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Changes to military health care system aimed at readiness

Speaking before the House Armed Services subcommittee on personnel during a Dec. 5 hearing on Capitol Hill, Assistant Secretary of Defense for Health Affairs Thomas McCaffrey (left), Army Lt. Gen. (Dr.) Ronald Place (second from left), director of the DHA, the service Surgeons General, and Joint Staff Surgeon outlined the necessity for the health care system to change in order to support warfighter readiness. (MHS photo) Speaking before the House Armed Services subcommittee on personnel during a Dec. 5 hearing on Capitol Hill, Assistant Secretary of Defense for Health Affairs Thomas McCaffrey (left), Army Lt. Gen. (Dr.) Ronald Place (second from left), director of the DHA, the service Surgeons General, and Joint Staff Surgeon outlined the necessity for the health care system to change in order to support warfighter readiness. (MHS photo)

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As the Department of Defense continues transitioning its military hospitals and clinics from the Army, Air Force, and Navy to the Defense Health Agency, its top medical leaders remain committed to providing the finest care possible to those in uniform, retirees, and their families.

Speaking before the House Armed Services subcommittee on personnel during a Dec. 5 hearing on Capitol Hill, Assistant Secretary of Defense for Health Affairs Thomas McCaffrey and Army Lt. Gen. (Dr.) Ronald Place, director of the DHA, outlined the necessity for the health care system to change in order to support warfighter readiness.

“Our primary mission is readiness – the readiness of medical personnel to support our forces in battle, and the medical readiness of combat forces to complete their missions. Readiness also entails caring for the families of our troops and our retirees, and their families,” McCaffrey and Place stated in a joint prepared statement for lawmakers. “As our service members deploy around the world, they need to know that their families back home are cared for and that in retirement they will receive a health benefit that recognizes the value of their service. Meeting this obligation to our beneficiaries is vital to recruiting and retaining a high-quality force.”

McCaffrey and Place assured the panel that the changes would provide the right number of skilled personnel and facilities to care for the force. Organizational improvements in both the direct- and private-care systems would ensure that patients have “a more standardized, dependable, high-quality experience.”

By freeing the military services from managing separate facilities, commanders can focus on manning, training, and equipping the force critical to readiness. Operating costs, too, should become more manageable, allowing for overall spending to remain below National Health Expenditure inflation rates.

Army Lt. Gen. (Dr.) Ronald Place, director of the DHA, speaks to the House Armed Services subcommittee on personnel. (MHS photo)
Army Lt. Gen. (Dr.) Ronald Place, director of the DHA, speaks to the House Armed Services subcommittee on personnel. (MHS photo)

“We are incorporating the findings of decades of reviews and studies that suggest ways to address the MHS’ siloed nature that has produced undesired variability and too little standardization among the institutions operated by the DoD,” they said. “That fragmentation serves neither our readiness mission nor our ability to provide the patient experience our families deserve.”

The Military Health System currently operates 475 hospitals and clinics and 248 dental clinics around the world. These facilities serve as readiness platforms, McCaffrey and Place said, where medical professionals hone their clinical skills through day-to-day practice so when the time comes, these caregivers are ready to deploy worldwide in support of military operations.

Under the transition, the merger of hospitals and clinics into DHA will be complete within the next two years, McCaffrey and Place told the panel. The transition took a major step Oct. 25, when DHA assumed administration and management of stateside MTFs.

“Working with the services, the DHA has established a rigorous, conditions-based process for transitioning to a market-based management approach,” McCaffrey and Place said.

A market is a group of MTFs in a geographic area – typically anchored by a large hospital or medical center - that operate as a system sharing patients, providers, functions, and budgets across facilities to improve the coordination and delivery of health care services. Market offices will provide centralized, day-to-day management and support to all MTFs within each market.

Quality, safety, access, and best business practices would be standardized and common for all MTFs, McCaffrey and Place said. “In the long run, our patients will see significant benefits from this reform,” they said.

Additional initiatives include:

  • Medical manpower reform. The DoD’s FY2020 budget proposal includes plans by each military department to realign approximately 18,000 positions from the uniformed medical force to operational forces. “Each military department conducted an assessment of its medical readiness requirements and determined that a smaller military medical end strength was feasible and that the potential risk to their missions was manageable,” McCaffery and Place said. “The department is carefully assessing the impacts of the proposed reductions by location and specialty to ensure that we maintain access to quality care for our beneficiaries.” With the reductions slated to begin next year, the military’s medical departments and DHA are working with TRICARE contractors and local providers to ensure a smooth transition. Beneficiaries would remain informed of any changes coming their way.
  • TRICARE reform. Implementation of virtual-health capabilities – to include the 24/7 Nurse Advice Line and appointing system, cyber-safe online messaging and mobile apps and telehealth, each would play key roles. Access to preventive care has been expanded, and referral requirements for urgent care have been streamlined. The next generation TRICARE contract will also expand value-based care models focused on improving health outcomes. 
  • MHS GENESIS, the standardized electronic health record system. MHS GENESIS would replace the antiquated legacy systems, offering providers with a “single, off-the-shelf health record ready for use whenever a military professional delivers care,” McCaffrey and Place said. MHS officials paid close attention to the results of deploying MHS GENESIS at four sites in the Pacific Northwest two years ago. The lessons learned have been implemented in training protocols for new users, IT infrastructure upgrades, and change management for users. The system is now in place at four locations in California and Idaho. In 2020, it will begin deploying at military installations in cycles, with completion expected within the next two years, McCaffrey and Place said. The Department of Veterans Affairs begins deploying the same health record in 2020.

“Once the VA completes its deployment of the same EHR, our service members will have a single medical record that follows them from the first day they are sworn in through their time in the DoD and VA systems.” McCaffrey and Place said.

Joining McCaffrey and Place on the panel were surgeons general from the three services – Army Lt. Gen. Scott Dingle, Air Force Lt. Gen. Dorothy Hogg, and Navy Rear Adm. (Dr.) Bruce Gillingham, along with Joint Staff Surgeon for the Joint Chiefs of Staff Air Force Brig. Gen. (Dr.) Paul Friedrichs.

Subcommittee members on both sides of the aisle sought assurances from the panel that all beneficiaries of the military health care system, to include family members and retirees, would continue to receive the care they need.

Rep. Susan Davis, D.-Calif., asked for specifics regarding proposed billet cuts, and each surgeon general provided the lawmakers with the number of personnel exceeding their uniform requirements.

Hogg said the Air Force has “a little over 4,000 medics” in that category, and Dingle said the Army identified 6,935 for conversion. The Navy number of 5,386 “is based on a careful analysis of the National Defense Strategy,” said Gillingham. The assessment process is ongoing.

Speaking to the magnitude of transformation efforts, McCaffery likened consolidating hospitals and clinics into one agency to a major merger.

“What we talk about in terms of this MTF transition is really, in essence, like a merger of separate health-care systems,” he said. “It is a big, heavy lift, and anyone who would think – whether it’s the military or any other organization – that we wouldn’t have challenges [is] not speaking realistically.

“That being said, I believe we are in an excellent spot in terms of how we’ve managed this.” 

Throughout the process, McCaffrey said, the agency is working continuously with the Army, Navy and Air Force medical departments to “manage this transition in a way that we don’t let it affect our active duty or beneficiaries.”

McCaffrey also couched the discussion about cost savings in terms of effectiveness, brought forth by consolidating the system into one that can respond to any mission requirement and still take care of beneficiaries’ needs.

“I think Congress recognized in 2017 that we could be more effective as a military medical enterprise if we didn’t have four separate systems,” McCaffrey said.

In their place would be a single “system that could respond to the mission requirements as an enterprise [and] that could have more standardization across the system – not just for our beneficiaries in their experience of care, but most importantly how it affects operational missions.”

The ability to use the same equipment and devices downrange that are now in place at MTFs, McCaffrey said, would do more than merely generate cost savings. Ultimately, he told the lawmakers, the new system would be “even more successful in meeting the mission.”

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