Supporting the Deployment of Healthy, Resilient and Fit Soldiers:

Soldier Medical Readiness

UNCLASSIFIED

10 October 2011

LTG Eric B. SchoomakerThe Army Surgeon General and

Commanding General, U.S. Army Medical CommandMG Richard A. Stone

Deputy Army Surgeon GeneralBG Darryl A. Williams

Commander, Warrior Transition Command andAssistant Surgeon General for Warrior Care

BG Brian C. LeinCommand Surgeon, U.S. Army Forces Command

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 1 of 32

Requirements

Medically Ready Force

Demand is high, but manageable.

Before Pre - Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 2 of 32

Requirements

Medically Ready Force Demand remains high, but manageable.

Budget and resources shrink.

Before With Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

Office of The Surgeon General 12 October 2011Slide 3 of 32

Requirements

Medically Ready Force

Modularity moved the faucet.

UNCLASSIFIED

After End of Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Demand increases but resources decreased (TESI)

Medically Not Ready Population

Office of The Surgeon General 12 October 2011Slide 4 of 32

Requirements

Medically Ready Force

Increasing Medically Not Ready PopulationForced the faucet to be moved higher to meet demand.

UNCLASSIFIED

ARFORGEN Cycle

Current End of Temporary End Strength Increase (TESI)

Demand remains high, TESI gone and MNR still increasing

Medically Not Ready Population

Medically Not Ready

A Strategic Problem

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10-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 4 of 32

Requirements

Medically Ready Force

OVERVIEWBefore

Demand is high, but manageable.

Pre - Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

Medically Not Ready

A Strategic ProblemUNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 1 of 32

Requirements

Medically Ready Force

Demand is high, but manageable.

Before Pre - Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 2 of 32

Requirements

Medically Ready Force Demand remains high, but manageable.

Budget and resources shrink.

Before With Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

Office of The Surgeon General 12 October 2011Slide 3 of 32

Requirements

Medically Ready Force

Modularity moved the faucet.

UNCLASSIFIED

After End of Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Demand increases but resources decreased (TESI)

Medically Not Ready Population

Office of The Surgeon General 12 October 2011Slide 4 of 32

Requirements

Medically Ready Force

Increasing Medically Not Ready PopulationForced the faucet to be moved higher to meet demand.

UNCLASSIFIED

ARFORGEN Cycle

Current End of Temporary End Strength Increase (TESI)

Demand remains high, TESI gone and MNR still increasing

Medically Not Ready Population

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 3 of 34

Requirements

Medically Ready Force

OVERVIEWBefore

Demand is high, but manageable.

Pre - Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 4 of 34

Requirements

Medically Ready Force

OVERVIEWBefore

Demand remains high, but manageable.

Budget and resources shrink.

With Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Medically Not Ready Population

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OVERVIEWAfter

Office of The Surgeon General 12 October 2011Slide 5 of 34

Requirements

Medically Ready Force

Modularity moved the faucet.

UNCLASSIFIED

After End of Temporary End Strength Increase (TESI)

ARFORGEN Cycle

Demand increases but resources decreased (TESI)

Medically Not Ready Population

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OVERVIEWCurrent

Office of The Surgeon General 12 October 2011Slide 6 of 34

Requirements

Medically Ready Force

Increasing Medically Not Ready PopulationForced the faucet to be moved higher to meet demand.

UNCLASSIFIED

ARFORGEN Cycle

After End of Temporary End Strength Increase (TESI)

Demand remains high, TESI gone and MNR still increasing

Medically Not Ready Population

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email address For more information go to: https://ke2.army.mil/bsc

- Promote, Sustain and Enhance Soldier Health- Train, Develop and Equip a Medical Force that Supports Full Spectrum Operations - Deliver Leading Edge Health Services to Our Warriors and Military Family to Optimize Outcomes

This has been a dynamic, living document since 2001

America’s Premier Medical Team Saving Lives, Fostering Healthy and Resilient PeopleARMY MEDICINE

Bringing Value…Inspiring TrustMaximize Value in Health Services

Effectively and efficiently provide the right care at the right time to

promote a healthy population and ready force.

Provide Global Operational Forces

Agile and adaptive medical teams ready to execute relevant,

responsive Health Services in any operational environment and in combination with any partnered

team.

Build the Team

A compelling place to serve and a preferred partner in leading joint interagency

health services.

Balance Innovation with Standardization

A culture of innovation which provides standardized solutions to support best

practices and optimal outcomes.

Optimize Communication and Knowledge

ManagementLeverage Communication to impart

knowledge and build meaningful, positive relationships.

Pat

ient

/Cus

tom

er/

Sta

keho

lder CS 5.0

Inspire Trust in Army

Medicine

CS 3.0 Responsive Battlefield

Medical Force

CS 2.0 Improved Healthy and

Protected Families, Beneficiaries and

Army Civilians

CS 1.0 Improved

Healthy and Protected Warriors

CS 6.0 Improved

Patient and Customer

Satisfaction

IP 1.0 Optimize Medical

Readiness

IP 8.0 Build Relationships and Enhance Partnerships

LG 2.0 Improve

Training and Development

IP 2.0 Improve

Information Systems

CS 4.0 Optimized Care and

Transition of Wounded, Ill, and Injured Warriors

IP 3.0 Implement

Best Practices

IP 9.0 Tell the Army Medicine

Story

LG 4.0 Improve

Knowledge Management

LG 1.0 Improve Recruiting and Retention of

AMEDD Personnel

Inte

rnal

Pro

cess

Lear

ning

and

G

row

th LG 3.0 Promote and Foster a

Culture of Innovation

IP 6.0 Improve Quality,

Outcome-Focused Care and Services

IP 5.0 Maximize Physical and Psychological

Health Promotion and Prevention

IP 7.0 Improve Access and Continuity of

CareIP 11.0

Synchronize Army Medicine

to Support Army Stationing &

BRAC

R 1.0 Optimize

Resources and Value

R 2.0 Optimize Lifecycle Management

of Facilities and IT Infrastructure

R 3.0 Maximize Human Capital

END

SM

EAN

SW

AYS

Res

ourc

e

IP 10.0 Leverage Research,

Development and Acquisition

Feedback Adjusts

Resourcing D

ecisions

To deliver the Strategic

Processes...

That achieve

our Strategic

Ends

We marshal our

Resources…

And enable our

People…

IP 4.0Provide

Safe Patient Care

UNCLASSIFIED

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Army Medicine TOP “10”

Office of The Surgeon General 12 October 2011Slide 8 of 34

Implement Comprehensive Pain Management Campaign Plan (CPMCP)

Develop and Implement Dismounted Complex Blast Injury Campaign Plan

Implement the Patient Centered Medical Home

Implement the Culture of Trust

Implement Soldier Medical Readiness Campaign Plan (SMRCP)

Support Physical DisabilityEvaluation System (PDES) Improvements

Implement mTBI/ConcussiveInjury Protocols

Implement Comprehensive BehavioralHealth System of Care (CBHSOC)Campaign Plan

Support to the HSS Assessment Task Force in Afghanistan

Design Civilian Workforce Development Plan

Develop Army Medicine Support to an IntegratedDOD – DVA Electronic Health Record

Plan, Resource, and ExecuteTSG/CG MEDCOM Transition

UNCLASSIFIED

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressOffice of The Surgeon General 12 October 2011Slide 9 of 34

The Soldier Medical Readiness Campaign Plan (SMR-CP) ensures a healthy and resilient force by:

• Identifying Medically Not Ready (MNR) Soldiers

• Coordinating programs to reduce the MNR population in

partnership with Forces Command, VA, and Leaders at

all levels

• Using Evidence-Based Programs for Health Promotion

and Injury Prevention

• Educating and informing the force

SMR-CP returns the maximum number of Soldiers to available/deployable status.

OUR MISSION TO SUPPORT SOLDIER READINESS

UNCLASSIFIED

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BG Brian C. LeinCommand Surgeon, U.S. Army Forces Command

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BOTTOM LINE UP FRONT

Numbers of non-deployable Soldiers have been increasing over the past five + years due to multi-factorial challenges

Top priority of Forces Command (FORSCOM) to decrease the number of non-deployable Soldiers significantly

Integrated Disability Evaluation System - a challenge across the Active and Reserve Component Force

Temporary Disability Retired List – an increasing and unrealized workload demand

Combined MEDCOM, IMCOM, FORSCOM, and DA strategic focus to ensure Soldiers are cared for and processes in place to fix the Non Deployable problem

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 11 of 34

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CURRENT ACTIONS (1 OF 2)

Commanders tracking Soldier and unit medical readiness at all leadership echelons, and reporting monthly

Getting after low hanging fruit now (delinquent Periodic Health Assessments, Hearing, Vision, Women’s Readiness, HIV)

Comprehensive training at Commander/1SG courses

Brigade Surgeon initiative

Ready = Available = Deployable-CSA Readiness Initiative

Standardizing reporting

Developing a standardized process for continuous Soldier Readiness Processing of Soldiers and units

Implementing directives to formalize tracking medical non-deployable status with gates of 90-180-240 days

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 12 of 34

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CURRENT ACTIONS (2 OF 2)

Participation in Soldier Medical Readiness Campaign Plan (consolidation of MEDCOM Medically Not Ready Campaign Plan and Army Command Personnel Non Deployable Campaign Plan)

Reviewing Combatant Command deployability standards - working towards DoD solution

Continuous Senior Level tracking of the effectiveness of the Integrated Disability Evaluation System

Implementing directives to improve the demobilization process for Reserve Component Soldiers

Comprehensive Soldier Fitness is key for Soldiers and Families

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 13 of 34

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MG Richard A. Stone Deputy Army Surgeon General

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CONCEPT OF OPERATIONS

Ensure Strategic Effectiveness & Communication EFFECTIVENESS & COMMUNICATION

Implement the Medical Management Programs

for the MNR Soldier Population

MEDICAL PROGRAMS

Identify the Medically Not Ready (MNR)

Soldier Population

MNR IDENTIFICATION

Coordinate, synchronize & integrate Health Promotion and

Injury Prevention Programs Across the

Army

HEALTH PROMOTION

End State: Support the deployment of healthy, resilient, and fit Soldiers and increase the medical readiness of the Army. Effectively manage the medically not ready population to return the maximum number of Soldiers to available/deployable status.

Optimize medical readiness systems

Enhance Soldier care to increase

medical readiness

Improve health and fitness, and

reduce injury rates

One unified effort to increase the medical readiness of the Army:Coherence across identification, medical programs, health promotion, assessment and communication

Office of The Surgeon General 12 October 2011Slide 15 of 34 UNCLASSIFIED

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IMPROVE MEDPROS ACCURACY / EFFICIENCYAND IMPLEMENT EPROFILE

-

5,000

10,000

15,000

20,000

25,000

30,000

35,000

40,000

45,000

50,000

Permanent 3 & 4 Profiles MRC 3B Temporary 3 & 4 Profiles

Source: MEDPROS and eProfile

MEDCOM ePROFILE

OPORD

Automation of medical non-deployables

HQDA EXORD

Published

MEDPROS began receiving Temp

Profiles > 30 days

Office of The Surgeon General 12 October 2011Slide 16 of 34 UNCLASSIFIED

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Other*Cardiovascular

Headache Maternal

Genitourinary Infect/Parasite

Digestive Resp Disease

Skin Sense Organ

Resp Infections Musculoskeletal

Ill-defined ConditionsMental Injury

Medical encounters

Individuals affected

Hospital bed days

Relative Burden of Injuries and Diseases, U.S. Army Active Duty, 2010

*Includes all ICD-9-CM code groups with less than 60,000 medical encountersDiagnosis group Injury contains both injury and musculoskeletal related injuriesPrepared by USAPHC Injury Prevention Program; Data source: Defense Medical Surveillance System, 2010

DATA-DRIVEN FOCUS OF LOE 3.0

Injuries are a leading health problem

Office of The Surgeon General 12 October 2011Slide 17 of 34 UNCLASSIFIED

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WHAT ABOUT MUSCULOSKELETAL INJURIES?

2nd leading cause for MEDEVAC

5th leading cause for hospitalizations

25 million limited duty days

$548 million in healthcare costs per year

73% of all VA disability cases are musculoskeletal

Office of The Surgeon General 12 October 2011Slide 18 of 34 UNCLASSIFIED

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SCREENING FIELD TESTS

Arch HeightGrip Strength

MovementStability

6 M Hop

Horizontal leap

Body CompAgility

Sprint/RAST

Balance

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MILITARY POWER PREVENTION AND PERFORMANCE (MP3): FT LEWIS STUDY

Risk Algorithms Developed & Tested in Collegiate/ Professional Athletes

Validate Algorithms in SOCOM, BCT, & Support

Units at Ft Lewis

VALIDATE

UNCLASSIFIED

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PERFORMANCE FUELING TO ENHANCE READINESS & RETURN TO DUTY

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 21 of 34

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“…the medical community needs to transform American medicine from a sick-care paradigm to a health-care paradigm where disease and injury prevention become the foundation for American health care. We in the Army must be part of that

transformation." LTG Eric B. Schoomaker, The Army Surgeon General

ResilienceShift toward prevention & early intervention

Threshold of adverse outcomes

Early assessments shifts away

from the threshold

UNCLASSIFIEDOffice of The Surgeon General 12 October 2011Slide 22 of 34

SHIFT

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BG Darryl A. Williams Commander, Warrior Transition Command

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“Soldier Success Through Focused Commitment”

WARRIOR CARE and TRANSITION PROGRAM

ARMY MEDICINE INSTITUTE OF LAND WARFARE PANEL

10 OCTOBER 2011

Office of The Surgeon General 12 October 2011Slide 24 of 34 UNCLASSIFIED

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Provide centralized oversight, guidance and advocacy empowering wounded, ill and injured Soldiers, Veterans and Families through a comprehensive transition plan for successful reintegration back into the force or into the community with dignity, respect and self-determination.

Wounded Illness Injured

“OUR MISSION…”

Office of The Surgeon General 12 October 2011Slide 25 of 34 UNCLASSIFIED

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Ft Hood

Ft SillFt Campbell

Ft Knox VAFt Eustis

Ft Stewart

Ft Bragg

Ft Gordon

Ft Jackson

Ft Belvoir

Ft Dix

FL

AR

Ft MeadeWRAMC

Ft Drum

West Point

MA

Ft Huachuca

Ft Sam Houston

Ft Polk

Ft Leonard WoodFt RileyFt Irwin

IL

Montana

North Dakota

South Dakota

Nebraska

KansasArizona

Texas

Oklahoma

Minnesota

Iowa

Missouri

Arkansas

LA MS

Wisconsin

IndianaOhio

WestVirginia

Penn.

Virginia

GeorgiaSC

NC

NY

Kentucky

VTNH

Maine

TN

CTMichigan

PR

Ft Wainwright

Schofield Barracks

Ft Richardson

Ft Carson

Wyoming

Colorado

Oregon

Idaho

Ft Lewis

UT

HI

AKWashington

CA

Balboa

Nevada

California

Ft Benning

AL

New Mexico

Michigan

Ft Irwin

Ft Bliss

Pacific RMC(Total 256)

Western RMC(Total 2,337)

Northern RMC(Total 3,219)

Southern RMC(Total 3,952)

)

Europe RMC(Total 120)

Warrior Transition Unit (WTU) Brigade (2)

WTU Battalion (15)

WTU Separate Company (12)

Community Based WTU (color by AOR) (9)

Soldiers in Units:WTU – 7,668CBWTU – 2,216Total – 9,884

Soldiers by COMPO:Active – 4,593ARNG – 3,193USAR – 2,098Total – 9,884

Office of The Surgeon General 12 October 2011Slide 26 of 34

“WHERE WE ARE…”

UNCLASSIFIED

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DoctrineWarrior Care

and Transition Program policies &

orders

TrainingWTU cadre

training courses, AW2

Advocate training

Organization29 WTUs and 9 CBWTUs

supporting an Army at war

MaterielProviding Soldiers

adaptive sports equipment to facilitate well-

being and healing

LeadershipLeader training at

PCCs, WTC leader course,

Annual Training Conferences

Personnel4,422 cadresupporting

47K Soldiers since 2007

FacilitiesWTU complexes provide a healing

environment for our Soldiers (27 projects

at 20 WTUs)

87% of current population have

deployed

10% of current population is

combat wounded

Separate18k Soldiers

have separated from the Army since Jun 07

Reset Train/Ready Available

Supporting the ARFORGEN Cycle

RC Soldiers inPost-

MobilizationScreening

(21%)

WCTP

Return to the ForceWTU/CBWTUs have

returned 19kSoldiers back to the force since Jun 07

Soldiers inpre-Mobilization

Screening(2%) Soldiers Injured

or who become Ill(45%)

Army Theme AlignmentPeople are our Army.Providing comprehensive support to Soldiers and Families.Nation's Force of Decisive Action –Ready Today, Prepare for TomorrowWarrior Transition Units inculcate resiliency.Meeting the Needs of the NationRetaining trained, experienced and resilient Soldiers benefits the Army and the Nation: estimated $6.1B in cost avoidance.

MEDCOM Theme AlignmentBringing ValueCurrently supporting 10k Soldiers and an additional 37k Soldiers since 2007.Inspiring TrustEmbodies the Army and Nation’s commitment

Total Population9,884

Office of The Surgeon General 12 October 2011Slide 27 of 34

MEDEVAC Soldiers

from theater(32%)

“SUPPORTING AN ARMY AT WAR…”

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Post Transition

Inprocessing

Assessment

Goal Setting

Transition Review

Rehabilitation

Reintegration

Car

eer

Em

otio

nal

Soc

ial

Fam

ily

Phy

sica

l

Spi

ritua

l

Parent Unit

Event

WTUAssignment

Decision

Transition from the Army

Remain in the Army

Number One Priority

Soldier Owned

Road Map

Goal SettingARFORGEN

Path to Independence

Comprehensive Transition Plan (CTP)

CTP Domains

CTP

Pro

cess

es

Office of The Surgeon General 12 October 2011Slide 28 of 34

Productive CivilianVeterans Affairs Medical CareTRICARECareer TransitionEducationWounded Warrior

“FOCUS ON THE FUTURE…”

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26-Oct-11Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressOffice of The Surgeon General 12 October 2011Slide 29 of 34

Warrior Transition Unit Community Based WTU

WTU

TRIAD of CAREPCM

1:200

1:10

SL

NCM

1:20

Squad Leader

Nurse Case Manager Medical Management

Primary Care ManagerSynchronize Specialty Care

• For all components

• Traditional Chain of Command (Squad Leader - Battalion Commander)

• Focused “Triad of Care” for each Soldier

• Army Wounded Warrior (AW2) Advocate for most seriously injured

• Best facilities on post; priority medical care

• Dedicated Family Support

– Soldier Family Assistance Center (SFAC)

– Family Readiness Support Assistant (FRSA)

• Primarily for Reserve Component Soldiers

• Modified Chain of Command (Platoon Sergeant – CBWTU Commander)

• Focused “Triad of Care” for each Soldier

• Live at home; medical care available CBWTU allows wounded, ill, and injured Soldiers to heal at home

• Duty at approved Title 10 duty site

• Dedicated Family Support

– Virtual Soldier Family Assistance Center (VSFAC)

“OUR COMMITMENT…”

Triad of Care

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CPT Elizabeth MerwinLogistics Captains Career Course, Selected for Army Civil Affairs

“When I found out I had breast cancer, I distinctly remember the moment like the world came to a stop. I tried to prepare myself to hear those words, but to hear the words ‘You have cancer,’ I don’t think anybody is truly prepared for that.”

SFC Landon Ranker (COAD)NCOIC Reconditioning Program, Warrior Transition Battalion, Ft Campbell

"But one of the symptoms of the head stuff is stuttering. In the early stages, I had headaches all the time. Now they only come when certain things trigger them. I have trouble with my balance. I've had to relearn how to carry my center.”

SGT(R) Robbie GauppMedically Retired, avid runner and medalist in the Warrior Games, Endeavor Games, and San Antonio Games (11 Gold Medals)

“Sometimes in life you feel like it’s a struggle, and you start giving up on life, but when you see other people go out there with injuries, some worse than you, it inspires you to say, ‘look, these people can make it, so I can make it too.’”

Office of The Surgeon General 12 October 2011Slide 30 of 34

“OUR NATION’S HEROES…”

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CULTURE OF TRUST

“My commitment and expectation to this great Army is that we will work on strengthening the bond of trust among those with whom we work, among whom we support and among those who march with us into battle. On the foundation of trust we will overcome any challenge we confront in the future.“

– GEN Martin E. Dempsey, 37th Chief of Staff of the Army

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The Army’s Home for Health…Saving Lives and Fostering Healthy and Resilient People

~ Partnerships Built on Trust

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Army Medicine Makes the Army Strong

BACK-UP SLIDES

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LOE 1 - MEDICALLY NOT READY (MNR) SOLDIER IDENTIFICATION PROCESS

Initiatives: 1.1 Improve MEDPROS Effectiveness1.2 Implement eProfile & Optimize Provider Profiling1.3 Optimize Medical Screening

The desired endstate is to optimize medical readiness systems.

eProfile HQDA EXORD 055-11

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LOE 2 - MNR MANAGEMENT PROGRAMS

Initiatives: 2.1 Implement Medical Management Center Program2.2 Establish RC – Soldier Medical Support Center2.3 Improve Reserve Health Readiness Program2.4 Improve PDES/IDES2.5 Improve SRP Processing and Medical/Dental RESET2.6 Assess Medical Requirements for the Operating Force2.7 Optimize AC BDE Surgeon Training and Selection2.8 Improve Warrior Care and Transition2.9 Reduce Dental Readiness Class 3 and Class 4 Soldiers2.10 Optimize Management of Technical Solutions

The desired endstate is to enhance Soldier care to increase medical readiness.

Office of The Surgeon General 12 October 2011UNCLASSIFIED

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LOE 3 - EVIDENCE-BASED HEALTH PROMOTION, INJURY PREVENTION, AND HUMAN PERFORMANCE

OPTIMIZATION PROGRAMS

The desired endstate is to improve health, fitness, and reduce injury rates.

Initiatives: 3.1 Coordinate and Support Health Promotion and Wellness Services3.2 Support Injury Prevention & HumanPerformance Optimization Initiatives3.3 Implement MTF & Unit Based MedicalManagement & Rehabilitation Programs3.4 Support Prioritized Research Efforts

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LOE 4 - EFFECTIVENESS

The desired endstate is to ensure strategic effectiveness.

Assessment processes are integrated into the other three lines of effort.

Initiatives:4.1 Evaluate Execution/Process4.2 Evaluate Injury, Physical Performance/Fitness, & Other Health Outcomes/Effectiveness Indicators4.3 Conduct MNR Surveillance & Monitoring

Office of The Surgeon General 12 October 2011UNCLASSIFIED