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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
Restructure or Realignment of Military
Medical Treatment Facilities
Thank you for choosing to participate in the Defense Health Agency care transition survey. As always, your care is
our top priority. By participating in this survey you are helping us to ensure that we provide the highest quality
care and best care experience throughout the transition of health care to our network partners and well into the
future. Survey participation is voluntary. You can skip questions you choose not answer, and you can stop
participating at any time. If you have any questions about the survey, please contact Ms. Ginger Schwenkler
([email protected] (mailto:[email protected])).
AGENCY DISCLOSURE NOTICE
The public reporting burden for this collection of information, 0720-XXXX, is estimated to average 10 minutes per response, including the time
for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. Send comments regarding the burden estimate or burden reduction suggestions to the Department of Defense,
Washington Headquarters Services, at [email protected]. Respondents should be aware that
notwithstanding any other provision of law, no person shall be subject to any penalty for failing to comply with a collection of information if it does
not display a currently valid OMB control number.
There are 19 questions in this survey.
Your Transition from MTF Primary Care
Manager PCM to Network PCM
Which of the following is your primary Military Health Plan?
Please choose only one of the following:
TRICARE Prime (including most Active Duty, TRICARE Prime Remote and TRICARE
Overseas)
TRICARE Select (previously known as TRICARE Extra or Standard [CHAMPUS])
TRICARE Plus
Other TRICARE Plan
Not sure
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
Did you encounter any problems during the transition from your military medical treatment facility (MTF)
primary care manager (PCM) to your new Network PCM?
Please choose only one of the following:
Yes
No
What issues did you encounter during the transition from your MTF PCM to your new Network PCM?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G00Q02]' (Did you encounter any problems during the
transition from your military medical treatment facility (MTF) primary care manager (PCM) to
your new Network PCM? )
Check all that apply
Please choose all that apply:
The Network PCM was not who I chose.
The Network PCM was too far from my residence.
The Network PCM assigned was no longer accepting new patients.
The Network PCM assigned was no longer practicing/moved/retired.
Other. (Please do not include any personally identifiable information.)
Other:
Your Care Since Transitioning to a Network
PCM
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
Do you know who your Network PCM is?
Please choose only one of the following:
Yes
No
I currently do not have a Network PCM.
Since transitioning to a Network PCM, have you made any appointments for a check-up or routine care
Please choose only one of the following:
Yes
No
How would you rate the ease of making the appointment for a check-up or routine care?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G02Q05]' (Since transitioning to a Network PCM, have you
made any appointments for a check-up or routine care)
Please choose only one of the following:
Poor
Fair
Good
Very Good
Excellent
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
How many days did you have to wait for an appointment for a check-up or routine care?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G02Q05]' (Since transitioning to a Network PCM, have you
made any appointments for a check-up or routine care)
Please choose only one of the following:
Same day
1 day
2 to 3 days
4 to 7 days
8 to 14 days
15 to 30 days
More than 30 days
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
Please indicate how much you agree or disagree with the following statements about when you were seen by
your new Network provider.
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G02Q05]' (Since transitioning to a Network PCM, have you
made any appointments for a check-up or routine care)
Please choose the appropriate response for each item:
N/A, I
have
not met
Neither
with
Agree
the
Strongly Somewhat nor
SomewhatStrongly provider
Disagree Disagree Disagree Agree
Agree
yet.
The provider explained
things in a way that
was easy to
understand.
The provider listened
carefully to me.
The provider seemed
to know the important
information about my
medical history.
The provider spent
enough time with me.
Overall, I am satisfied
with the healthcare I
received from my new
Network provider.
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Using any number from 0 to 10, where 0 is the worst provider possible and 10 is the best provider possible,
what number would you use to rate your new Network provider?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G02Q05]' (Since transitioning to a Network PCM, have you
made any appointments for a check-up or routine care)
Please choose only one of the following:
0
1
2
3
4
5
6
7
8
9
10
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How does your healthcare with your Network PCM compare to your healthcarewith your MTF PCM before the
transition?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G02Q05]' (Since transitioning to a Network PCM, have you
made any appointments for a check-up or routine care)
Please choose only one of the following:
My healthcare is worse now with a Network PCM.
My healthcare is about the same with a Network PCM as with my previous MTF PCM.
My healthcare is better now with a Network PCM.
I currently do not have a Network PCM or I have not received care since transitioning to
the Network PCM.
About the Transition from MTF PCM to
Network PCM
Were you aware of the impending transition of your healthcare from MTF PCM to a Network PCM?
Please choose only one of the following:
Yes
No
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
How did you hear about the transition?
Only answer this question if the following conditions are met:
Answer was 'Yes' at question ' [G03Q11]' (Were you aware of the impending transition of
your healthcare from MTF PCM to a Network PCM? )
Check all that apply
Please choose all that apply:
Communication from MTF
The local news
Family member, friend, or word of mouth
Town hall
Military organization
Did you contact the MTF and/or a member of the Beneficiary Transition Cell for assistance or more
information about the transition?
Please choose only one of the following:
Yes, I contacted the MTF.
Yes, I contacted a member of the Beneficiary Transition Cell.
No, but I contacted someone else.
No, I did not contact anyone.
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When you contacted the MTF and/or a member of the Beneficiary Transition Cell for assistance, did they
answer all of your questions?
Only answer this question if the following conditions are met:
Answer was 'Yes, I contacted the MTF.' or 'Yes, I contacted a member of the Beneficiary
Transition Cell.' at question ' [G03Q13]' (Did you contact the MTF and/or a member of the
Beneficiary Transition Cell for assistance or more information about the transition? )
Please choose only one of the following:
Yes
No
Please indicate how much you agree or disagree with the following statement. When I contacted the MTF or
member of the Beneficiary transition Cell for assistance, I was treated with courtesy and respect.
Only answer this question if the following conditions are met:
Answer was 'Yes, I contacted the MTF.' or 'Yes, I contacted a member of the Beneficiary
Transition Cell.' at question ' [G03Q13]' (Did you contact the MTF and/or a member of the
Beneficiary Transition Cell for assistance or more information about the transition? )
Please choose only one of the following:
Strongly Disagree
Somewhat Disagree
Neither Agree nor Disagree
Somewhat Agree
Strongly Agree
Demographics
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
What is your age?
Choose one of the following answers
Please choose only one of the following:
18-24
25-34
35-44
45-54
55-64
65-75
75 or older
What is your beneficiary category?
Choose one of the following answers
Please choose only one of the following:
Active Duty
Active Duty Family Member
Retiree and Family Member under 65 years old
Retiree and Family Member over 65 years old
Are you Hispanic or Latino?
Please choose only one of the following:
Hispanic or Latino
Not Hispanic or Latino
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MAX Survey - Restructure or Realignment of Military Medical Treatment Facilities
What is your race?
Check all that apply
Please choose all that apply:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Thank you for completing this survey.
Submit your survey.
Thank you for completing this survey.
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| File Type | application/pdf |
| File Modified | 2023-09-12 |
| File Created | 2023-09-12 |