The National Defense Authorization Act (S 2943) signed into law Dec. 23 orders an avalanche of changes to the Tricare healthcare benefit used by service members, retirees and their families. It also makes sweeping reforms to how the military direct-care system is organized and operates.

The sheer number of changes and additional studies being mandated, filling 40 sections and 150 pages of the Act, is more impressive than any short list of highlights we might be able to review here.

“There’s a lot of good stuff in there. There’s a lot of stuff we’re still puzzling over,” said Dr. Karen S. Guice, acting assistant secretary of defense for health affairs. She will serve in that post only two more weeks, until the Trump administration assumes responsibility for the $50-billion-a-year military healthcare system and a beneficiary population of 9.6 million.

The authorization act for fiscal 2017 “is full of ideas, concepts and new things for us to tackle,” said Guice in a phone interview. She added that it contains “a remarkable series of provisions that set forth some challenges [and] provides us with new authorities that we’re greatly looking forward to.”

But Guice emphasized many new provisions to modernize Tricare and improve access will only accelerate reforms that the department already has been piloting or planning to adopt, though perhaps not at the speed Congress desired. The department’s guide has been recommendations of the 2014 Military Healthcare System Review, which then-Defense Secretary Chuck Hagel ordered to take a hard look at performance and outcomes at military facilities and through civilian purchased care networks, Guice said.

Beneficiaries have started to see the fruits of that effort in greater access to care and a nurse advice line. They will see more when the new generation of Tricare purchased care contracts takes effect this year, and also with gradual rollout of MHS Genesis, the new electronic health records system. All this before many of the new defense bill initiatives kick in in 2018 and years beyond. Associations advocating for beneficiaries wonder how many changes the health system can implement before chaos rules.

Guice doesn’t sound worried for the staff she’s leaving behind.

“We have a lot of very experienced, motivated peopled who just like to tackle challenges,” she said. “Also, we are looking at this across the enterprise so it’s the Army, Navy, Air Force all coming together about how we actually do this.”

The Senate version of the defense bill had called for dismantling the medical headquarters of the Army, Navy and Air Force surgeons general. The enacted law is a compromise that directs a shift of key management functions done by the services to the Defense Health Agency, leaving the surgeons general to recruit, educate and train their military and civilian health care providers and to advise the health agency on medical readiness issues.