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Secretary Calls for Improved Customer Focus in Medical

By Douglas J. Gillert
American Forces Press Service

WASHINGTON, July 22, 1996 – Assistant Secretary of Defense for Health Affairs Dr. Stephen Joseph called customer focus the No. 1 priority for the military health services system.

"Our customers need to have their phone calls answered promptly, they need to be asked if they can be helped and they need to be treated courteously, as important people," Joseph said July 16 at the 1996 TRICARE Lead Agent Conference in Vienna, Va.

Lead agents and their staffs conduct the business end of TRICARE, DoD's health care program. The theme of this year's conference was "best practices," and plenary and breakout sessions throughout the three-day meeting dealt with ways to make health care more efficient, cost effective and customer oriented.

Joseph said re-engineering business practices will enable the lead agent staffs to mold military health into "the best system in the world," he told the conferees. "It is your opportunity, to identify the functional obstacles that restrain you from being a fully customer-focused operation ... [and] implement changes that will enhance operations."

Improving the health care system, Joseph said, requires the collaborative efforts of health affairs, the service surgeons general and the Joint Staff. "That's why I talk about the 'Defense Health Program, Inc.'," he said. "This is a corporate venture. Together, we are re-engineering the system of military medicine."

He said lead agent and medical treatment facility staffs also play critical roles in improving the system, citing the more than 300 suggestions and innovations documented in binders distributed at the beginning of the conference. "But there are many really tough issues we are wrestling with," he added. At the top of Joseph's list is portability of the TRICARE benefit between regions.

"The mobility of our patient population demands this feature," he said. Portability would eliminate confusion or reduction in services when patients enrolled in one TRICARE region travel to another region and require medical care while they are there, officials explained. Joseph said the lack of portability currently is a major issue with some of the beneficiary associations.

"Portability would certainly make it easier, particularly when you have family members [eligible for DoD health care] living in different states," said John Geoghegan of the Air Force Sergeants Association. "Right now, for example, a sergeant and his family enrolled in TRICARE Prime [DoD's health maintenance organization] in Texas, with a daughter away at college in California, would have to pay two enrollment fees. Obviously, portability would be a major beneficial change to the current TRICARE setup."

Such change is integral to making TRICARE "user friendly," Joseph said. "Many of your suggestions are to that end," he told the conferees. "Whether the user is a hospital corpsman, an admissions or records clerk, a patient, a contract physician, the resource manager, a pharmacist downtown, a wing commander or one of our lead agents, we must simplify the processes of TRICARE and eventually make them transparent to the user."

Finally, he said, it's time to "focus our attention, our performance, our analogies, our initiatives [and] our improvements on our customers' needs. This refocusing is not a marginal change," he said. "It involves measuring performance and practice in each and every military treatment facility, analyzing productivity and effectiveness and making the necessary modifications for improvement."

To facilitate customer focus, Joseph announced a decision by his office and the service surgeons general to periodically measure the effectiveness of military facilities, by a common set of standards. An annual "report card" on military treatment facilities will evaluate patient access to care, quality improvements, utilization, costs and health standards, he said.

"These report cards will enable medical facilities to compare themselves with other facilities of similar size and specialty mix," he said. "Lead agents, major commands and the surgeons general also will be able to evaluate their facilities and compare across regions, commands and services."

The evaluations will allow treatment facilities to recognize what processes work or don't work and make appropriate changes, he added.

One way to improve the health care business, the secretary said, is by developing cooperative agreements between health care facilities. Under TRICARE, he said, the "barriers of colloquialism are collapsing. There's an outpouring of cooperation, and you have begun to recognize the power of working jointly, not only with the military but also with Veterans Affairs, the Indian Health Service, the Coast Guard and other federal agencies. This translates into more seamless delivery of care for our patients ... and in many cases, significant cost avoidance."

He noted an agreement reached between TRICARE Region II (southern Virginia and North Carolina) and three VA hospitals in the region. "They pooled their requirements for laboratory records custody and, using the VA's authority, awarded one five-year contract that may well avoid almost $3 million in operating costs," he said. "In addition, they gained working relationships with one another, with one laboratory that met their combined standards for high quality."

Improved business practices within the military health services system also include designating regional medical centers for specialized treatment services. The services, Joseph said, will enhance continuity of patient care, avoid the cost of obtaining such care outside the military system and solidify the value of DoD medical centers.

"Shortly, we will improve 10 such services involving liver and bone-marrow transplantation, advanced neuro-imaging and cardiac surgery," he said.

Doctor (Lt. Gen.) Edgar R. Anderson Jr., Air Force surgeon general, challenged conferees to share ideas for innovation and improvement.

"The quality movement gives everybody both the opportunity and the responsibility to come forward with the best ideas," Anderson said.

He cited one military treatment facility where advanced practice nurses and internal medicine physicians conduct an after-hours adult primary care clinic, to the delight of customers.

"That's got to be our standard, he said. "'Satisfaction' won't get it; 'delight' is what we're searching for."

The general called business practice re-engineering an endlessly evolving effort. "It's axiomatic in the culture of quality that you never achieve perfection," he said. "Constant quality improvement is a recipe for success. Conversely, satisfaction with the status quo is a recipe for disaster."

TRICARE, according to Joseph, is like a train moving down the track at good speed and on time, with many destinations.

"It's important that we realize there is no end point," he said. "[TRICARE] is a continuing, evolving and self-renewing effort. So it's important that we focus our energies on fuel-efficiency to give us the competitive edge we need ... to set an optimum level of operations to ensure we have the flexibility to keep innovating and improving."

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