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Pacific Rim Challenges Health Care Delivery

By Douglas J. Gillert
American Forces Press Service

CAMP H. M. SMITH, Hawaii, June 24, 1996 – As the U.S. Pacific Command surgeon, Rear Adm. William J. McDaniel, views the Pacific Theater as three entities offering distinctive challenges to health care delivery.

The entities are Hawaii, Alaska and the Western Pacific, which comprises Guam, Okinawa, Japan, Korea, Singapore, Thailand, Indonesia and "every place else U.S. service members are stationed out there," McDaniel said. His charge: to establish TRICARE, DoD's managed health care plan, throughout the area.

McDaniels previous experience as commander of the naval hospital at Portsmouth, Va., set up his current assignment.

"I was in charge for three years of demonstrating TRICARE in the Tidewater region," the admiral explained. Congress directed the demonstration in 1992 to see how well the Army, Navy and Air Force medical facilities in the area could work together, integrate their staffs and assess a civilian network to cover those areas they could not cover.

Following the test, the Navy surgeon general asked McDaniel to do something similar for the Pacific basically, to "improve the delivery of health care."

Hawaii proved the least challenging, McDaniel said. The state's decadesold managed care system, coupled with plentiful military medical resources, made establishing TRICARE relatively seamless and painless. But the command's other two customers Alaska and the Western Pacific are different stories.

To get a handle on the challenges ahead, McDaniel held a conference last summer with representatives from every DoD medical facility in the Pacific. Out of that came the TRICARE Pacific Executive Council, which McDaniel chairs and hosts once a month. Members outside Hawaii tune in by video teleconference. They discuss issues pertinent to improving health care delivery across the vast region.

Alaska was the secondeasiest target to hit, McDaniel said. There, a consortium of federal health care providers uniquely links the resources of military facilities with Veterans Affairs, Native American Health Service and Bureau of Indian Affairs facilities.

"They have their own council, and they're doing essentially the same thing in Alaska that we're attempting out here," McDaniel said. "They're pooling their assets to improve health care delivery and stretch the federal health care dollar."

While each participant may not individually have a lot of impact, McDaniel said, collectively they wield the influence necessary to write effective contracts for additional medical support. "They can get people to make deals with them as a group in a way they could not do individually," he explained.

In addition, the partnership has made it easier for them to share resources laboratory Xrays and reports and even people through visitations to facilities experiencing shortfalls.

The TRICARE Region 12 office at Tripler Medical Center, Hawaii, has assisted the Alaska consortium in establishing contracts with civilian providers in the 49th state a complementary effort as McDaniel sees it. And that's what TRICARE will bring to Alaska, he said complementary support to the DoDplus system.

For any system to work, McDaniel said, the factions must be able to communicate with each other. That's a challenge Alaska's partnership has faced and the facilities in Hawaii have faced. To a much greater extent, it's a challenge to TRICARE deployment in the Western Pacific.

"When I arrived here, I sent out a team to see what [computer and communications] systems exist in the Western Pacific," McDaniel said. "They identified some 200 standalone systems that were good systems in and of themselves, but they couldn't talk with each other."

McDaniels team drew up a health care delivery plan to create connections, particularly between closely grouped DoD medical facilities in Japan and Korea. In Japan, for example, a common server will be installed that will treat all U.S. medical facilities in the country as if they were one. That way, said McDaniel, if a patient at Camp Zama is referred to a specialist at Yokota Air Base, for example, the common server allows transmittal of Xray results, laboratory reports, the physician consult and any other pertinent information faster and easier that it could be sent by email or fax.

In addition, regions in the Pacific are establishing crosscredentialing of professional staffs, so that any physician can fill in at another hospital or clinic in the region. The facilities also use each other for referrals and radiology and laboratory studies.

For example, the commanders of the Air Force clinic and Navy hospital on Okinawa formed a partnership that recognized each other's strengths and capabilities, and which types of cases and patients each was ideally suited for. Such resource sharing, McDaniel said, often precludes costly, timely aeromedical evacuations. "Instead of [the Air Force] sending a patient all the way back to Tripler, maybe he can be treated at the Navy hospital right there.

"That's the simplest form of TRICARE making sure our medical facilities that are closest to each other work together as closely as possible, the admiral said. "From that point of view, we're doing extremely well.'

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