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Continuity key to health care transition to Madigan

Madigan Army Medical Center Public Affairs

Published: 01:52PM June 26th, 2014

By now, active duty family members living within a 30-minute drive from Madigan Army Medical Center, and who currently see a primary care provider in the TRICARE Prime Network, should have received a letter reassigning them to a Madigan clinic.

The pending transition has left many to wonder why they have to change providers and how they can be excused from the reassignment. Below are the most common questions asked, as well as answers provided by Julie Martin, Madigan’s Chief of TRICARE Operations.

I like my current doctor. Why do I have to change providers?

Because Madigan has the capacity and resources to accommodate more patients, it has become possible to provide medical services to those who qualify for care, namely TRICARE beneficiaries living in the area. With that said, Madigan providers work diligently to maintain continuity of care.

Does this mean I can’t see my specialty care provider either?

The reassignment only changes primary care providers. Specialty referrals are processed by a contractor who refers to Madigan’s service availability report for specialty care access. If care cannot be provided by Madigan, the patient will be able to see his or her current specialty care provider.

Does road traffic factor in when calculating who lives within 30-minutes to a Madigan clinic?

Drive time to our clinics may still be farther away than the network clinic patients currently receive care. Using the Google mapping program is the standard from residence to the nearest primary clinic but we do not take traffic into account. “This standard is set by Defense Health Agency and the government approves the mapping software used by the contractor to calculate the 30-minute drive time,” said Martin.

Many patients are under the impression that they must be seen at the Main Madigan hospital on JBLM, unaware that many of the Madigan Patient-Centered Medical Homes are actually located off-base.

“We have enrollment availability at the Puyallup PCMH, as well as the South Sound PCMH that sees patients living in and around the Lacey and Olympia areas,” said Martin. Patients who live on or closer to McChord can also opt to enroll at the McChord PCMH. Each houses its own lab and pharmacy, and all of the PCMHs are certified by the National Committee on Quality Assurance.

Will I be able to see the same provider at every appointment?

For the most part, you will be seen by the same provider at every appointment, barring any scheduled leave by that particular provider. However, patients will have direct access to their primary care team via Relay Health, an online tool that allows patients to request appointments, refill prescriptions and get medical advice online, for free.

If I want to stay with my current provider, can I request a waiver?

Yes, waivers to be dismissed from reassignment may be granted for the following reasons:

• PCS orders moving the family this year

• Retirement orders this year and if the plan members in the family decide to move out of the area.

• Outside the 30-minute drive time

• Unique medical situations where it makes sense to keep the beneficiary with their current provider.

• ETS orders within six months

“Unfortunately, when we have capacity to provide care, convenience of network provider locations is not sufficient enough to grant a waiver,” said Martin, who personally calls every person that submits a waiver to ensure she understands the circumstances and can answer any questions that come up in conversation.

Currently, retired military and their family members on TRICARE prime are being invited to enroll in the Madigan PCHMs, to include Family Practice and Internal Medicine located at Madigan Army Medical Center. Once Active Duty Family Members who received reassignment letters are situated with their new providers, invitations to enroll in a Madigan PCHM will be sent to TRICARE Prime beneficiaries living outside of the 30-minute radius, as well as TRICARE Standard beneficiaries.

TRICARE Prime patients interested in switching their primary care provider to a Madigan PCMH can call United Healthcare Military and Veterans at 1-877-988-9378.

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