0720-0031_ss-b_11.21.18

SUPPORTING STATEMENT – PART B

B.  COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS

1.  Description of the Activity

Congress has directed Department of Defense (DOD) to conduct annual surveys over 4 years of both beneficiaries and civilian providers to determine the adequacy of access to health care and mental health care providers to determine the adequacy of access to health care and mental health care providers for nonenrolled beneficiaries. The survey is administered to a stratified random sample of providers over a period of four years. Each year under the guidance of the DoD project lead, the contractor responsible for sampling, analysis and reporting assembles the sampling frame, and draws the sample, then provides the sample with contact information to another contractor, which administers the survey by mail and by telephone. The responses are returned to the analysis contractor, which edits them and removes duplicate responses, and adds them to responses from previous years. That contractor calculates non-response adjusted sampling weights for the full set of respondents, and attaches them to an analytic file containing responses and selected provider characteristics. For reporting purposes, geographic units are defined based on their relation to TRICARE during the reference period of the most recent survey year, then analyzes the results and prepares briefings and reports as directed by Congress. Details of this activity are described below.

Sampling Procedure: Survey Locations

Section 712 of Fiscal Year (FY) 2015 National Defense Authorization Act (NDAA) has extended the requirement to conduct the survey from 2017 through 2020. Congress directed that DHA survey each year 20 markets in which Prime is offered and 20 in which Prime is not offered every year, and to incorporate recommendations from beneficiary and provider representatives in the choice of survey sites. To fulfill this mandate, strata are be constructed identifying all of the zip codes in each state that are designated as TRICARE Prime Service Area (PSA) and those that are designated as non-PSA.

The population of each of the resulting state-level markets will be measured as the total number of Select-eligible beneficiaries, plus Selected Reserve. States with small non-PSA or PSA populations will be combined with nearby states to avoid creating strata with small populations. The result will be approximately 37 PSA strata and 35 non-PSA strata. Samples of 20 PSA and 20 non-PSA strata for each of the four years will be selected during the first year of the survey. Sampling is conducted with probability proportional to size, so that markets with large populations, using the population definition described above, will be surveyed in up to four years. Because the PSA and non-PSA regions were formed based on the number of beneficiaries and not the number of providers, some regions with large number of providers are sampled at relatively low rates.

To fulfill the requirement that they be consulted regarding survey locations, provider and beneficiary representatives are presented with the list of states scheduled for survey in each year. From the list of areas to be surveyed in the current year, they suggest cities and towns where access should be measured. Health Service Areas (HSAs) corresponding to these cities and towns are identified. A list is created based on those recommendations, and sorted in priority order. Each HSA is allocated a sample of a fixed number of providers or all providers in the HSA, whichever is smaller. HSAs are included in priority order until the remaining sample is allocated. Those HSAs not sampled in one year are considered for a future year’s list.

Sampling Procedure: Creation of Sample Frame

The TSS provider survey includes both physicians and non-physician mental health providers. Therefore, two separate questionnaires with common questions are fielded. The first questionnaire is for physicians and the second is for non-physician mental health providers. The provider list is assembled from 6 sources:

• American Medical Association (AMA) master data file for physicians (Physicians-MDs and Doctors of Osteopathy-DOs) including Psychiatrists

• State licensing records, through LISTS, Inc. for mental health non physicians

• American Association of Marriage & Family Therapists through INFOCUS Marketing

• National Association of Social Workers through INFOCUS Marketing

• American Psychiatric Nurses Association

• NPI- the National Plan Provider and Enumeration System from the Centers for Medicare and Medicaid Services (CMS) for psychiatric nurses from all PSAs and HSAs and mental health professionals (non-physicians) from Hawaii (see http://nppesdata.cms.hhs.gov/cms_NPI_files.html)

Physicians are selected from the AMA Physician Master File, if their type of practice is office based or unclassified patient care, with a principle employer other than the Federal Government. The following physician specialties are excluded:

Aerospace

Allergy and Immunology/Clinical Laboratory

Anatomic/Clinical Pathology

Anesthesiology

Bloodbanking/Transfusion Medicine

Chemical Pathology

Clinical Biochemical Gene

Clinical Pharmacology

Cytopathology

Epidemiology

Forensic Pathology

Forensic Psychiatry

Hematology/Pathology

Medical Management

Medical Microbiology

Medical Toxicology

Neuropathology

Pathology

Pediatric Anesthesiology

Public Health and General Preventive Medicine

Underseas Medicine

Mental Health providers are selected from sources above as follows:

• Social Workers: from National Association of Social Workers through INFOCUS Marketing and NPI

• Psychiatric Nurses: from the American Psychiatric Nurses Association and NPI

• Psychologists: from LISTS and NPI

• Marriage and Family Therapists: from the American Association of Marriage & Family Therapists through INFOCUS Marketing and NPI

• Pastoral Counselors: from LISTS and NPI

• Mental Health Counselors: from LISTS and NPI

• Psychiatrists: from the AMA file

Because the Mental Health sample is derived from 6 different data sources, the sources must be merged together to remove duplicates and to obtain the best contact information for each provider. Contact information from the NPI is given first priority because the NPI contains office (i.e. work) addresses and phone numbers. That contact information is supplemented with contact information from the various other data sources.

The attached table presents frame counts obtained for regions surveyed in the first two years of the current survey cycle. If a region was surveyed twice, the count from the most recent survey is provided.

2017/2018 Frame Counts

	Total Providers	PCP	Specialist	Psychia-trist	MH Counselor	Marriage/Family Therapist	Psycho-logist	Social Worker	Nurse
Total from Sampled Strata	1,311,541	249,446	298,737	28,598	231,232	54,199	102,692	221,156	22,599
PSA Total	865,459	161,394	196,675	20,921	214,946	44,348	71,044	142,530	13,601
Non-PSA Total	446,082	88,052	102,062	7,677	119,168	9,851	31,648	78,626	8,998
Sitename	Total Providers
PSA
Alabama PSA	7,007	2,283	2,146	81	1,378	104	237	665	113
Arizona PSA	19,131	4,682	6,058	437	3,457	373	1,355	2,326	443
Arkansas PSA	6,315	1,279	1,482	84	1,978	43	316	990	143
California PSA	214,438	35,136	39,077	5,299	54,236	31,424	20,680	25,682	2,904
District of Columbia/Maryland PSA	38,743	7,597	9,954	1,258	6,153	312	3,674	9,164	631
Florida PSA	66,415	13,387	17,697	1,224	18,204	1,355	4,122	9,533	893
Georgia PSA	33,101	7,533	8,668	789	8,003	793	2,336	4,485	494
Indiana PSA	13,650	2,920	3,452	253	2,619	355	858	2,885	308
Kansas PSA	9,109	1,779	1,878	172	1,201	706	1,014	2,144	215
Kentucky PSA	11,774	2,045	2,678	265	2,496	473	1,190	2,322	305
Mississippi PSA	3,494	683	789	40	1,183	41	133	530	95
Missouri PSA	16,808	3,212	4,464	366	3,918	181	1,136	3,292	239
ND, SD, NE, MN, IA PSA	7,988	1,578	1,658	100	3,048	84	396	969	155
Nevada PSA	11,649	1,531	1,759	119	5,549	692	574	1,268	157
New York PSA	100,047	16,808	23,221	3,800	12,093	820	9,770	31,747	1,788
North Carolina PSA	9,870	2,180	2,219	216	1,962	239	754	2,157	143
Oklahoma PSA	12,445	1,379	1,784	131	7,068	284	517	1,182	100
Oregon/Washington PSA	39,297	5,742	6,399	588	18,299	1,511	2,144	3,836	778
Pennsylvania PSA	38,099	7,295	10,051	1,070	8,546	666	4,264	5,666	541
South Carolina PSA	11,032	2,194	2,683	273	3,429	145	577	1,529	202
Tennessee PSA	5,403	1,313	1,582	73	1,070	73	336	858	98
Texas PSA	70,305	15,963	21,101	1,716	16,825	1,443	4,418	7,921	918
Utah PSA	9,916	1,427	1,926	156	3,061	318	580	2,190	258
West Virginia/Virginia PSA	26,192	6,053	6,618	630	4,763	330	2,234	5,026	538
Wisconsin/Illinois PSA	54,641	10,752	11,664	1,213	14,152	725	4,749	10,760	626
WY, CO, MT, ID PSA	28,590	4,643	5,667	568	10,255	858	2,680	3,403	516
Non-PSA
AK, WA, HI NonPSA	10,751	1,754	1,302	92	5,243	366	458	1,341	195
Arkansas NonPSA	4,155	934	667	35	1,678	32	126	589	94
DE, MD, VA NonPSA	6,232	1,585	2,009	131	1,073	46	359	903	126
Florida NonPSA	19,005	3,945	5,411	330	4,660	326	1,024	2,993	316
Florida NonPSA	17,859	3,914	5,323	327	3,933	333	1,005	2,704	320
Illinois NonPSA	9,045	2,050	2,031	95	2,998	77	312	1,341	141
Indiana NonPSA	9,472	2,074	2,242	114	1,846	217	658	2,126	195
Iowa NonPSA	8,289	2,036	1,957	114	1,621	217	408	1,739	197
Iowa NonPSA	7,243	2,043	1,978	105	996	160	359	1,423	179
Kentucky NonPSA	6,953	1,288	1,335	65	2,452	103	424	1,120	166
MA, CT, RI NonPSA	18,623	2,143	2,792	459	5,713	620	1,345	5,069	482
Michigan NonPSA	28,599	4,360	5,317	386	5,782	164	3,377	8,788	425
Minnesota NonPSA	26,115	5,397	6,191	466	3,517	2,095	3,799	4,153	497
Mississippi NonPSA	5,484	1,172	1,400	82	1,626	111	222	720	151
Missouri NonPSA	8,032	1,675	1,827	160	2,298	59	625	1,268	120
Montana NonPSA	3,338	726	728	45	996	28	195	536	84
New Jersey/Pennsylvania NonPSA	21,120	4,454	5,396	411	5,235	157	1,575	3,484	408
North Carolina NonPSA	33,577	5,996	7,613	742	8,283	723	3,054	6,678	488
North Carolina NonPSA	30,772	6,003	7,498	719	6,996	689	2,489	5,934	444
Ohio NonPSA	46,371	8,453	11,606	916	11,481	277	3,068	9,518	1,052
Oklahoma NonPSA	10,459	1,379	1,313	74	5,834	176	321	1,252	110
Oklahoma NonPSA	9,556	1,394	1,324	72	5,235	171	305	949	106
Oregon NonPSA	26,252	4,028	4,188	445	10,524	794	1,855	3,619	799
South Carolina NonPSA	5,685	1,480	1,513	58	1,801	112	116	510	95
Tennessee NonPSA	18,430	4,331	5,069	307	4,103	521	962	2,501	636
Tennessee NonPSA	18,253	4,340	5,077	321	3,739	488	1,243	2,440	605
Texas NonPSA	15,018	4,453	3,864	217	4,259	190	592	1,267	176
Wisconsin NonPSA	21,394	4,645	5,091	389	5,246	599	1,372	3,661	391

Sampling Procedure: Survey Sample

In each year, providers in the randomly selected PSAs and non-PSAs (including the designated HSAs if they are contained in those areas) contribute to national and regional estimates, though with a lower sampling weight as the total number sampled in a particular area increases. Stratified samples of providers are selected from the frame within the randomly selected PSAs and non-PSAs and the purposively selected HSAs. The TSS Provider Survey sample is stratified by

1. Prime service area

2. Non-Prime service area,

3. HSA, and

4. Type of provider: physician or mental health.

Strata are a combination of type of area (PSA, non-PSA, or HSA) and type of provider. Within each physician stratum we implicitly stratify the providers by primary care provider or specialists and selected a systematic sample. Within each mental health stratum we implicitly stratify by type of provider (social work, psychiatric nurse, psychologists, marriage and family therapist, pastoral counselor, and mental health counselor) and select a systematic sample. Implicit stratification results in a sample that is proportional to the distribution of the types of providers. Psychiatrists are included within the mental health sample.

Survey Fielding

The survey is fielded to the billing managers of randomly sampled providers by mail with an online option, and telephone follow-up to non-respondents. Procedures for collecting information are described in “Procedures for Collection of Information” below.

Weighting

The analysis of survey data from complex sample designs, such as this one, requires application of weights to accomplish the following:

• Compensate for variable probabilities of selection

• Adjust for differential response rates

• Improve the precision of the survey-based estimates through post-stratification [for details, see Brick and Kalton (1996) and references cited therein], and trim extreme weights.

Sampling weights are equivalent to the reciprocal of the probability of each provider’s selection into the sample. Survey sampling weights account both for the probability of selection in the first stage, i.e. that a geographic area is sampled, and in the second stage, i.e. that within an area, an individual provider is sampled. The HSAs selected for oversampling are parts of areas randomly selected in the first stage and therefore have the same first stage probability of selection. However, they are oversampled in the second stage and responses from those areas are thus assigned smaller sampling weights than others in their strata. A propensity model estimates the probability of response as a function of an array of provider characteristics from the sample frame. Sampling weights are further adjusted for nonresponse within the classes formed based on the percentiles of propensity scores from a propensity model.

Finally, the nonresponse adjusted weights are poststratified to the frame totals to obtain specific domain weighted totals equal to the population totals, and some extreme weights are trimmed to reduce the excessive effect of extreme weights on variance inflation. Poststratification is performed based on reporting units that take into account changes in TRICARE’s administrative structure as described below.

Because of the complex sample design and the divergence between sampling and reporting units, weights are applied and precision of estimates is measured using replicate weights. To construct replicate weights, the entire file of sampled cases is first sorted in sample selection order in which the stratification variables are used in the sorting process. Next, 50 mutually exclusive and exhaustive systematic subsamples of the full sample are identified in the sorted file. A jackknife replicate is then obtained by dropping one subsample from the full sample. As each subsample is dropped in turn, 50 sets of jackknife replicates are produced. The weighting process after the modeling is applied to the full sample is then applied separately to each of the jackknife replicates to produce a set of replicate weights for each record. The propensity score modeling is skipped. Instead the weighting cells from the propensity scores from the full sample weight are adopted in the replicate weights construction. Then, a series of jackknife replicate weights is attached to the final data in order to construct jackknife replication variance estimates.

2.  Procedures for the Collection of Information

As described above, contact information for sampled providers is transmitted to the vendor responsible for fielding the survey. Each sample member is assigned an internally generated ID number. Only that ID is used when the survey is fielded. Responses are recorded and the response data is incorporated into the analysis file using the internally generated ID and reports are prepared.

A multi-mode data collection method is used through a mailed survey with internet option and a telephone follow-up survey. An initial mailed survey is sent to members of the target population within specified geographic areas, with a follow-up mail survey sent within a defined period after the first. The initial and follow-up survey includes a cover letter signed by a senior DHA director requesting the recipient’s participation and requesting a response by return mail, internet or facsimile, as well as providing a toll-free number to call with any questions and a web address to take the survey via the internet (See Attachments for the mail instruments). If providers’ responses to the mailing are not obtained, their offices are contacted by telephone. The telephone survey uses a standardized Computer Assisted Telephone Interview (CATI) protocol.

Mailed surveys are sent to the provider’s stated work address only, and not the residence, to the extent the work address is different from the home address and can be discerned. Telephone follow-up is to the work address as well, and, similarly, to the extent the work telephone is different from the home address and can be discerned. These surveys are designed to be answered by the billing manager or person responsible for the provider’s billing practices, to minimize the burden on the provider’s practice, and to obtain data the billing expert may be most knowledgeable about. If a recipient receives multiple surveys for multiple providers in the same office or practice group, the recipient is asked to complete a separate mail survey or answer to a separate scripted telephone survey for each provider.

The survey operations contractor administers the telephone survey. The vendor uses standard telephone survey research methodology in administering the telephone questionnaires to include documentation of interviewer training, valid retrievable call records, and a log of interview sessions. A computerized telephone matching service (if needed) and Directory Assistance are used to track current telephone numbers. To optimize the chances of locating respondents and enlisting cooperation, calls are made at different times of the day, on different days of the week, but calls are made only during normal business hours. Calls are not made during weekend or evening hours.

The survey is fielded only to providers with specialties reimbursed by TRICARE, and only to providers who offer care in an office-based practice. Information from the frame is not always sufficient to determine eligibility. Therefore, procedures for determining eligibility are incorporated in fielding and subsequent data processing methods, as described below.

TRICARE reimburses mental health providers of the following types:

• Psychiatrists (or other physicians)

• Clinical psychologists

• Certified psychiatric nurse specialists

• Clinical social workers

• Certified marriage and family therapists

• Pastoral counselors

• Mental health counselors

For purposes of this survey, we elected to survey only those who may choose whether to accept TRICARE patients. Therefore, the first 3 questions of the mental health provider survey instrument (see mental health and physician questionnaires) attempt to “weed out” any providers who are not reimbursable by TRICARE and who are not able to choose.

A respondent is counted as part of the final sample if they are eligible for the survey and a respondent to the questionnaire.

A respondent is not considered to be a valid respondent to the survey if they did not respond to any of the following questions: PROVIDE (Question 1), AWARE (Question 2 for Physician, Question 3 for mental health), ACCEPT (Question 4 for Physician, Question 6 for mental health). If a respondent answers any one of these questions, then they are considered to be a valid respondent.

Dispositions are assigned and verbatim responses are coded by the survey administrator to facilitate analysis. The coded response data and the original responses are both returned to Mathematica, where they are reviewed and incorporated into a file for subsequent processing and analysis.

Reporting and Analysis

Because Congress directed that the survey be performed over a four-year period and because of changes in the planned and actual locations in which Prime is offered, the strategy for weighting, reporting and analysis must accommodate changes in stratum definitions. Therefore, in order to fulfill the requirement that the TSS include each year 20 regions in which Prime is not offered, non-PSA strata are divided into smaller geographically contiguous regions. These regions are designated reporting strata.

In order to provide more specific information to users, as response data accumulates, sampling strata may be divided into smaller units for reporting purposes. These reporting units are, as much as possible, contiguous areas of the same PSA type and approximately the same sample size. Twenty of these reporting units are produced for each year of the survey. Thus, in the surveys second year, 40 PSA and 40 non-PSA units will be created and used for post-stratification and reporting purposes. In the third year, 60 of each type, and in the fourth year, 80 of each type will be created and reported

In addition, the division of the U.S. into PSA and non-PSA areas may change during the four cycles. If that is the case, the sample design will remain unchanged but reporting units of up to 4 types may be created: continuous PSA, continuous non-PSA, former PSA and former non-PSA.

Estimation procedures

The main provider survey items are questions regarding acceptance of new TRICARE patients, new Medicare patients, and any new patients. We convert response categories to dichotomous variables as follows: one if the response is “Yes” and zero if the response is “No” or “I don’t know.”

We calculate rates and compare results for local health care markets in two ways: we estimate rates for HSAs designated by stakeholders and for the individual PSA and non-PSA strata described above. We also present illustrative maps of the U.S. indicating whether the PSAs and non-PSAS surveyed fall in the top, middle, or bottom third with respect to the main access and acceptance measures. We compare responses between beneficiaries and providers residing in PSAs and those in non-PSAs.. In some of the analyses, we also compare across three types of PSAs (excluding former PSAs): MTF catchment areas not affected by Base Realignment and Closure (BRAC), which we label “MTF PSAs”; areas in which the MTF was designated for BRAC, which we label “BRAC PSAs”; and all other PSAs.

When provider survey responses are assigned weights based on the inverse likelihood of selection, the rates calculated from these responses accurately measure the proportion of all providers aware of TRICARE or that will accept a new TRICARE patient. However, the rates may not capture the level of awareness or acceptance that a TRICARE beneficiary will encounter when seeking care—which depends on the extent to which TRICARE beneficiaries are found near these providers. To develop rates more likely than the total proportion of providers to reflect the experience of TRICARE users, we also calculated rates reweighted according to the number of TRICARE-eligible beneficiaries in the markets these providers serve. Thus, we include supplemental exhibits with two rates. The first rate uses the original provider weights based on each provider’s inverse likelihood of selection. The second set of rates uses weights based on the number of TRICARE-eligible beneficiaries in the stratum.

In addition to the comparisons above, PSAs and non-PSAs are classified into regions with high and low concentrations of Selected Reserve (SR) members, according to the ratio of SR members to providers (PCPs, specialists, or mental health providers). The results show the contrast between areas with high concentrations of SR members and those with low concentrations.

In order to calculate rates and test hypothesis that rates differ between analytic categories or compared to benchmark, weighted rates are calculated using non-response adjusted sampling weights described above, and variance of estimates is calculated using Jackknife replicate weights. Calculation of variance in the TSS requires a design-based variance estimation technique that is available in most statistical software packages for analysis from a complex survey data set. For reports and briefings prepared by the analysis contractor, SUDAAN® 10.0 (Research Triangle Institute, Research Triangle Park, North Carolina) is used.

Precision objectives

The sample design and projected sample size, will permit local and national estimates for key analytic domains meet precision objectives. If the objective of approximately 40 percent of eligible returns for each provider sampled is met and design effects are consistent with those obtained in previous surveys, the design is projected to yield local estimates for each provider type with 95% confidence intervals less than +/- 10 percentage points around an estimate of 50 percent. This level of precision is sufficient to detect markets with substantially better or poorer than average acceptance or awareness of TRICARE Standard or Select. It will also generate precise national estimates of rates for PSA and non-PSA markets, which are key analytic domains for Congress, GAO and DHA, with projected confidence intervals of +/- 2 percentage points for a single year and +/- 1 percentage point for the 4-year cycle. Because a smaller proportion of mental health providers than physicians surveyed is eligible, mental health providers must be sampled at a higher rate than physicians to meet these objectives.

Precision objectives by year

Stratum	Projected sample size	Estimated Design Effect*	Precision**
Market	500	2.21	7 percentage points
Physician	260	1.57	8 percentage points
Mental Health Provider	240	1.97	9 percentage points
Aggregate Estimates 2017
National	20,000	5.38	2 percentage points
PSA/non-PSA	10,000	4.84	2 percentage points
Physician	10,400	4.73	2 percentage points
Mental Health Provider	9,600	4.90	2 percentage points
Aggregate Estimates: 2017 + 2018
National	40,000	5.38	1 percentage points
PSA/non-PSA	20,000	4.84	2 percentage points
Physician	20,800	4.73	1 percentage points
Mental Health Provider	19,200	4.90	2 percentage points
Aggregate Estimates: 2017 + 2018 + 2019
National	60,000	5.38	1 percentage points
PSA/non-PSA	30,000	4.84	1 percentage points
Physician	31,200	4.73	1 percentage points
Mental Health Provider	28,800	4.90	1 percentage points
Aggregate Estimates: 2017 + 2018 + 2019 + 2020
National	80,000	5.38	1 percentage points
PSA/non-PSA	40,000	4.84	1 percentage points
Physician	41,600	4.73	1 percentage points
Mental Health Provider	38,400	4.90	1 percentage points

*Estimated from 2017 and 2018 data

** 95% Confidence interval half-length around p=0.5

Use of periodic or cyclical data collections to reduce respondent burden

The mandate governing the survey requires that the nation be surveyed every four years and that estimates for 20 PSA and 20 non-PSA markets be provided each year. Our sampling procedure meets this mandate by providing the required number of local estimates in each year, with national estimates of increasing precision over the four years. Providers sampled in any year of the 4-year cycle are excluded from subsequent years. This sample design reduces burden while meeting precision objectives by ensuring that no provider is surveyed more than twice in an eight year period.

3.  Maximization of Response Rates, Non-response, and Reliability

The cover letter that accompanies each mailed survey is the primary method used to encourage participation in the survey effort. Both the cover letter and telephone script appeal to the respondent’s patriotism, and include information about the purpose of the survey and a brief description of how the information will be used by DHA. For offices with multiple selected physicians and mental health providers, the billing manager recipient will receive separate surveys for each requested physician, and will be asked to complete one survey for each. In addition, telephone interviewers are trained in interviewing techniques designed to minimize incidences of respondent refusals to participate in the survey. They ask respondents to answer separately for each physician in cases where multiple doctors are being surveyed in the same office.

Non-response analyses have indicated that membership in the TRICARE network is positively related to survey response. Thus, in order to ensure that the data can be generalized to the universe under study, an indicator of network membership is obtained by linking to the sample frame an indicator of network membership from membership lists provided by the TROs. If non-response adjusted sampling weights are employed, rates calculated from survey responses are representative of the population under study.

4.  Tests of Procedures

The sample and results of surveys fielded from 2012 to 2015 were recently evaluated by the Government Accountability Office (GAO) in 2017 and found to be statistically and methodologically sound.

The extended legislation required the Department to establish benchmarks for primary and specialty care providers (including mental health providers) to determine adequacy of providers available to TRICARE-eligible beneficiaries. The GAO was required to review the processes, procedures and analyses used by DoD to determine the adequacy of the number of health care and mental health care providers available to TRICARE-eligible beneficiaries. GAO have evaluated the data collection and security processes with respect to conformance with OMB guidelines, and concurred with our methodology and processes.

5.  Statistical Consultation and Information Analysis

a. Individual(s) consulted on statistical aspects of the design.

Eric Schone, Ph. D.

Mathematica Policy Research

Phone: 202-484-4839

Nancy Clusen

Mathematica Policy Research

Phone: 202-484-5263

b. Person(s) who will actually collect and analyze the collected information.

Eric Schone, Ph. D.

Mathematica Policy Research

Laura N. Pinnock, MSPH

Altarum Institute

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