{"id":69281,"date":"2023-08-16T23:45:05","date_gmt":"2023-08-16T23:45:05","guid":{"rendered":"https:\/\/one.sightlinemg.com\/marinecorpstimes\/uncategorized\/2023\/08\/16\/protest-of-65-billion-tricare-west-health-contract-goes-to-court\/"},"modified":"2026-08-08T15:49:23","modified_gmt":"2026-08-08T15:49:23","slug":"protest-of-65-billion-tricare-west-health-contract-goes-to-court","status":"publish","type":"post","link":"https:\/\/one.sightlinemg.com\/marinecorpstimes\/pay-benefits\/military-benefits\/health-care-benefits\/2023\/08\/16\/protest-of-65-billion-tricare-west-health-contract-goes-to-court\/","title":{"rendered":"Protest of $65 billion Tricare West health contract goes to court"},"content":{"rendered":"\n

The start of new Tricare contracts<\/a> remains up in the air as a protest involving the West Region\u2019s $65.1 billion contract heads to federal court.<\/p>\n\n\n\n

Although Defense Health Agency<\/a> officials say there will be no disruption to patient care, the ongoing dispute could delay some of the improvements beneficiaries were expecting. The new Tricare contracts, for example, would allow patients to transfer specialty care referrals to a new doctor when they move, even if their new duty station is not in their current Tricare region. Also possibly delayed are service improvements that are expected to reduce the average time to answer customers\u2019 calls to 20 seconds.<\/p>\n\n\n\n

Eventually, the new contracts \u201cwill improve military readiness, health care delivery, clinical quality, patient safety and beneficiary access to health care \u2026 while containing costs for more than 9.6 million Tricare beneficiaries,\u201d said DHA spokesman Peter Graves.<\/p>\n\n\n\n

The new contracts for the Tricare East and West regions, with a potential combined value of $136 billion over nine years, were originally scheduled to start in August 2024. While the dispute over the Tricare West contract moves through the court, the current contracts will remain in effect to ensure there is no disruption to patient care, Graves said.<\/p>\n\n\n\n

Pitched battle<\/h2>\n\n\n\n

The Government Accountability Office announced Tuesday that it had denied Health Net Federal Services\u2019 second protest and affirmed defense health officials\u2019 selection in December of TriWest Healthcare Alliance Corp.<\/a> of Phoenix as the new managed care support contractor for the Tricare West Region.<\/p>\n\n\n\n

Health Net, the current Tricare contractor for the West Region, has confirmed to Military Times that they will take the next step, going to the U.S. Court of Federal Claims to challenge the selection.<\/p>\n\n\n\n

Health Net \u201cdisagrees with the Government Accountability Office\u2019s decision to deny our protest,\u201d company officials told Military Times.<\/p>\n\n\n\n

While the dispute involves just the West Region, the delay could affect both contracts, Graves said. The $70.9 billion East Region contract was awarded to Humana Government Business (Humana Military) of Louisville, Kentucky, the current contractor.<\/p>\n\n\n\n

In light of Health Net\u2019s stated intention to challenge the decision in federal court, he said, the Defense Health Agency hasn\u2019t taken immediate actions to start work on the T-5 contract, a reference to this being the fifth in a series of Tricare contracts. The agency \u201cwill wait until a decision is published by the Court of Federal Claims before starting work on either T-5 contract,\u201d he said.<\/p>\n\n\n\n

DHA officials are now waiting for Health Net to file its protest with the court so that they \u201cmay review the complaint\u2019s merits,\u201d Graves said.<\/p>\n\n\n\n

Meanwhile, current Tricare contracts will continue.<\/p>\n\n\n\n

\u201cWe are proud to continue partnering with the DHA, the service branches of the military, and our providers in support of beneficiaries under the current Tricare contract throughout 2023 and 2024,\u201d Health Net officials stated.<\/p>\n\n\n\n

There are now more than 2.8 million Tricare beneficiaries in the West Region. Once the dispute is settled, an additional 1.5 million will be transferred there from six states now in the East Region: Arkansas, Illinois, Louisiana, Oklahoma, Texas and Wisconsin.<\/p>\n\n\n\n

Who\u2019s best?<\/h2>\n\n\n\n

According to information made public in the GAO\u2019s announcement of its decision, Health Net officials argued that TriWest lacks an existing Tricare network, while Health Net already has an established one. They also argued that TriWest will face various technical challenges and risks that defense health officials failed to reasonably consider.<\/p>\n\n\n\n

The Defense Health Agency\u2019s source selection decision document stated that Health Net was rated as \u201cacceptable\/low risk\u201d in network management, while TriWest was rated \u201coutstanding\/low risk,\u201d according to information in the the GAO decision.<\/p>\n\n\n\n

Defense health officials said they were well-aware of the risks.<\/p>\n\n\n\n

\u201cThe agency contends that its evaluator carefully considered TriWest\u2019s approach to network management and concluded that it was outstanding and would permit a rapid network build in the western region,\u201d according to the GAO decision.<\/p>\n\n\n\n

In addition, health agency evaluators noted that TriWest could cover significant portions of the required network through its existing network of providers, \u201cand that TriWest proposed to supplement that existing network with major health plans in all 26 states in the coverage area. The evaluators further recognized that TriWest had obtained letters of commitment from these new prospective providers,\u201d according to the GAO.<\/p>\n\n\n\n

\u201cThis was part of TriWest\u2019s overall approach to build a network with significant excess capacity, and as a result, TriWest proposed to exceed the solicitation\u2019s requirement by significant margins,\u201d according to information in the GAO decision<\/p>\n\n\n\n

The GAO decision also noted that in reviews of past performance, the Defense Health Agency concluded that, although the two bidders received the same rating, TriWest\u2019s performance was superior for several reasons.<\/p>\n\n\n\n

Both Health Net and TriWest were contracted for a similar managed care effort for the Department of Veterans Affairs\u2019 Patient-Centered Community Care. But the agency noted that \u201ccontractor performance assessment reports reflected that Health Net experienced negative performance issues \u2026 that resulted in the VA indicating that it would not recommend [Health Net] for similar requirements in the future, while the [contractor performance assessment reports] for TriWest during the same period reflected positively assessed performance,\u201d according to the GAO decision.<\/p>\n\n\n\n

\u201cVA declined to exercise options on Health Net\u2019s contract and instead expanded TriWest\u2019s contract to cover the region formerly operated by Health Net,\u201d according to information in the decision.<\/p>\n\n\n\n

In its protest, Health Net argued that both Health Net and TriWest experienced substantial performance problems with the VA contracts, but both had improved their performance over time, and the agency\u2019s evaluations didn\u2019t treat these similar trends equally.<\/p>\n\n\n\n

However, the GAO decision stated \u201cwe cannot conclude that impermissible disparate treatment occurred in this case.\u201d<\/p>\n","protected":false},"excerpt":{"rendered":"

In light of the continuing legal challenges, the timing of the new Tricare contracts is unclear.<\/p>\n","protected":false},"author":7,"featured_media":107636,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"_yoast_wpseo_meta-robots-noindex":"","_yoast_wpseo_meta-robots-nofollow":"","_yoast_wpseo_canonical":"","_acf":"","_yoast_wpseo_primary_category":155,"_jetpack_feature_clip_id":0,"_jetpack_memberships_contains_paid_content":false,"footnotes":"","_smg_distribution_targets":[]},"categories":[101,155,23,83,12,25,15],"tags":[],"coauthors":[3302],"class_list":["post-69281","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-daily-news-roundup","category-health-care-benefits","category-home","category-military-benefits","category-news","category-newsletters","category-pay-benefits"],"acf":{"subheadline":"","legacy_arc_id":"SXIA6QDWUZE3NK7KK2MYB2HLPE","arc_canonical_url":"\/news\/your-military\/2023\/08\/16\/protest-of-65-billion-tricare-west-health-contract-goes-to-court\/","remove_feature_photo":false,"is_sponsored":false,"subtype":"","redirect_url":"","disable_inline_ads":false,"native_logo_pretext":"Presented By:"},"yoast_head":"\nProtest of $65 billion Tricare West health contract goes to court - 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