a. Contracts for health care: best value contracting
(a)
(b)
(1) consideration shall be given to the factors specified in the regulations; and
(2) greater weight shall be accorded to technical and performance-related factors than to cost and price-related factors.
(c)
(Added
Statutory Notes and Related Subsidiaries
Comptroller General Review of Defense Health Agency Oversight of Transition Between Managed Care Support Contractors for the TRICARE Program
"(a)
"(1)
"(2)
"(A) A description and assessment of the extent to which the Defense Health Agency provided guidance and oversight to the outgoing and incoming managed care support contractors for the TRICARE program during the transition described in paragraph (1) and before the start of health care delivery by the incoming contractor.
"(B) A description and assessment of any issues with health care delivery under the TRICARE program as a result of or in connection with the transition, and, with respect to such issues-
"(i) the effect, if any, of the guidance and oversight provided by the Defense Health Agency during the transition on such issues; and
"(ii) the solutions developed by the Defense Health Agency for remediating any deficiencies in managed care support for the TRICARE program in connection with such issues.
"(C) A description and assessment of the extent to which the Defense Health Agency has reviewed any lessons learned from past transitions between managed care support contractors for the TRICARE program, and incorporated such lessons into the transition.
"(D) A review of the Department of Defense briefing provided in accordance with the provisions of the Report of the Committee on Armed Services of the House of Representatives to Accompany H.R. 5515 (115th Congress; House Report 115–676) on TRICARE Managed Care Support Contractor Reporting.
"(b)
"(c)
Value-Based Purchasing and Acquisition of Managed Care Support Contracts for TRICARE Program
"(a)
"(b)
"(a)
"(1)
"(A) The quality of health care provided to covered beneficiaries under the TRICARE program.
"(B) The experience of covered beneficiaries in receiving health care under the TRICARE program.
"(C) The health of covered beneficiaries.
"(2)
"(A)
"(i) link payments to health care providers under the TRICARE program to improved performance with respect to quality, cost, and reducing the provision of inappropriate care;
"(ii) consider the characteristics of the population of covered beneficiaries affected by the value-based incentive program;
"(iii) consider how the value-based incentive program would affect the receipt of health care under the TRICARE program by such covered beneficiaries;
"(iv) establish or maintain an assurance that such covered beneficiaries will have timely access to health care during the operation of the value-based incentive program;
"(v) ensure that such covered beneficiaries do not incur any additional costs by reason of the value-based incentive program; and
"(vi) consider such other factors as the Secretary considers appropriate.
"(B)
"(i) the size, scope, and duration of the value-based incentive program is reasonable in relation to the purpose of the value-based incentive program; and
"(ii) the value-based incentive program relies on the core quality performance metrics adopted pursuant to section 728 [amending section 1073b of this title and enacting provisions set out as notes under section 1071 of this title].
"(3)
"(b)
"(1) decisions relating to such acquisition;
"(2) approving the acquisition strategy; and
"(3) conducting pre-solicitation, pre-award, and post-award acquisition reviews.
"(c)
"(1)
"(A) improve access to health care for covered beneficiaries;
"(B) improve health outcomes for covered beneficiaries;
"(C) improve the quality of health care received by covered beneficiaries;
"(D) enhance the experience of covered beneficiaries in receiving health care; and
"(E) lower per capita costs to the Department of Defense of health care provided to covered beneficiaries.
"(2)
"(A)
"(B)
"(3)
"(4)
"(5)
"(A) The maximization of flexibility in the design and configuration of networks of individual and institutional health care providers, including a focus on the development of high-performing networks of health care providers.
"(B) The establishment of an integrated medical management system between military medical treatment facilities and health care providers in the private sector that, when appropriate, effectively coordinates and integrates health care across the continuum of care.
"(C) With respect to telehealth services-
"(i) the maximization of the use of such services to provide real-time interactive communications between patients and health care providers and remote patient monitoring; and
"(ii) the use of standardized payment methods to reimburse health care providers for the provision of such services.
"(D) The use of value-based reimbursement methodologies, including through the use of value-based incentive programs under subsection (a), that transfer financial risk to health care providers and managed care support contractors.
"(E) The use of financial incentives for contractors and health care providers to receive an equitable share in the cost savings to the Department resulting from improvement in health outcomes for covered beneficiaries and the experience of covered beneficiaries in receiving health care.
"(F) The use of incentives that emphasize prevention and wellness for covered beneficiaries receiving health care services from private sector entities to seek such services from high-value health care providers.
"(G) The adoption of a streamlined process for enrollment of covered beneficiaries to receive health care and timely assignment of primary care managers to covered beneficiaries.
"(H) The elimination of the requirement for a referral to be authorized prior receiving specialty care services at a facility of the Department of Defense or through the TRICARE program.
"(I) The use of incentives to encourage covered beneficiaries to participate in medical and lifestyle intervention programs.
"(6)
"(A) assess the unique characteristics of providing health care services in Alaska, Hawaii, and the territories and possessions of the United States, and in rural, remote, or isolated locations in the contiguous 48 States;
"(B) consider the various challenges inherent in developing robust networks of health care providers in those locations;
"(C) develop a provider reimbursement rate structure in those locations that ensures-
"(i) timely access of covered beneficiaries to health care services;
"(ii) the delivery of high-quality primary and specialty care;
"(iii) improvement in health outcomes for covered beneficiaries; and
"(iv) an enhanced experience of care for covered beneficiaries; and
"(D) ensure that managed care support contracts under the TRICARE program in those locations will-
"(i) establish individual and institutional provider networks that will provide timely access to care for covered beneficiaries, including pursuant to such networks relating to an Indian tribe or tribal organization that is party to the Alaska Native Health Compact with the Indian Health Service or has entered into a contract with the Indian Health Service to provide health care in rural Alaska or other locations in the United States; and
"(ii) deliver high-quality care, better health outcomes, and a better experience of care for covered beneficiaries.
"(d)
"(e)
"(1)
"(2)
"(A) Whether the approach of the Department of Defense for acquiring managed care support contracts under the TRICARE program-
"(i) improves access to care;
"(ii) improves health outcomes;
"(iii) improves the experience of care for covered beneficiaries; and
"(iv) lowers per capita health care costs.
"(B) Whether the Department has, in its requirements for managed care support contracts under the TRICARE program, allowed for-
"(i) maximum flexibility in network design and development;
"(ii) integrated medical management between military medical treatment facilities and network providers;
"(iii) the maximum use of the full range of telehealth services;
"(iv) the use of value-based reimbursement methods that transfer financial risk to health care providers and managed care support contractors;
"(v) the use of prevention and wellness incentives to encourage covered beneficiaries to seek health care services from high-value providers;
"(vi) a streamlined enrollment process and timely assignment of primary care managers;
"(vii) the elimination of the requirement to seek authorization for referrals for specialty care services;
"(viii) the use of incentives to encourage covered beneficiaries to engage in medical and lifestyle intervention programs; and
"(ix) the use of financial incentives for contractors and health care providers to receive an equitable share in cost savings resulting from improvements in health outcomes and the experience of care for covered beneficiaries.
"(C) Whether the Department has considered, in developing requirements for managed care support contracts under the TRICARE program, the following:
"(i) The unique characteristics of providing health care services in Alaska, Hawaii, and the territories and possessions of the United States, and in rural, remote, or isolated locations in the contiguous 48 States;
"(ii) The various challenges inherent in developing robust networks of health care providers in those locations.
"(iii) A provider reimbursement rate structure in those locations that ensures-
"(I) timely access of covered beneficiaries to health care services;
"(II) the delivery of high-quality primary and specialty care;
"(III) improvement in health outcomes for covered beneficiaries; and
"(IV) an enhanced experience of care for covered beneficiaries.
"(f)
"(1) The terms 'covered beneficiary' and 'TRICARE program' have the meaning given those terms in section 1072 of title 10, United States Code.
"(2) The term 'high-performing networks of health care providers' means networks of health care providers that, in addition to such other requirements as the Secretary of Defense may specify for purposes of this section, do the following:
"(A) Deliver high quality health care as measured by leading health quality measurement organizations such as the National Committee for Quality Assurance and the Agency for Healthcare Research and Quality.
"(B) Achieve greater efficiency in the delivery of health care by identifying and implementing within such network improvement opportunities that guide patients through the entire continuum of care, thereby reducing variations in the delivery of health care and preventing medical errors and duplication of medical services.
"(C) Improve population-based health outcomes by using a team approach to deliver case management, prevention, and wellness services to high-need and high-cost patients.
"(D) Focus on preventive care that emphasizes-
"(i) early detection and timely treatment of disease;
"(ii) periodic health screenings; and
"(iii) education regarding healthy lifestyle behaviors.
"(E) Coordinate and integrate health care across the continuum of care, connecting all aspects of the health care received by the patient, including the patient's health care team.
"(F) Facilitate access to health care providers, including-
"(i) after-hours care;
"(ii) urgent care; and
"(iii) through telehealth appointments, when appropriate.
"(G) Encourage patients to participate in making health care decisions.
"(H) Use evidence-based treatment protocols that improve the consistency of health care and eliminate ineffective, wasteful health care practices."