Health care service for military sees own buildup

Baltimore-based company particularly busy since mobilization for Iraq war

April 06, 2003|By M. William Salganik | M. William Salganik,SUN STAFF

In a windowless room with map-covered walls, troop deployments are monitored meticulously.

The maps are not of Iraq, but of the states from Virginia to Maine. And the "contingency operations center" is not at the Pentagon or any military facility but in the Inner Harbor headquarters of Sierra Military Health Services Inc., a Baltimore-based company that manages health care for active and retired military personnel and dependents in the Northeast.

As the United States has mobilized for the war in Iraq, Sierra Military has had to marshal its own forces.

"It's been dramatic in terms of increased workload," said David R. Nelson, president of Sierra Military.

Sierra has seen the number of new members it enrolls monthly jump 50 percent, to about 15,000 in each of the past three months as more reservists and National Guard members have been called up. Once on active duty, they and their families become eligible for the military health program, called Tricare, administered in the region by Sierra.

Sierra enrolls more than 1 million people.

Each activation means benefits briefings for the newly mobilized and for spouses. Sierra has conducted more than 500 three-hour briefings, explaining health insurance benefits to more than 50,000 people, according to Sue Mechlinski, vice president for health services at Sierra Military.

The military keeps plans for troop movements and mobilizations closely guarded, so most of the briefings must be arranged on short notice.

Heavy volume

In addition to the briefings, Sierra also has seen an increase in traffic at the 40 customer-service centers it maintains throughout the region, on or near military posts, including 15 in the Baltimore-Washington area.

At one of the busier centers, at National Naval Medical Center in Bethesda, there have been 400 walk-ins per week recently, according to Nelson - four to five times normal volume - as new members seek information about benefits.

Among Sierra's other tasks:

The military requires a variety of medical tests for those about to be shipped out. Most of these are handled on post, but some are referred to Sierra's civilian network. For example, Nelson said, men older than 50 need to be given a prostate test before they are deployed, generating referrals to civilian urologists. And with deployment looming, the tests must be done immediately.

Paul Jagunich, vice president for provider network operations, said Sierra uses computer mapping to track whether it has enough specialists in its network, and in each locality, to serve the beneficiaries.

Military treatment facilities, ranging from small on-post clinics to giants such as the Bethesda Naval and Walter Reed Army medical centers, normally provide most of the care to Sierra's enrollees, including dependents and retirees. But as staff from those facilities are busy with other things or redeployed to the war zone - Bethesda Naval personnel, for example, are staffing the USNS Comfort, a Baltimore-based hospital ship now in the Persian Gulf - Sierra is sending more people to its civilian network for treatment.

In a typical week, Sierra processes 11,000 such referrals. Two weeks ago, the total approached 15,000. Last week, Sierra was on a pace for nearly 20,000. The 75 nurses who handle the referrals have been working two to four hours of overtime a day, Mechlinski said, and nurse-managers have been pitching in to handle the workload.

The military can call on Sierra to hire staff to replace those redeployed from military health centers. Bethesda Naval has great demand for registered nurses, licensed practical nurses and technicians. Sierra is hiring about 100, "but the number changes minute to minute as they get in reservists" to replace some of the redeployed staff, said Dr. Kathryn Buchta, Sierra Military's chief medical officer.

For Sierra Military, the test of its ability to perform comes at a critical time. The military is combining its 12 Tricare regions into three, and Sierra is competing in a larger, 21-state region. That contract is expected to be awarded this year. If Sierra wins, according to Nelson, employment - now 725 in the region, including nearly 500 in Baltimore - could grow to between 1,500 and 2,000.

Nelson said Sierra Military has added 50 to 60 people since the Sept. 11, 2001, terrorist attacks as the military began its buildup, with 20 to 25 coming in the past few months. It is continuing to hire.

While all of this means lots of extra costs for Sierra Military, its Tricare contract provides for payments to be adjusted based on enrollment and other factors.

Positive effect

The net effect should be a modest increase in profit, according to Gregory Crawford, a health analyst with Fox-Pitt Kelton in San Francisco who follows Sierra Health Services Inc., the Nevada-based managed care company that is the parent of Sierra Military.

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