Military Health System: Modernizing with a Global Focus MG Richard W. Thomas, MD, DDS, FACS Director, Healthcare Operations DHA 16 September 2015 “Medically

Military Health System: Modernizing with a Global Focus

MG Richard W. Thomas, MD, DDS, FACSDirector, Healthcare Operations DHA

16 September 2015

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

The“ Why”

2

Agenda

• MHS Reform and the Defense Health Agency (DHA)

• Military Health System (MHS) Strategic Landscape

• Future Operational Environment

• Conclusion

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force” 3

The World We Live In...

Artic Land Right DisputesArtic Land Right Disputes

Cyber attacks on Cyber attacks on critical critical

InfrastructureInfrastructure

Cuba Cuba InstabilityInstability

Support to Civil Support to Civil AuthoritiesAuthorities

Destabilizing Destabilizing TCOsTCOs

Haiti in CrisisHaiti in Crisis

Columbia Columbia InsurgencyInsurgency

Venezuela Venezuela InstabilityInstability

Peru Peru InsurgencyInsurgency

Counter-narcotic Counter-narcotic OperationsOperations

Terrorist Terrorist WMD threatWMD threat

Natural Natural DisastersDisasters

UnaccompaniUnaccompanied Minorsed Minors

WildfiresWildfiresBorder Border

SecuritySecurity

EbolaEbola

Military-Military Military-Military PartnershipsPartnerships

COCOM Theater COCOM Theater Security Security

Cooperation Cooperation ProgramProgram

EgyptEgypt

Balkan Balkan InstabilityInstability

Pakistan Pakistan TensionsTensions

Territorial Territorial DisputesDisputes

PiracyPiracy

AfghanistaAfghanistann

Ukraine/Ukraine/Russia Russia

TensionsTensions

China/China/India India

RivalryRivalryIsraeli/ Israeli/ Palestinian Palestinian

TensionTension

Boko Boko HaramHaram

Yemen Yemen InstabilityInstability

ISIL/ISISISIL/ISIS

EU EU FrictionFriction

Domestic Domestic Terrorist Terrorist threatsthreats

LibyaLibya

HumanitariHumanitarian Crisisan Crisis

Governance Governance ChallengesChallenges

CorruptionCorruption

Sudan Sudan ConflictConflict SomaliaSomalia

SE Asia SE Asia TensionsTensions

PDRKPDRKWMDsWMDs

ChinChinaa

IndiaIndia

FamineFamine


Who We Are:

• 151,785 personnel (84,564 military / 67,221 civilians)

• 55 Inpatient hospitals and medical centers

• 373 Ambulatory care clinics

• 264 Dental clinics

• 253 Vet clinics

• 550,194 Network providers

• 3,812 TRICARE network acute care hospitals

• 1,757 Behavioral health facilities

• 59,670 Contracted (network) retail pharmacies

Who We Serve: 9.5 M Beneficiaries

• 5.0 M TRICARE Prime

• 3.7 M in direct care

• 1.3 M in contractor networks

• 2.3 M TRICARE Standard/Extra

• 2.0 M TRICARE For Life

The Military Health System*:Who We Are and Who We Serve

*FY 2015 TRICARE Annual Report


MHS Spending Over Time

Includes Normal Cost contributions to the Medicare Eligible Retiree Health Care Fund (MERHCF)

Military Health System Expenditures

Drivers of Healthcare Costs•Health care inflation (5.7% projected between 2013-23)•Demographics (age, lifestyle, chronic conditions)•Emerging (and often expensive) new treatments

Drivers of Healthcare Savings•Standardization across the enterprise•Optimization of direct care system•Integration across direct and purchased care systems•Health of the Force


USD(P&R)ASD(HA)

DHA Director

POLICY DEVELOPMENT & OVERSIGHT

POLICY EXECUTION Combat Support Agency Responsibilities

Admin & Mgt EEOO Comptroller

DHA OGC

Special Staff

Manpower

EHR Functional Champion

METC HQ

DMRTI

JMESI

IPO PEO DHMS

Secretary of Defense

Chief of Staff

Component Acquisition Executive

Analytics

Communications

Prog IntegrationSmall Business

Def Health BoardStrategic Mgt

HA / DHA Liaison

Procurement

Innovation

DoD/ VA PCO

CJCS

NCR MedicalDirectorate

Business Support Directorate

Health IT Directorate (CIO)

Research Development & Acquisition Directorate

Healthcare Operations Directorate (CMO)

Education & Training Directorate

Defense Health Agency

Academic Review& Oversight

Prof Development , Sustainment, & Prog Mgmt

Shared ServiceShared Service

TRICARE Health Plan

Pharmacy

Clinical Support

Public Health

Readiness

Warrior Care Program

Advanced Development

Science & Technology

Clinical Infrastructure Program

Veterans Affairs R&D Liaison

Portfolio Mgmt and Customer Relations

Innovation and Advanced Technology Dev (CTO)

Infrastructure & Operations

Solution Delivery

Defense Health Service System (DHSS)

Defense Health Clinical Systems (DHCS)

Information Delivery

Cyber Security

Facility Planning

Medical Logistics

Budget & Resource Management

Program Integrity

Walter Reed NationalMilitary Med Center

Ft. BelvoirCommunity Hospital

Joint Pathology Center

Operations

7

Military Services Total Force and Medical Department Comparisons

““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

Source: DMRR, FY2015

Army Air Force Navy (MC)

10.4%

8.1%

9.2%

9.8%

9.9%

9.8% 7.3%

8.7%

7.5%

Medical Departments

Total Military Strength

8

Five Essential Characteristics of Leadership within Military Medicine

9““Medically Ready Force…Ready Medical Force”Medically Ready Force…Ready Medical Force”

And The Operational Environment That Lies Ahead...


“Medically Ready Force… Ready Medical Force”

TheaterHospital

Care

Definitive Care

“Level 4”

CASEVAC/MEDEVAC Policy: 1 Day

TACTICAL AEPolicy: 7 Days

STRATEGIC AEPolicy: 15 Days

Damage Control

Resuscitation/Surgery< 1 Hour

< 24 Hours

2-3 Days

Tactical CombatCasualty Care

Continuum of Care


Leveraging Science and Technology


National Security /Military StrategyImplications for Military Medicine

• Urgency remains high for robust medical research portfolio across the spectrum of military operations

• Threats continue from both combat and non-combat scenarios (e.g., infectious disease and stability of governments)

• Acute, intermediate and long-term needs (PTSD, TBI, amputee care) of our service members and veterans remain a core moral obligation of the Department and the Nation


Questions?


Documents

Military Health System: Modernizing with a Global Focus MG Richard W. Thomas, MD, DDS, FACS Director, Healthcare Operations DHA 16 September 2015 “Medically