For nearly 30 years, Kennell and Associates has supported the Defense Health Agency in various healthcare cost and policy analyses. Under the Policy Support and Analytical Services contract (HT0011-20-C-0006), Kennell conducts critical cost and policy analyses, develops and analyzes provider reimbursement, analyzes data integrity, and performs provider quality and safety measurement that directly benefit Active Duty personnel, their dependents, and retirees.
TRICARE Reimbursement Rates
Each year, Kennell develops TRICARE reimbursement rates for private sector care, including inpatient hospitals, physician services, injectable drugs, children's hospitals, and other services. Rate updates are statutorily required and support over $15 billion in healthcare costs annually. Annual updates ensure accurate payment rates and beneficiary access to private sector care, which is critical for military readiness and retention.
Savings Estimates
For all major changes to TRICARE policy, savings/cost estimates are completed to help support Departmental decision making. These estimates range from the impact of changes to DHA’s managed care support contracts to evaluation of Congressional or Administration reform proposals. Kennell’s data and actuarial expertise for these cost estimates enables policy decisions to be made quickly with the information needed to properly evaluate the impacts.
Premium-Based TRICARE Programs
By statute, annual updates to the beneficiary premiums for voluntary TRICARE programs are required to keep revenue consistent with program costs. Kennell’s annual updates ensure that premiums are actuarially sound and that revenue is not lost. These programs include TRICARE Young Adult, TRICARE Reserve Select, TRICARE Retired Reserve, and the Continued Healthcare Benefit Program and cover over 450,000 beneficiaries.
Indexing of Cost Shares
Kennell calculates statutorily required actuarial adjustments to cost sharing levels (i.e., copayment levels, catastrophic caps, enrollment fees) for TRICARE Prime and Select to account for medical inflation. This annual indexing of out-of-pocket costs for TRICARE enrollees prevents budget overruns and ensures that cost sharing levels increase at appropriate levels.
USFHP Ceiling Rates
Annual actuarial calculation of U.S. Family Health Plan (USFHP) ceiling rates ensures that the program, which provides healthcare to 160,000 TRICARE beneficiaries, does not increase costs to the government. Kennell provides the actuarial and program expertise to calculate appropriate rates to meet the statutory requirements.
Children’s Hospitals
Hold harmless reconciliation payments make up a substantial portion of payments to Children's Hospitals. Kennell’s timely development and calculation of these amounts helps the Department meet the statutory and regulatory requirements and helps ensure beneficiary access to care.
Operational Data Feeds
Kennell produces monthly data feeds to managed care support contractors that support DHA’s provision of private sector care. Among other important activities, these mission critical data feeds help ensure care coordination for program beneficiaries.
HEDIS Quality Measures
As a result of a GAO audit, statute requires quarterly calculation of HEDIS quality measures for DoD facilities, which Kennell performs. In order to use HEDIS, DHA must maintain certification from the National Center for Quality Assurance (NCQA). Kennell’s code and processes repeatedly pass audits from NCQA to demonstrate that code and results are accurate. Accurate determination of HEDIS measures ensures that DoD facilities are held to appropriate quality and safety standards.