|Change and Readiness in the Military Health System|
|Col Kara Gormont, USAF, MSC|
All healthcare organizations are subject to regulations, oversight, compliance, cost constraints, patient satisfaction scores, and a multitude of other pressures that inform choices and impact bottom-line resourcing decisions. The Military Health System (MHS) has all of those pressing concerns and one additional impact that supersedes all others; readiness.
What does 'readiness' mean? Readiness for the MHS can mean a lot of different things depending on who you ask, but one thing that rings true for all is that every MHS medical professional needs to be ready to respond to our nation's needs to the full scope of their clinical ability. Unfortunately, our current system does not always deliver on that requirement.
Our direct care system is comprised of 120,000 employees, 55 hospitals, and 300 clinics, and a partnership with a purchased care system which delivers care to 9.6 million beneficiaries across the world (Burns, 2016). The 'direct care' is delivered through utilizing Army, Navy, and Air Force personnel assets. These three military services all have their own headquarters, formulate their own strategic priorities, make purchases, and deliver products and services through their own structures. The Senate MHS Reform overview noted that the MHS was "designed decades ago, and over time has emphasized delivery of peacetime healthcare at the expense of strengthening operational medical force readiness (Senate MHS Reform Overview)." Currently, there is very little collaboration, economies of scale, joint oversight, and partnership amongst the services.
That structure leads to fragmentation of care, inefficiencies, and stove piping. Focusing on delivering the benefit, has led to many small Primary Care Medical Homes established throughout the world. This outpatient focus compounds the problem of providing ready medical forces. Active duty military members spend a good portion of their career in these outpatient platforms. As you can imagine, outpatient medicine does not keep you practicing at the full scope you would need to deliver care in a warzone. Sometimes this focus on benefit delivery, can cloud our focus of preparing Airmen to remain resilient, improve health, and even in some cases deploy. The missions of delivering the TRICARE benefit, providing 'ready medical' Airmen while also ensuring 'medically ready' Airmen are not always easily balanced. In the past the MHS has had difficulty balancing these missions.
The National Defense Authorization Act of 2017 (NDAA 2017) is like a cattle prod from Congress to fix our system and focus our efforts. If you work in healthcare you have heard of transformational change. But there are few systems as large as the MHS, who have been charged with completely overhauling a system as complex as this in less than six years. The entire system will be realigned under the Defense Health Agency (DHA) no later than 2022, although there is action to move that up by the fall of 2020. Through a singular organizational structure, the DHA will integrate all medical services. This will be done through streamlining, integrating, focusing on quality, access, affordability, and readiness. The need for reform is significant, the annual appropriations for the MHS is $50 billion a year and is roughly 10% of the entire Department of Defense budget.
The stakes of getting the new system right are high. We must make wide sweeping reform to provide those who have, and are, currently serving our nation's needs. Not only must we deliver a health benefit that is patient centered, holistic, and effective; we also must get 'readiness' right. We must be able to prepare 'medically ready' military members who will protect our nation's interests. Further, we must provide 'ready medical' personnel who can take care of those military members as they protect our nation. The MHS leaders in Hawaii are ready for these challenges. We are ready to work together to enhance medical care to our beneficiaries, streamline processes to improve efficiencies, while driving down costs. We are ready, now more than ever, to collaborate with our civilian counterparts on ways to do all of those things more effectively.