Colonel Christopher PriestDirector, Reserve Medical Programs

Force Health Protection and ReadinessOffice of the Assistant Secretary of Defense for Health Affairs

DEPLOYMENT HEALTH ASSESSMENT 2012 USAR LEADERSHIP CONFERENCE

SEPTEMBER 21, 2012

Purpose

Provide an overview of the Department of Defense policy guidance, reported data

trends and observations of program management concerns

2

Agenda

• Why do we need a Post Deployment Health Assessment/Reassessment?

• Integrating the Health Assessment Cycle• Current policy and statutory requirements• Health Affairs Quality Assurance Program

– Observations on compliance– Referral Management– QA follow-up

• Conclusion

3

PDHRA – Good for the Army

• Critical Commander tool for promoting wellness and enhancing unit readiness

• Drives early identification of health issues post-deployment

• Prioritizes treatment of potentially serious conditions that result from deployment

• Promotes post-deployment reintegration

4

PDHRA – Good for the Soldier

• Enhances the deployment-related continuum of care

• Provides screening and opportunity for Soldier education

• Identifies resources; facilitates access to care

• Can serve as a tool to guide restoration of health and functioning after deployment

5

PDHRA – A Collaborative Effort

• Health Affairs – Establishes DoD policy, develops the tool, monitors adherence

• Army G-1 – Leads the effort; ensures Army policy consistency, develops procedures for implementation

• Human Resources – Oversees the program; ensures timelines are met

• Medical Community – Ensures proper screening and follow-up care if needed

• Line Leadership – Involvement and support are crucial to success

• The Soldier – It’s always about the Soldier and their Families…keep the main thing the main thing

6

Health Assessment Cycle

Retirement/Separation &

Beyond

Post-Deployment

Re-assessment

Pre-Deployment

Deployment

In Garrison

AccessionBaseline Health

Assessment

SecondaryPrevention

TertiaryPrevention

Periodic Health

Assessment

Post-Deployment

PrimaryPrevention

Operations

Mental Health

Assessments

7

Review of Current Policy

• DoDI 6490.03 is the principal DoD policy guidance– Assessments required for:

• Readiness to deploy • Negative effects of deployment on health• Requires pre- and post-deployment health assessments, and;• PDHRA conducted 90-180 days following return from deployment• Enhanced in late 2007

– Added coverage for TBI, alcohol abuse, impact of physical or emotional problems on work, relationships, etc.

– Standardized questions in the PDHA wherever possible– Re-certified in September, 2011– Pertinent Army Regulations: 40-66, 40-501

• Revising Assessments– All deployment assessments are being revised– Goal: Make as science-based and user-friendly as possible

8

Changes to DD 2900 (PDHRA)

• Incorporate Mental Health Assessment per NDAA12

• Question sequence

• Comment space for Soldier responses

• Alcohol audit-C questions – raise cut off

• Deleting TBI questions

• Additional guidance for provider

• Modify demographic information

• Additional comment space for clinician

• Soldier unsure response options deleted

• Exposure open ended question

• Modify force protection questions

• Deleting Major/Minor Concerns

9

Review of Current Policy: 2012 NDAA Section 702

• Mental Health Assessment mandate – Updates requirements mandated in NDAA10, Sec 708:

• Conducted in a private setting• Administered by qualified clinicians• Results recorded in medical record;

– Change in scheduling• Pre-deployment: beginning 120 days before deployment• Post-deployment: 180-365 days after redeployment; 18-30 months

after redeployment • PDHRA form revised to incorporate mental health assessment

• RCs lack electronic means to conduct MH assessments and upload to MEDPRO– Manual System; form storage and retrieval issues?– Case Management?

10

TRICARE and the VA

• TRICARE Eligibility and Access‾ Transition Assistance Management Program (6 mos) post -

deployment is an invaluable tool for Soldier Reintegration• Full TRICARE benefit at no-cost to the Soldier• Resolved the concurrent benefit issue for those Soldiers

retained on Active Duty for medical care

‾ Services authority to retain or return to Active Duty those Soldiers who meet the criteria for Medical Retention Processing

‾ Care authorized by the Medical Management Support Office (MMSO) for documented LOD conditions resulting from the period of active duty

• This is a Hot Topic issue with TMA and the Services• Documentation is the key

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TRICARE and the VA

• Veterans Affairs‾ Is an invaluable partner to provide continuity of care‾ Provides up to five years of care post-mobilization

• DD214• Provides full access to the VHA as a category 6 beneficiary

‾ Military Health Record data (AHLTA) is available to the VA‾ VA record data is not readily available to the RC… you have

to ask for it‾ Bi-directional data feeds is a key topic in the DoD-VA

working groups

• Other challenges‾ Difficulty in integrating personal health insurance utilization ‾ Referred care conducted by means other than the Federal

programs is difficult to coordinate12

Force Health Quality Assurance

• Pertinent findings from 2011/12 QA Visits:– PDHRAs are being administered, however:

• PDHRAs are not getting into AFHSC’s Defense Medical Surveillance System (Service data feed, not a compliance issue)

• Compliance with meeting the 90-180 day timeline has improved!• There's little evidence Service Members are getting help for

identified issues, especially within the Guard and Reserve– Disconnects between Personnel and Medical– Lack of a referral tracking tool– Lack tracking of referral recommendations, limited case

management– Follow-up largely unknown after initial screening except for

encounter data from the Military Health System

– A lot of focus on pre-deployment and post-mobilization medical issue identification, but not enough focus on PDHRA medical issue tracking and follow-up

13

14

Deployment Health Assessment Process

Navy, Marine, Coast Guard

members initiate health assessment

Army members

initiate health assessment

Air Force members

initiate health assessment

Assessment printed and

put in Service Member’s

record

Assessment sent to AFHSC

(electronic)

Assessment stored in Service system

(electronic)

Assessment stored in DMSS

Electronic Health Record (AHLTA)

Sent to VA

Data available for analysis

Does not meet AFHSC business rules (a non-

valid SSN or a non-valid form date

(including future dates))

Services notified of assessment forms requiring

adjudication

Available to Providers who have ability to assess

Service System

DHIMS

Meets AFHSC business rules

Completed by Provider

Completion of PDHRA (DD2900)based on CTS Roster

Data Source: DMSSPrepared by: Armed Forces Health Surveillance Center (AFHSC)

FHP&R Proponent: Col Butel

Data Source: DMSS (AFHSC)

Related Policy: DoDI 6490.03

RC data reflects completion as of certification date, and removal of those deployed to unknown deployment location

This metric reflects the proportion of those returning from deployment who have completed the DD2900 health assessment within 60 days prior and up to 210 days post deployment end based on the “Provider Certification Date”

Deployment dates are based on DMDC rosters and includes deployments lasting longer than 30 days Excludes those without a deployment end date and those with an unknown deployment location 15

63

50

6760

52

0

7364

76

39

69

20

20

40

60

80

100

DOD Air Force Army Navy Marines Coast Guard

23568 3479 18093 463 1486 47

% o

f tho

se w

ho re

turn

ed fr

om d

eplo

ymen

t and

co

mpl

eted

the

DD

2900

DD2900 RESERVE COMPONENTS

2010Q4 2011Q4 2011Q3

Deployment Health Assessments, Feb - Jul 2012% Active Duty Army – Top % Army Reserve/National Guard – Lower

General Health Good to

Excellent

Medical or Dental Problems Reported

Medical Referral Indicated

Pre-deploy (DD 2795)

96%

99%

13%

9%

6%

3%

Post-deploy (DD 2796)

89%

88%

32%

39%

23%

26%10% are Emergency or

Immediate care referrals

Post-deployReassessment

(DD 2900)83%

81%

29%

45%(Depression 9%; PTSD 128%;

TBI 6%, Alc 33%)

18%

26%

16

TBI Recommended Referrals and Types of MHS Encounters (60 days) - PDHA

17

This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2796 health assessment within 60 days prior and up to 60 days post deployment return based on the “Provider Certification Date”

Follow-up encounters include those encounters that occurred following a TBI referral within 60 days of the provider certification date on the DD2796

Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS

*Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard

FHP&R Proponent: Ms. Elizabeth Fudge

Related Policy: 10744f of Title 10 US Code of Public Law 108-375

Data Source: DMSS data compiled and summarized by AFHSC

14% 15%

56%32%

17%2%

7% 3%

11%

9%

25%12% 3%

31%16%

12%

21% 50%

50%33%

50%12%

8%

33%

44%

17%30%

25%

50%

25%

17%

35%

19%

14% 22%4% 7%

100%

67%

25%

67%

41%

68%

0%

20%

40%

60%

80%

100%

Reserve National Guard

Reserve National Guard

Reserve Reserve Reserve National Guard

Reserve National Guard

Reserve Reserve Reserve Reserve

Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4

2010 2010 2011 2011 2010 2011 2010 2010 2011 2011 2010 2011 2010 2011

5,864 6,912 365 40 555 652 115 324 5 4

Army Navy Air Force Marine Corps Coast Guard

Perc

ent o

f Ser

vice

Mem

bers

with

a p

ositi

ve T

BI

Rec

omm

ende

d R

efer

ral o

n th

e D

D27

96

TBI and MH Medical Encounter After TBI Recommended Referral on DD2796 within 60 days Only TBI Encounter After TBI Recommended Referral on DD2796 within 60 days Only MH Encounter After TBI Recommended Referral on DD2796 within 60 days Any Other Encounter After TBI Recommended Referral on the DD2796 within 60 days No Known Medical Encounter After TBI Recommended Referral on DD2796 within 60 days

Mental Health Recommended Referrals and Types of MHS Encounters (60 days) - PDHRA

18

This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2900 health assessment within 90 days to 180 days post deployment return based on the “Provider Certification Date”

Follow-up encounters include those encounters that occurred following a positive MH Referral within 60 days of the provider certification date on the DD2900

Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS

*Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard

FHP&R Proponent: Lt Col Lawson

Related Policy: NDAA 2012, Section 702; 10744f of Title 10 US Code of Public Law 108-375

Data Source: DMSS data compiled and summarized by AFHSC

10% 11% 12% 9% 8%

38%

11% 6%27%

16% 10%

26% 23% 23% 23% 29%

50%

50% 23%22%

22%22%

12%

64% 67% 65% 68% 64%

13%

50%66% 72%

52%62%

77%

0%10%20%30%40%50%60%70%80%90%

100%

Reserve National Guard

Reserve National Guard

Reserve Reserve Reserve National Guard

Reserve National Guard

Reserve Reserve Reserve Reserve

2010 2010 2011 2011 2010 2011 2010 2010 2011 2011 2010 2011 2010 2011

Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4 Q4

685 3,971 1,566 4,769 205 25 25 194 67 213 80 404 0 0

ARMY NAVY AIR FORCE MARINE CORPS COAST GUARD

Perc

ent o

f Ser

vice

Mem

bers

with

a P

ositi

ve M

H

Rec

omm

ende

d R

efer

ral o

n th

e DD

2900

MH Medical Encounter After MH Recommended Referral on the DD2900 Any Other Encounter After MH Recommended Referral on the DD2900No Medical Encounter After MH Recommended Referral on DD2900

The Challenge…

• Essential to track PDHRA referrals and document Line of Duty requirements

• USAR must shift into a case management mentality

• It is not enough to simply comply with the PDHRA requirements . There are tools to ensure Soldiers get follow-on care but the clock is ticking

• Stratify the effort, what do you care about most?

• Impacts on a fit and healthy operational force, capable of sustained operations

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The Way Ahead

• Avoid assessment fatigue– Command must emphasize importance of assessments– Provide help for identified concerns to show value– Make assessments easy and efficient for personnel and providers

• Enhance efficiencies and increase Soldier compliance– Work to synchronize timing of all deployment-related required

assessments to reduce soldier burden, reduce time away from training and for RC, time away from civilian employment

• PDHRA timeliness is critically important– Health issues tend to worsen if not addressed– 180-day TAMP eligibility facilitates seeking care

• Follow-up is key– Failure to act negatively impacts everyone – Soldiers/civilians,

their families, and the Army – Track the referrals to conclusion– The Gold Standard: Integrated delivery of health care

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You Are Critical to Success

• The Army and Line Leaders– Leadership and support

• Positively affects Soldier attitude• Maximizes operational readiness

– Day-to-day program execution

• Human Resources – Oversees the program– Ensures timelines are met

• Medical Community – Identifies concerns– Provides early treatment and intervention

• Conference Organizers– Conveys program importance– Increases program effectiveness

•

Automate the Process!

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Conclusion

Thank You!

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