The reforms are intended to develop a long-term strategic framework to help all MHS components to better coordinate and integrate their efforts and their shared mission of ensuring a ready medical force. They include both private sector and military medical treatment facilities (MTFs) of all sizes and types.

The first four “markets” in this optimization plan were successfully launched in the National Capital region, the central North Carolina region, Jacksonville Naval Hospital and surrounding health care facilities, and in the coastal Mississippi region.

In November, DHA restarted planning for the next five markets. Lein described the markets as “intermediate management organizations that group together synergies.” The next five are in the Tidewater region of Virginia; San Antonio, Texas; Puget Sound region of Washington state; Hawaii; and Colorado Springs, Colorado.

“These are very mature markets that have had multi-service cooperation since 2003 and 2004,” he noted. DOD plans to certify and stand up these markets by April.

The next 11 markets are smaller hospitals and clinics, which will be certified and stand up later this year.  The last three “will be the most challenging,” as they are made up of 90 small or stand-alone medical facilities across the United States, such as in Minot, North Dakota, Lein said.

There also will be a market for Europe and one for the IndoPacific. “The expectation is that these markets overseas are also available for combatant commands in case of conflict or major disasters,” Lein said.

The DHA is moving forward with the review and analysis of the MTFs, which is being done as part of the Section 703 mandate, a Congressional directive in the National Defense Authorization Act of 2017. Lein said this means “we have to ensure that the managed care support contractor has got the capability for caring for our beneficiaries to the same quality, and to the same standard, and to the same access that was provided on base.”

As for medical manpower reductions, which have been discussed in the past, Lein said, “there has been no agreement or commitment at any level between the secretaries or the secretary of defense on ways ahead for reduced military billets.”

What keeps Lein up at night? “The pent-up demand,” he said, for “new prescriptions for high blood pressure medications, cholesterol-reducing medications, diabetes, and cancer medications”. The prescription numbers “bottomed out in April” and “haven’t gotten back to baseline,” Lein noted.

The National Cancer Institute noted that cancer diagnoses were down 50% across the U.S. last year. “My concern…is we are going to have a lot of pent-up demand” for diseases that have not been diagnosed, such as breast cancer cases, “that will be worse than if diagnosed a year ago.” The same goes for lung and colorectal cancers, for diabetes, and high blood pressure, he added.

Lein said he fears “we’re going to get a bow wave of people coming in for care” and that the “huge and pent-up demand is going to come crashing down on our nation in terms of requiring care.”

“For appropriate reasons, people were scared to come in to medical treatment facilities or were told not to come in,” he said. Now, “we have put out the message to come in, at a minimum virtually, or in person.”