New Defense Health Agency Exceeds Goals, Officials Say
By Terri Moon Cronk
American Forces Press Service
WASHINGTON, Feb. 28, 2014 The Defense Department’s new health care organization has exceeded its goals since standing up five months ago, top health care officials told the House Armed Services Committee’s personnel subcommittee here Feb. 26.
Dr. Jonathan Woodson, assistant secretary for defense for health affairs, and Air Force Lt. Gen. (Dr.) Douglas J. Robb, director of the new Defense Health Agency, appeared before subcommittee members to update them on DHA’s progression.
Both officials said the agency is ahead of expectations and goals.
DHA was established after defense leaders organized a task force three years ago to look at how to make military medicine more efficient, more effective and more affordable.
The agency is “an important reform in the Military Health System [and] a needed reform in this era of significant challenges for [DOD] in American health care at large,” Woodson said.
“Our national security and defense strategies must be supported by a strong, relevant, agile and forward-leaning Military Health System,” he said.
Good evidence exists that joint integrated care improves results in combat, Woodson said. If a service member is wounded in combat, a Navy corpsman will often be the first to treat the patient, who is then transported while receiving critical care to a military medical center staffed by all three services, where “definitive, advanced care will be given by a multiservice health care team, he explained.
The synchronized system “transcends service and command distinction [and] has resulted in the highest survival rates and the lowest case fatality rates in recorded warfare,” Woodson said.
“[Defense Secretary Chuck Hagel] has outlined his priorities for managing the significant change needed in the coming years,” Woodson said.
“These include introducing institutional reforms, re-evaluating military force planning construct, preparing for prolonged readiness challenges, protecting investments in emerging military capability, balancing forces between active and reserves and reforming personnel and compensation policies.”
Woodson said he has six lines of effort to support Hagel’s priorities:
-- Modernizing Military Health System management with an enterprise focus;
-- Defining and delivering medical capabilities needed in the 21st century;
-- Investing in and expanding strategic partnerships;
-- Assessing the balance of DOD’s medical core structure;
-- Modernizing the TRICARE health program, and
-- Defining the Military Health System’s global health engagement requirement.
Those efforts will help DOD meet its “overwhelming” aims of readiness, improve the health of people it serves, improve the experience of care in the military and responsibly manage costs, Woodson said.
By modernizing management structure, DHA represents a major DOD milestone and is a starting point for comprehensive enterprise-wide reform, he said.
“There is dramatic change occurring in American health care that will affect how we do business,” Woodson said, “and require us to refresh our thinking of health, health care, and health care delivery systems.”
Rising costs, technology sub-specialization, information management access and workforce issues challenge the American health care system, he said.
“Health systems across the country -- including ours -- are focused on ways to reduce variation in care, improve patient safety and more effectively use health information technology to improve clinical decision-making and outcomes,” Woodson said. “Within the military, there are additional imperatives for designing an integrated health system which includes more joint phasing, joint operations and maintaining readiness.”
DOD Health Affairs, the Military Health System and DHA are partnered in such a process, he said.
“We have created agile governance for policy and enterprise-wide operational decision-making,” Woodson said. “We are holding ourselves accountable using a disciplined process for identifying opportunities in using comments [and] enterprise-wide performance measures to see and check what we are doing.”
DHA uses the Government Accountability Office’s approach to conduct business case analyses and business process re-engineering efforts, Woodson said.
DHA director Robb said his agency “stands as a supporting organization, ensuring that the combatant commanders and the service medical departments have the resource support” to meet their missions.
“We have made significant progress in the first 150 days of this reform effort. And we are in-track with most of our major milestones,” he said.
The discipline and rigor necessary to “do business” also has given DHA insight into its most-challenging issues and in some cases has allowed it to “rapidly introduce new processes,” Robb told legislators.
“We have accelerated timelines for implementation and achieved savings, reduce variation and streamlined processes earlier than initially projected,” he said.
One role of DHA is managing numerous “shared services” that combine activities like medical information technology, medical logistics and TRICARE for the Army, Navy and Air Force.
For example, Robb said, identifying and changing buying behaviors in medical logistics is putting DOD’s health care on a path “to cover our investment costs and save over $10 million when we previously projected no savings for this year.”
Another $25 million in savings this fiscal year has been identified by consolidating service medical chief information officers into DHA, he added.
“The most significant cost savings potential for the department still remains in the purchase health care sector,” Robb said. “Our efforts to improve the execution of the TRICARE health plan are focused on the long-term systemic challenges, and how we better integrate our direct care and private-care health services delivery and contract for health care support.”
As the existing generation of TRICARE contracts expires, DOD is looking at reshaping contracts to take advantage of strategic sourcing, improving integration with military medical facilities, reducing unnecessary overhead, and achieving more simplicity and flexibility for its patients and the government, the DHA director said.
“[We’re] proud of the work we have accomplished,” Robb said, “But [we’re] even more eager to identify ways we can integrate our system on behalf of the incredible people that we are privileged to serve.”
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