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Pediatric care in the military rated 'excellent' but can improve

Experts say pediatric care within the Military Health System is excellent as they strive to improve and provide top-quality care for military children. (U.S. Navy photo by Jacob Sippel) Experts say pediatric care within the Military Health System is excellent as they strive to improve and provide top-quality care for military children. (U.S. Navy photo by Jacob Sippel)

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Children's Health | Health Readiness | Preventive Health | Military Health System Review Report

FALLS CHURCH, Va. — In a year of change within the Military Health System, parents can rest assured that industry experts, physicians, and leaders have been working diligently to improve pediatric care across the enterprise.

The Defense Health Board, made up of nationally recognized civilian medical experts, has completed a top-to-bottom review of pediatric health care in the military and recently released a comprehensive report of their findings and recommendations. According to the report, when the quality of life (including physical and mental health) of the families of service members is compromised, the Department of Defense’s military mission is compromised as well.

“Taking good care of our dependent beneficiaries is a readiness issue,” said Dr. Terry Adirim, acting Principal Deputy Assistant Secretary of Defense for Health Affairs. “It’s critical that our active duty service members, whether deployed or not, should not have to worry about their children.”

The MHS is committed to delivering quality health care rooted in prevention, focused on wellness, and committed to patient satisfaction. The board found that care for more than 2 million military children eligible for TRICARE is generally excellent, but there are opportunities for improvement. The board’s recommendations were based on four overarching findings:

  • Beneficiaries find health care delivery inside the MHS difficult to navigate. The Department needs to assure a positive patient and family experience, and high-quality, coordinated care for all pediatric beneficiaries.
  • The MHS lacks an enterprisewide system to accurately and consistently track care, cost, and quality of services provided. Outcomes should be tracked, measured, and reported across the MHS to ensure delivery of cost-effective, quality care to all pediatric beneficiaries.
  • MHS care for pediatric beneficiaries, whether through a military treatment facility or civilian provider, varied. Care should be standardized to support patient- and family-centered, timely, and efficient care to all pediatric beneficiaries.
  • High-quality, coordinated health care is inconsistently provided for pediatric patients with chronic conditions and complex requirements who need integrated services, especially during relocations or deployments. The MHS should improve access and use telehealth technology to provide integrated and continuous care for all beneficiaries regardless of location.

The MHS has made progress on a few points ahead of the report’s release as it works with families, providers, industry experts, and advocacy groups to improve, said Adirim. Advances continue in the areas of standardization and coordination of care, and ensuring families have access to the best care available. MHS GENESIS, the new electronic health record, will continue to be phased into military treatment facilities. It is designed as a standardized system to allow for consistent and coordinated care, and to provide a means of gathering metrics.

Efforts are also underway to ensure children and their families receive continuous quality care covered by TRICARE, and have seamless access to subspecialty care. The transition from three TRICARE regions to two may help reduce differences in care, said Navy Capt. Edward Simmer, chief clinical officer for TRICARE Health Plans at the Defense Health Agency. The MHS is focused on integration so that the same care and standards are applied, whether patients are receiving care at a military treatment facility or through a civilian provider, he added.

“We do a very good job of pediatric care in the MHS, but we could do better,” said Simmer. “We are working to make this so it’s one system of care. And no matter where you’re getting that care, it should look very similar.”

Dr. Jeremy Lazarus, a psychiatrist and board member, said the recommendations highlight opportunities to strengthen patient and family experiences during the ongoing transition in the MHS, particularly in clinical preventive services, primary and specialty care, and behavioral health. Improving access to and coordination of care is especially important for children with complex health care needs, he added.

“A number of system issues that are outlined in the report are similar to many of the issues going on in the private sector,” said Lazarus. As subcommittee chair for neurological and behavioral health, Lazarus worked with retired Maj. Gen. George Anderson, subcommittee chair for health care delivery, on the review. “This is an opportunity for MHS to be a leader in implementation of pediatric quality measures, where measures haven’t been nearly as researched or used as those in adult medicine.”

Throughout the assessment, senior leaders worked with the board to help members understand the complexity of the MHS, said Adirim. Listening to the suggestions and concerns of advocacy groups, parents, and doctors is critical to identifying issues in a large, integrated system, she added.

“Our priority is to make access to the care as easy and seamless as possible,” said Adirim. “I look forward to working with the board to ensure the recommendations are met, and working with families and advocacy groups to ensure changes are communicated.”

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