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#### TRICARE ADULT BENEFICIARY REPORTS HELP INDEX

Glossary
Finding Scores for Your Region
Finding Scores for Your MTF
What Time Periods the Report Covers
Report Columns
Enrollment Groups
Beneficiary Groups
About the Health Care Survey of DoD Beneficiaries
Survey Questions
CAHPS 2.0 Survey Questions
How Scores are Calculated
Where Benchmarks Come From
How Scores are Adjusted
Technical Help: How Scores are Compared to Benchmarks
Trends
TRICARE Regions
MTFs Included in Beneficiary Reports
What the Colors Mean
Standard and Printer-Friendly Versions
For More Information
Adjusting CAHPS 2.0 Scores
Healthy Behaviors
MTF Service Affiliation
Weighting

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### Glossary

HCSDB — Health Care Survey of DoD Beneficiaries
MHS — military health system
PCM — primary care manager
NCBD — National CAHPS Benchmarking Database
MTF — Military Treatment Facility
CONUS MHS — MHS in Continental United States, plus Hawaii and Alaska
CAHPS — Consumer Assessment of Health Plans Survey
Benchmark — A goal or standard of comparison
Composite — A score based on a combination of items

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### Finding Scores for Your Region

To find scores for your region, click on a beneficiary or enrollment group in the Report Menu on the home page of this site. This will bring up a report page showing all regions in the MHS. Many of the scores are composites which average together scores for several aspects of health care. To see the breakdown of a composite score, click on any column heading. This will also show you this year's score compared to last year's score. If you are already in a report and you want to find scores for your region for a different beneficiary or enrollment group, click on that group at the bottom of the page. All groups are listed at the bottom of every page.

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### Finding Scores for Your MTF

Reports at the MTF level are available only for certain groups: all MHS beneficiaries, active duty beneficiaries, TRICARE Prime enrollees, and enrollees with a military PCM. To find scores for your MTF, click on any of these beneficiary or enrollment groups in the Report Menu on the home page of this site. This will bring up a report showing all the regions in the MHS. Click on the region containing your MTF to bring up a regional report. The rows in that page are the MTF's in your region. Many of the scores are composites which average together scores for several aspects of health care. To see the breakdown of a composite score, click on any column heading. This will also show you this year's score compared to last year's score. If you are already in a report page and you want to find scores for your MTF for a different beneficiary or enrollment group, click on that group at the bottom of the page.

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### What Time Periods the Report Covers

The survey is fielded each quarter, and beneficiaries are asked about their care in the past 12 months. Each year label in the report refers to the year in which the surveys were fielded. Before 2006, surveys were grouped by calendar year. Beginning in 2006, they are grouped in fiscal year. Current scores combine results from surveys fielded in each of the 4 quarters of FY 2006 into a single score which describes a period from October 2004 to June 2006. Scores labeled 2005 describe a period from October 2003 to June 2005, and scores labeled 2004 describe the period from October 2002 to June 2004.

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### Report Columns

Scores in the reports are based on responses to questions in the Health Care Survey of DoD Beneficiaries. There are two types of scores: single numeric ratings and composites. The single numeric ratings reflect questions that ask beneficiaries to rate some aspect of their health care on a scale of 0 to 10. The composites average together responses from several different but related questions.

To see the complete text of survey questions, click on Survey Questions in the help menu. It shows composites, the individual questions comprising them, and the numeric ratings questions. To see the average responses to questions making up a composite, click on the composite column heading in any report.

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### Enrollment Groups

Enrollment groups classify beneficiaries according to their relationship to TRICARE Prime, the MHS's managed care plan. To see scores for Prime enrollees, enrollees with a military primary care manager (PCM), enrollees with a civilian PCM, or nonenrolled beneficiaries (TRICARE Standard/Extra users), click on that group in the Report Menu on the home page or at the bottom of any report page. The report for any enrollment group reflects only the scores for that group. For prime enrollees and nonenrollees with a military PCM, reports show scores at the regional and MTF level. For nonenrolled beneficiaries or enrollees with a civilian PCM, reports show scores at the regional level only.

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### Beneficiary Groups

Beneficiary groups classify beneficiaries according to their relationship to the armed services. To see scores for active duty beneficiaries, active duty family members, or retirees, click on that group in the Report Menu on the home page or at the bottom of any report page. The report for any beneficiary group reflects only the scores for that beneficiary group. For active duty beneficiaries, reports show scores at the regional and MTF level. For active duty family members or retirees, reports show scores at the regional level only.

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### About the Health Care Survey of DoD Beneficiaries

The Health Care Survey of DoD Beneficiaries (HCSDB) is a congressionally mandated annual survey. It is designed to measure beneficiaries' satisfaction with and access to health care in the military health system (MHS). The survey is revised and mailed out each quarter and sent to a new sample of approximately 50,000 beneficiaries. Many questions are taken from the Consumer Assessment of Health Plans Survey (CAHPS), which is often used to assess civilian beneficiaries' experiences with health care. Other questions are devised to meet the special needs of the MHS.

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### Survey Questions

Getting Needed Care — Composite

> Since you joined your health plan, how much of a problem, if any, was it to get a personal doctor or nurse you are happy with?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to see a specialist that you needed to see?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to get the care, tests or treatment you or a doctor believed necessary?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, did you need approval from your health plan for any care, tests, or treatment?

> In the last 12 months, how much of a problem, if any, were delays in health care while you waited for approval from your health plan?

> - A big problem
> - A small problem
> - Not a problem

Getting Care Quickly — Composite

> In the last 12 months, when you called during regular office hours, how often did you get the help or advice you needed?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, not counting times you needed health care right away, how often did you get an appointment for health care as soon as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, when you needed care right away for an illness, injury, or condition, how often did you get care as soon as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often were you taken to the exam room within 15 minutes of your appointment?

> - Never
> - Sometimes
> - Usually
> - Always

Courteous and Helpful Office Staff — Composite

> In the last 12 months, how often did office staff at a doctor's office or clinic treat you with courtesy and respect?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often were office staff at a doctor's office or clinic as helpful as you thought they should be?

> - Never
> - Sometimes
> - Usually
> - Always

How Well Doctors Communicate — Composite

> In the last 12 months, how often did doctors or other health providers listen carefully to you?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers explain things in a way you could understand?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers show respect for what you had to say?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers spend enough time with you?

> - Never
> - Sometimes
> - Usually
> - Always

Customer Service — Composite

> In the last 12 months, did you look for any information about how your health plan works in written material or on the Internet?

> In the last 12 months, how much of a problem, if any, was it to find or understand this information?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to get the help you needed when you called your health plan's customer service?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, did you have with paperwork for your health plan?

> - A big problem
> - A small problem
> - Not a problem

Claims Processing — Composite

> In the last 12 months, how often did your health plan handle your claims in a reasonable time?

> - Never
> - Sometimes
> - Usually
> - Always
> - Don't Know

> In the last 12 months, how often did your health plan handle your claims correctly?

> - Never
> - Sometimes
> - Usually
> - Always
> - Don't Know

Rating of Health Plan

> Using any number from 0 to 10 where 0 is the worst health plan possible and 10 is the best health plan possible, what number would you use to rate your health plan?

> - 0 Worst health plan possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best health plan possible

Rating of All Health Care

> Using any number from 0 to 10 where 0 is the worst health care possible and 10 is the best health care possible, what number would you use to rate all your health care in the last 12 months?

> - 0 Worst health care possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best health care possible

Rating of Personal Doctor

> Using any number from 0 to 10, where 0 is the worst personal doctor or nurse possible and 10 is the best personal doctor or nurse possible, what number would you use to rate your personal doctor or nurse?

> - 0 Worst personal doctor or nurse possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best personal doctor or nurse possible

Rating of Specialist

> We want to know your rating of the specialist you saw most often in the last 12 months. Using any number from 0 to 10 where 0 is the worst specialist possible and 10 is the best specialist possible, what number would you use to rate the specialist?

> - 0 Worst specialist possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best specialist possible

Preventive Care — Composite

> When did you last have a blood pressure reading?

> - Less than 12 months ago
> - 1 to 2 years ago
> - More than 2 years ago

> Do you know if your blood pressure is too high?

> - Yes it is too high
> - No it is not too high
> - Don't Know

> When did you last have a Pap smear test?

> - Within the last 12 months
> - 1 to 3 years ago
> - More than 3 but less than 5 years ago
> - 5 or more years ago
> - Never had a Pap smear test

> Are you under age 40?

> - Yes
> - No

> When was the last time your breasts were checked by mammography?

> - Within the last 12 months
> - 1 to 2 years ago
> - 2 years to less than 5 years ago
> - 5 or more years ago
> - Never had a mammogram

> In what trimester is your pregnancy?

> - First trimester
> - Second trimester
> - Third trimester

> In which trimester did you first receive prenatal care?

> - First trimester
> - Second trimester
> - Third trimester

> When did you last have a cholesterol screening that is a test to determine the level of cholesterol in your blood?

> - Less than 12 months ago
> - 1 to 2 years ago
> - More than 2, but less than 5 years ago
> - 5 or more years ago
> - Never had a cholesterol screening

### CAHPS Version 2.0 Survey Questions

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### How Scores are Calculated

Composite scores for ease of access, and communication and customer service are all calculated by averaging together the scores for individual questions. The possible responses to each question are ordered from the worst to the best. For the composites "Getting Needed Care" and "Customer Service", each question's score is the percentage of responses falling in the best category ("Not a Problem"). For the other composites, a question's score is the percentage of responses in the best two categories (in most cases, "Usually" and "Always"). When MTF scores are reported, MTF percentages for each question are calculated, summed and divided by the number of questions in the composite. Regional scores are the averages of MTF scores. When only regional scores are reported (in the retiree table, for example), regional percentages for each question are calculated, summed and divided by the number of questions.

The preventive care composite is the percentage of preventive care that beneficiaries should have gotten that they actually received. For instance, for a region or MTF, the number of mammograms or other care that beneficiaries reported is summed and then divided by the number they should have gotten based on their ages and sex.

A rating score is the percentage of beneficiaries who rate an aspect of care 8 or higher.

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### Where Benchmarks Come From

Most of the questions in the HCSDB are based on questions from the Consumer Assessment of Healthcare Providers and Systems (CAHPS) Health Plans Survey. Because many health plans that serve the civilian population use that survey to assess the experience of their enrollees, their CAHPS results can be used as benchmarks for comparison with care delivered in the MHS. Benchmarks for the composites and numeric ratings taken from CAHPS come from the National CAHPS Benchmarking Database (NCBD) for 2003 through 2005. The NCBD collects responses to the survey from a national sample of health plans that serve the civilian population. Results from each plan for beneficiaries who responded by mail are averaged together, weighted equally. The benchmarks are adjusted to correspond to the age and health of TRICARE users.

Benchmarks for preventive care and smoking are taken from Healthy People 2010. These are goals set by the federal government for the percentage of Americans getting preventive care.

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### How Scores are Adjusted

All the scores except the preventive care scores are adjusted for beneficiary characteristics. The HCSDB asks beneficiaries about their health. The relationship between their health, their age, and their health care ratings and responses to the questions in the composites is measured by regression. The regressions are used to calculate average responses for a region or MTF catchment assuming their beneficiaries are at the age distribution and health status average for members of that enrollment or beneficiary group. Then scores are adjusted again by the difference between the group benchmark and the benchmark for all TRICARE users, so that all scores can be compared to the same benchmark.

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### Technical Help: How Scores are Compared to Benchmarks

CAHPS scores and benchmarks are adjusted for beneficiary age and health status (see How Scores are Adjusted). The precisions of the MHS scores and benchmarks are calculated using the residuals from the regressions used to adjust the scores and accounting for the survey's complex sample design. The precision of a benchmark is calculated based on a sample design in which every health care product has equal weight. T-tests measure the probability that the difference between the score and the benchmark occurred by chance. If p is less than .05, the difference is significant.

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### Trends

Trends are calculated as the difference between the scores for 2004 and 2006. Because benchmarks are adjusted based on characteristics of TRICARE users, they may change slightly from year to year. To measure the change not caused by changes in age or health status, compare the trend in a region's or MTF's score to the trend in the benchmark.

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### TRICARE Regions

Click for a map of TRICARE regions.

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### How MTFs Are Assigned

The MTF scores in TRICARE Beneficiary Reports combine results from "parent" and "child" facilities. MTF scores are shown only if enough beneficiaries from that site respond to meet report precision requirements.

MTF's are assigned based on enrollment for enrollees with military PCM's, and by catchment area of residence for non-enrollees and enrollees with civilian PCM's. Clinics are usually combined with parent facilities. Sometimes several facilities are combined into one. For combination rules see the HCSDB Adult Sample Design.

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### What the Colors Mean

The colors of the scores on each page show whether a score differs significantly from its civilian benchmark. A difference is significant if it is large enough that it is unlikely to occur by chance (i.e., the probability that it occurs by chance is less than 5 percent). If a score is significantly higher than the benchmark, it is green and bold. If it is significantly lower than the benchmark, it is red and italicized. Scores that are not significantly different from the benchmark are blue.

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### Standard and Printer-Friendly Versions

TRICARE Beneficiary Reports are available in two versions: standard and printer-friendly. On your computer screen, the standard version is usually the easier of the two versions to read. You can make the table rows scroll past while the table headings stay in place. If the standard version does not work well on your screen, or if you prefer it, the printer-friendly version presents both the header and rows as a single sheet. If you would like to print out a page, use the printer-friendly version. If you would like to use a table at your desk top, each page can be downloaded in an Excel spreadsheet by clicking on the link found at the bottom of the page.

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### For More Information

The questions, survey methods, and calculations are described in detail in the 2006 Health Care Survey of DoD Beneficiaries: Technical Manual.

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### Adjusting CAHPS 2.0 Scores

In January, 2004, the survey switched from version 2.0 to CAHPS 3.0. CAHPS 2.0 scores are compared to benchmarks based on CAHPS 2.0 questions and CAHPS 3.0 scores are compared to benchmarks based on CAHPS 3.0 questions. Scores in FY2004 contain a weighted average of scores from CAHPS 2.0 and CAHPS 3.0. They are compared to a benchmark that is a weighted average of CAHPS 2.0 and 3.0 benchmarks.

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### CAHPS Version 2.0 Survey Questions

Getting Needed Care — Composite

> With the choices your health plan gave you, how much of a problem, if any, was it to get a personal doctor or nurse you are happy with?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to get a referral to a specialist that you needed to see?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to get the care you or a doctor believed necessary?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, were delays in health care while you waited for approval from your health plan?

> - A big problem
> - A small problem
> - Not a problem

Getting Care Quickly — Composite

> In the last 12 months, when you called during regular office hours, how often did you get the help or advice you needed?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did you get an appointment for regular or routine health care as soon as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, when you needed care right away for an illness or injury, how often did you get care as soon as you wanted?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did you wait in the doctor's office or clinic more than 15 minutes past your appointment time to see the person you went to see?

> - Never
> - Sometimes
> - Usually
> - Always

Courteous and Helpful Office Staff — Composite

> In the last 12 months, how often did office staff at a doctor's office or clinic treat you with courtesy and respect?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often were office staff at a doctor's office or clinic as helpful as you thought they should be?

> - Never
> - Sometimes
> - Usually
> - Always

How Well Doctors Communicate — Composite

> In the last 12 months, how often did doctors or other health providers listen carefully to you?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers explain things in a way you could understand?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers show respect for what you had to say?

> - Never
> - Sometimes
> - Usually
> - Always

> In the last 12 months, how often did doctors or other health providers spend enough time with you?

> - Never
> - Sometimes
> - Usually
> - Always

Customer Service — Composite

> In the last 12 months, how much of a problem, if any, was it to find or understand information in the written materials?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, was it to get the help you needed when you called your health plan's customer service?

> - A big problem
> - A small problem
> - Not a problem

> In the last 12 months, how much of a problem, if any, did you have with paperwork for your health plan?

> - A big problem
> - A small problem
> - Not a problem

Claims Processing — Composite

> In the last 12 months, how often did your health plan handle your claims in a reasonable time?

> - Never
> - Sometimes
> - Usually
> - Always
> - Don't Know

> In the last 12 months, how often did your health plan handle your claims correctly?

> - Never
> - Sometimes
> - Usually
> - Always
> - Don't Know

Rating of Health Plan

> We want to know your rating of all your experience with your health plan. Use any number from 0 to 10 where 0 is the worst health plan possible, and 10 is the best health plan possible. How would you rate your health plan now?

> - 0 Worst health plan possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best health plan possible

Rating of All Health Care

> We want to know your rating of all your health care in the last 12 months from all doctors and other health providers. Use any number from 0 to 10 where 0 is the worst health care possible, and 10 is the best health care possible. How would you rate all your health care?

> - 0 Worst health care possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best health care possible

Rating of Personal Doctor

> We want to know your rating of your personal doctor or nurse. Use any number from 0 to 10 where 0 is the worst possible doctor or nurse possible, and 10 is the best personal doctor or nurse possible. How would you rate your personal doctor or nurse now?

> - 0 Worst personal doctor or nurse possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best personal doctor or nurse possible

Rating of Specialist

> We want to know your rating of the specialist you saw most often in the last 12 months, including a personal doctor, if he or she was a specialist. Use any number from 0 to 10 where 0 is the worst possible specialist possible, and 10 is the best specialist possible. How would you rate your specialist?

> - 0 Worst specialist possible
> - 1
> - 2
> - 3
> - 4
> - 5
> - 6
> - 7
> - 8
> - 9
> - 10 Best specialist possible

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### MTF Service Affiliation

The Beneficiary Reports present scores according to the service of beneficiaries' MTFs. These are the MTFs to which the beneficiaries are enrolled. If beneficiaries are not enrolled, their MTF is their assigned catchment area. Beneficiaries who are not enrolled or assigned a catchment area are in the "Other" category.

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### Healthy Behaviors

The healthy behaviors composite is made up of three scores: the non-smoking rate, the counseled to quit rate and the percent not obese. The non-smoking rate is age and sex adjusted proportion of beneficiaries who have never smoked or have quit for more than 12 months. The counseled to quit rate is the proportion of smokers with physician visits in the last 12 months who were counseled to quit at least once. The percent not obese is the age and sex adjusted proportion with a body mass index (BMI) below the level classified as obese: less than 30. The BMI is equal to the weight in kilograms divided by the square of the height in meters. Height and weight are self-reported in the HCSDB.

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### Sample Weights

The results in the TRICARE Beneficiary Reports are based on questionnaires mailed to a stratified random sample of beneficiaries. That means that everyone who responds to the survey stands in for other beneficiaries who were not mailed a questionnaire or who did not respond. When percentages are calculated from these responses, the responses on each returned questionnaire are given a weight corresponding to the number of beneficiaries that respondent represents. The weights are calculated in two stages, sampling, when beneficiaries are assigned a weight based on the number sampled, and a non-response adjustment, which is based on the proportion of the surveys that are returned. Beginning with the quarterly report for October, 2005 and the annual report for 2006, we use a non-response adjustment based on several factors, such as the beneficiary’s age, sex and rank, that were not part of the original sample design. As a result, scores more accurately reflect the TRICARE population.

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