How would you save the military money in medical expenses?

Stop giving dependents a free ride on their sponsor's health insurance.  Have a minor co-pay in the single digits for a PCM visit and have a hefty co-pay for emergency room visits that don't qualify as a "life, limb, or eyesight" emergency.
This should free up a whole lot of appointments in your local TMC and end the practice of using the ER as an alternative to waiting to see a doctor for three days or less.

Charge a small copay less than $20.00, it will reduce some of the " I am just here because I have free health insurance." it may make people think twice before seeking care for the common cold.

Here are my big three:

Most poigniantly, changing philosophy on what healthcare is in the military is fundimental before even thinking about making fiscal cutbacks. The main problem with the healthcare that we are used to is that healthcare was always something that was done afterwards and begrudgeingly at that. you would spraine you ankle, spend hours in sick call just for a bottle of motrin and a straw to "suck it up" with and thats if you even went to sick call. because of the stigma many leaders put on getting medical treatment, soldiers would push through the pain and deal with it. What did that cause? well 5 years down the road the military has to pay for ankle replacement because that tendon that could have been fixed with some minimal physical therapy has now ruptured.

There is already many processes in the works that are cutting some reduntcancies. the Base Realignment Commission would be the first to recognize. for some reason we had bases for each branch, and often they are very close to each other. why have seperate medical facilities for each post when you could join these bases together and have a Military Treatment Facility that covers all services.

as for making soldiers pay for missing appointments i kind of agree with there being some kind of reparation. If you miss an appointment in the civilian sector you get charged your deductable anyway. but why do people focus on this issue always confounds me because on average it only counts for about 5% of lost funds. what we need to focus on is the appointments we send out to network. there is an average of 30% of outpatient services that get sent out to network. thats a lot of money, because those 30% of appointments already exist in our facilities then we refer them out and pay the civilian institution. so we just payed double for a service we could have performed.

training, i agree should be centralized and remove redundant training. no sense on doing two kind of different classes that cover the same thing.

a Physicians Assistant being assigned to every battalion makes a lot of sense. however, you might have to consider the kind of work load that PA will be under. A Small battalion may have 350+ soldiers. that is one hell of a patient load, i find it difficult to believe that to PA would be able to give effective care to every one under his purview.

Just a couple of thoughts.

SSG Sweeney,

1. Your #1 is going into effect right now: http://www.militarytimes.com/article/20131001/BENEFITS06/310010042/

2. Retirees served honorably for those benefits FOR their families and a sudden increase in out-of-pocket cost could have a grave effect on their fixed incomes. I recently saw a wheelchair-bound Korean War vet and his wife miscalculate their meager grocery cost and they came up short. Instead of letting them decide if they could do without cheese or bananas, I paid the difference. Imagine what they would have to sacrifice to pay unexpected copay increases.

3. I totally agree with you about PAs. They do a GREAT job at weeding out BS.

4. Each missed appointment costs an MTF around $100. I say deduct it from the Servicemember's pay, if they don't have a good excuse for missing it.

Number one get rid of all the bogus charges that the medical field has created, if you ever look at a bill from a civilian facility and compare what is actually paid by your insurance to what they are supposed to write off, there is proof right there. If they are able to write off for example $28,000 from a $30,000  bill of charges because the insurance only allowed $200 to be paid, that shows that the costs are over inflated to start with. There was a time when doctors were paid in chickens and produce, and they were happy with and generally cared for their patients even when they couldn't afford to pay for the service. It is a major scam for the expenses, and needs to be revamped to the reality and cut out the fat that causes the over inflated mechanisms that are currently in place .

We have far too many providers in administrative positions and not generating revenue.

Well let me get my soap box out:  First when I joined like most of you I was promised free medical and dental for life for me and my family, well that was a lie, Now we pay for Tricare and Tricare dental. The combining of all military health care under the PHA I don't like, as then you will be competing with even more people to try and get a appoint, Keep the government out of health care, if you want to control cost it need to be with the drugs and suppliers, that is where the major cost are at. We have let healthcare get so for out of line, by allowing jury's to award these millions in law suites, don't get me wrong if they do something wrong like remove a kidney instead of the gall blatter yea sue the shit out of them, but a few million for something that did not hurt you or cause you lost of limb or body part why? The military care system and Tricare works, now stop raising it because I am retired, and stop pushing us into more poverty then helping.

I like the idea of the PAs,  who seem competent and eager to help veterans and active duty alike.

This may be counter intuitive, however if they really want to cut expenses, they need to grow military medical capabilities. Build military hospitals back up and stop paying civilian providers to perform functions that military providers could do at half the cost.