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Written by: Christopher Plein, Ph.D., West Virginia University and MFLN Military Caregiving TeamIt is late September, which means that the pressure is on for Congress to pass appropriations legislation for the next fiscal year starting on October 1. In recent years, Congress and the President have fallen short in meeting this deadline. Budget season is now known for political showdowns and continuing resolutions. However, this year is different. Both the Senate and the House have approved appropriations for the new National Defense Authorization Act, although Presidential approval is still pending. You can keep updated on the Act’s progress through various media outlets, including Stars and Stripes.A few weeks ago, I wrote a blog about the new John S. McCain National Defense Authorization Act for Fiscal Year 2019. As we discussed, the new Act contains important provisions relating to military personnel and families. The NDAA also includes important provisions that will further shape and develop the ever-evolving military health system.The military health system has developed over the course of the 20thcentury in parallel to the civilian health system. As new approaches to service delivery and new demands for healthcare services have emerged in society, the military has largely followed suit. As we discussed in the May blog, we can trace this trend back to at least the 1930s. This evolution has not been without controversy or challenges.In recent decades, two major developments have shaped the delivery of healthcare in the military. The first is the increasing reliance on healthcare delivered by providers “outside of the gate.” The second major trend has been growing consumer demand for more comprehensive and effective services that benefit service members and their families.According to the Department of Defense, the Military Health System serves approximately 9.5 million beneficiaries both in the United States and overseas. DOD estimates peg healthcare expenses at about 9 percent of the DOD’s annual base budget. In preparing its request for the new NDAA, the DOD outlined its continuing strategy of relying evermore on purchased or contracted care delivered by providers rather than direct services provided by Military Treatment Facilities and affiliated facilities.The military health system, through the TRICARE program, relies greatly on third party administrators to coordinate contractual and payment arrangements with civilian-based providers. In adopting this approach, the DOD relies on regional TRICARE contractors or third party to administrators to help coordinate access to care and to manage billing and reimbursement for providers. An overview of major developments in TRICARE delivery is available through one our recent MFLN webinars. These and all of our webinars are archived through the MFLN website.Families are also increasingly aware, and advocate for, access to more specialized services and resources that can help in caregiving and treatment. Recently the MFLN hosted a webinar on TRICARE benefits for behavioral health. Next month, on October 17, we will host a webinar on TRICARE’s Enhance Care Health Option (ECHO) program that provides support to qualified family members with special care needs.As noted by the DOD, the annual NDAA process allows improvements and innovation aimed at addressing concerns to be developed and implemented. These efforts reflect, in part, assessments and studies that have been conducted by various government supported commissions and task forces established to assess military family well-being and healthcare. This year’s NDAA is no different. In addition to continuing efforts to coordinate and manage care delivery in a large and complex system, other developments bear noting.Like their civilian counterparts, Military families are concerned about the increasing cost of insurance and healthcare coverage. The new NDAA mandates that no additional cost-share requirements be placed on service members and their families. As discussed in a recent Stars and Stripes article this is an added benefit to across the board raises that have been authorized for service members.Prescription drugs are an important part of today’s healthcare paradigm, but coordination of their use is not without challenge. As in the civilian world, in the military there is greater attention being given to coordination of prescription practices, patient demand for specific brand name drugs, and the overall costs of prescription drugs. Reflecting our national awareness of the opioid crisis, increased efforts to monitor and control the prescription of opioids are being undertaken. These and other provisions are summarized in a recent Senate Armed Services Committee news release.We live in an era of post-modern healthcare characterized by a number of factors and concerns, not the least among these being that patients and their families expect responsive healthcare and will advocate for benefits and services. In this way, healthcare in the military reflects broader developments in our society. This year’s NDAA reflects these broad social forces that are at work. We can continue to see further developments in the evolution of the Military Health System.