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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 Version 5.0)
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
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
US 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
Other — All non-Army/Navy/Air Force MTFs
[Region] Other — All [Region] non-Army/Navy/Air Force MTFs*
[Region] Region-Other — MTFs in [Region] without enough observations for reporting*
*Where [Region] can be North, South, or West

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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 3 quarters of FY 2014 into a single score which describes a period from October 2012 to March 2014. Scores labeled 2012 combine results from 4 quarters and describe a period from October 2010 to June 2012, and scores labeled 2013 combine results from 3 quarters describe the period from October 2011 to March 2013.

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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 Standard/Extra Users (those who say they use TRICARE Standard/Extra most or are enrolled in TRICARE Reserve Select), click on that group in the Report Menu on the home page or at the bottom of any report page. Click on Purchased Care to combine beneficiaries enrolled in Prime to a civilian PCM with Standard/Extra users. The report for any enrollment group reflects only the scores for that group. For prime enrollees and enrollees with a military PCM, reports show scores at the regional and MTF level. For Purchased Care Users, 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 (CAHPS Version 5.0, Beginning 2014; for CAHPS Version 4.0 please see: FY2013 Help Page)

Getting Needed Care — Composite

> In the last 12 months, how often did you get an appointment to see a specialist as soon as you needed?

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

> In the last 12 months, how often was it easy to get the care, tests or treatment you thought you needed through your health plan?

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

Getting Care Quickly — Composite

> In the last 12 months, when you needed care right away, how often did you get care as soon as you needed?

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

> In the last 12 months, how often did you get an appointment for a check-up or routine care at a doctor's office or clinic as soon as you needed?

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

How Well Doctors Communicate — Composite

> In the last 12 months, how often did your personal doctor listen carefully to you?

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

> In the last 12 months, how often did your personal doctor explain things in a way that was easy to understand?

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

> In the last 12 months, how often did your personal doctor show respect for what you had to say?

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

> In the last 12 months, how often did your personal doctor spend enough time with you?

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

Customer Service — Composite

> In the last 12 months, how often did your health plan's customer service give you the information or help you needed?

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

> In the last 12 months, how often did your health plan's customer service staff treat you with courtesy and respect?

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

Claims Processing — Composite

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

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

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

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

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

Healthy Behaviors — Composite

> Have you ever smoked at least 100 cigarettes in your entire life?

> - Yes
> - No

> Do you now smoke cigarettes or use tobacco every day, some days or not at all?

> - Every day
> - Some days
> - Not at all

> In the last 12 months, how often were you advised to quit smoking or using tobacco by a doctor or other health provider in your plan?

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

> In the last 12 months, how often did your doctor or health provider discuss or provide methods and strategies other than medication to assist you with quitting smoking or using tobacco? Examples of methods and strategies are: telephone helpline, individual or group counseling, or cessation program.

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

> How much do you weigh without your shoes on?

> How tall are you without your shoes on?

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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. 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 for FY 2012 and FY 2013 come from the National CAHPS Benchmarking Database (NCBD) for 2011; whereas, benchmarks for FY 2014 come from the National Committee for Quality Assurance (NCQA) for 2013. Both NCBD and NCQA collect 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 or internet 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 2020. 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 2012 and 2014. 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 here to learn more about how the TRICARE regions are divided.

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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 2014 Health Care Survey of DoD Beneficiaries: Technical Manual.

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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 the age and sex adjusted proportion of beneficiaries that currently does not smoke. The counseled to quit rate is the proportion of smokers or tobacco users with physician visits in the last 12 months who were counseled to quit sometimes, usually, or always. 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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