Defense Health Agency’s Contractor Standards and Health Challenges
“The Defense Health Agency (DHA) expects all contractors to uphold the highest standards regarding performance and adherence to their contractual duties. If a contractor does not meet these responsibilities, we will utilize all available remedies within the contract to ensure proper performance is reinstated. We won’t shy away from using these options as needed,” a DHA statement read. “Although we’re keeping all options open, there are currently no plans to prematurely recompete the Western Region Managed Care Support Contract.”
This situation recalls a similar instance over ten years ago when the Defense Health Agency—then known as the Tricare Management Activities Office—overseen an early transition of benefits administrators.
The Government Accountability Office’s 2014 Migration Report indicated that “inadequate guidance and insufficient oversight led to issues in healthcare delivery.” The new contractor, UnitedHealth, faced challenges in meeting certain requirements initially, which might disrupt the continuity of care for beneficiaries and incur unnecessary expenses.
The GAO recommended several steps the DHA should follow to guarantee a smooth transition in the future, and by 2016, it noted that these measures had been successfully put into action.
In January, Shoemaker revisited the speech-language pathologist clinic for a swallowing evaluation after halting regular therapy sessions in August.
His cancer treatment resulted in scarring and muscle thickening in his throat, complicating his ability to swallow. He often carries a cup with him due to dry salivary glands that cause mucus buildup, requiring dilation procedures to widen his throat.
When Mr. Shoemaker has trouble swallowing, food, liquids, and stomach contents can unintentionally enter his airway, posing a risk of aspiration that could lead to pneumonia or even be fatal.
During the test, his speech therapist, Katrina Jensen, passed a small camera through Shoemaker’s nose down to the back of his throat to observe him swallowing different types of food.
Every attempt resulted in aspiration, which is particularly concerning because, as Jensen noted, some individuals might not even be aware it’s happening.
“The safest option would likely be to get a feeding tube,” she suggested.
Looking up, Shoemaker’s expression shifted. He recalled using a feeding tube for about six months at the start of his cancer treatment during radiation therapy. “I’m not a fan,” he admitted.
According to Jensen, her treatment has faced significant interruptions, which wouldn’t have happened had care not been denied. “They have been denying care,” she stated, referring to Tri-West.
“It’s pretty frustrating,” Shoemaker said. “I don’t want to keep saying that I owe anything, but the truth is, I do. I’ve held up my end of the agreement, and now it’s their turn to do the same.”
After his appointment, he headed home, putting on a brave front for his family.
“I want them to feel hopeful. Dad is still here, and things will get better, right?” he remarked.
However, he harbored deeper concerns. He felt that the outcome of the swallow test and the suggested feeding tube indicated he was on a worrying path. “You might think you have more time,” he reflected. “But maybe this shows I really don’t.”
Mr. Shoemaker continues to face unresolved issues with TriWest, indicating that he is encountering new denials related to other health insurance plans.
“I require constant care, and it needs to be spot-on. I can’t have someone asking me endless questions,” he expressed.
If he were still working as an Army recruiter, he mentioned he would need to adjust his message. Lifelong medical care is no longer a certainty.
“I’ve always loved the Army and the purpose it provided. I was proud to help enlist people and watch them pursue a better life,” he said. “And now, it feels like everything I’ve cherished has turned its back on me.”
