The United States Department of Defense’s (DoD) Defense Health Agency (DHA) provides TRICARE health insurance coverage for over 9.5 million beneficiaries worldwide. These beneficiaries include active-duty service members, retired personnel, and their families. Altarum has the honor of helping the DHA achieve the Quadruple Aim—enhancing patient experience, improving population health, reducing costs, and improving the work life of health care providers—via the knowledge gained through administering three health care surveys to beneficiaries.
These three surveys—the Health Care Survey of Department of Defense Beneficiaries (HCSDB), the TRICARE Select Survey of Beneficiaries (TSS-B), and the TRICARE Select Survey of Civilian Providers (TSS-P)—are unique in that they provide DHA with important data not obtainable through other means, such as self-reports of the quality of their health care, details of patient-provider interaction, and information on delayed or missed care. The HCSDB, a Consumer Assessment of Healthcare Providers and Systems (CAHPS(R)) survey, provides insights beyond what is collected at or about health care encounters. Conducted since 1995, this survey invites 300,000 DoD beneficiaries annually to share their health experiences. The survey captures from the experiences and opinions all types of beneficiaries: those who actively use clinical services, those who don’t, and those, such as spouses, who may be using other primary health care insurance providers.
Altarum has partnered with DHA on these surveys for almost two decades, using rigorous survey design science and methodologies, a deep understanding of Military Health System operations and data security, and system architecture implementation. We’ve created a system to field survey invitations from within DoD firewalls to ensure that we can reach Active Duty service members via email. Survey data are collected quarterly, with a rotating question set each quarter to gather timely information on topics of interest to senior health leaders, such as responses to the Covid-19 pandemic, adoption of telehealth, and drivers of mental health outcomes.
We, along with our partner Westat, apply our unique DoD experience and analytic skills to understanding survey results to provide the DHA with a comprehensive view of beneficiary population health, wellness, and costs. Each year, we help the DHA consolidate these findings into a 100+ page document, the Annual Evaluation of the TRICARE Program Section, on the activities and impact of the TRICARE system which is presented to Congress.
The Altarum team provides DHA with expert consulting when it comes to developing survey questions on topics of interest to senior leaders. We start by guiding the client through focused discussions of its enterprise goals, breaking the information down into distinct research questions and eventually survey text developed through an evidence-based review of the literature and prior survey findings. Question sets developed by Altarum have generated critical pieces of information for DHA, such as questions related to Covid-19 vaccination and trust in the healthcare system, and food and financial security as DHA increases its focus on measuring social determinants of health (SDOH).
Chris Duke, Senior Researcher at Altarum, explains the nature of these surveys: “The surveys are special because they cover all TRICARE beneficiaries, and not just those who have had a recent health care encounter. We have the flexibility to quickly study areas of interest. When Covid-19 started spreading, we were able to ask Covid-19–related questions in the very next survey, allowing us to study rates of vaccination and trends over time and learn how preventive care changed during Covid-19.”
Timely survey questions developed by the Altarum team have quickly become a necessary asset to DHA leadership in understanding the needs of their healthcare beneficiaries. For example, survey questions addressing SDOH developed in 2023 may become permanent fixtures of the survey as improving equity in health care becomes the fifth aim of DHA in what some are now calling the Quintuple Aim. Going into 2024, the Altarum survey team will remain alert and agile to respond to the needs of senior health leaders.