Defense officials have asked Congress to approve a new structure for the military health care system that, along with higher Tricare fees, would help to curb runaway medical costs.
The plan is to elevate Tricare management to a more powerful Defense Health Agency, with new authority to more effectively use the military's direct care system and to more carefully manage purchased care through Tricare support contractors.
Each branch's medical commands would still continue to run separately. The Defense Health Agency is seen as an important pillar of any unified health command.
But one strong reason to keep Army, Navy and Air Force medical commands, led by separate surgeons general, is operational medicine.
The Navy is trained to deliver care to units afloat and to deployed Marines, the Air Force has expertise in aerial platforms and Army doctors are trained to deliver medical ground support in combat areas.
Thus, the goal is to design a system that creates the best quality in health care (and) access, but preserves the unique features that individual service cultures offer.
The health agency would be led by a three-star officer and would report to the department's most senior health official. The surgeons general would focus heavily on operational medicine and less on the garrison care and insurance benefits for troops, retirees and their families.
The savings from creating the health agency would be about $50 million a year.
But more substantial savings - in the billions of dollars annually - are expected once the health agency is operating to eliminate waste and can impose new business processes on military hospitals and clinics, and on purchased care contracts that govern Tricare civilian networks.
One key goal of the health agency will be to fully use brick-and-mortar resources and reverse the exodus in recent years of patients to the more costly civilian Tricare network.