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Military Health Care Consolidation Moves to Next Phase

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The Defense Health Agency will take the next step this fall in evolving health care across the Military Health System, which oversees the care and well-being of some 9.5 million people, including service members, families and retirees.

As part of Phase 2 of the MHS overhaul, half of the roughly 375 military treatment facilities in the United States that had been previously operated by the Army, Navy or Air Force will move under the control of the DHA.

Eventually, every military treatment facility will move under the DHA, and the agency has opted to manage those facilities by dividing them into a variety of "markets."

A man in a gray jacket puts a blood pressure cuff on a seated service member.
Occupational Therapist
Mark Marsico, an occupational therapist at Walter Reed National Military Medical Center in Bethesda, Md., cares for a patient who has a wrist injury, March 28, 2019.
Photo By: Mark Oswell, DOD
VIRIN: 190328-D-II189-879

The large-market segment includes the national capital region, San Diego, San Antonio and Southwestern Kentucky, among others. The DHA has identified about 20 such large markets.

Small markets will include Central Louisiana, Las Vegas, New England, Central Virginia and Central Oklahoma. About 16 similar small markets have been identified.

Finally, the nearly 70 treatment facilities that don't fall within the boundaries of either a small or large market will be part of a "stand-alone" segment managed by the same office that manages the small markets.

Similar markets eventually will be formed in Europe and the Indo-Pacific region, home to about 75 military treatment facilities.

A nurse in blue scrubs holds a thermometer in the mouth of a patient who is in a hospital bed.
Medical Center
Army 1st Lt. Gabrielle Williams, a nurse, at Walter Reed National Military Medical Center in Bethesda, Md., cares for a patient, April 26, 2019.
Photo By: Mark Oswell, DOD
VIRIN: 190426-D-II189-002
A female patient in a hospital gown talks with female health care provider wearing gray scrubs. A diagnostic machine is between them.
Mammogram Technician
Jennifer Oubre, a certified mammogram technician at Naval Health Clinic Corpus Christi in Texas, validates a patient’s identity to prevent wrong-patient error prior to administering a mammogram, April 21, 2017.
Photo By: Bill W. Love, Navy
VIRIN: 170421-N-KF478-582

Navy Vice Adm. (Dr.) Raquel Bono, the Defense Health Agency's director, said these changes should be transparent, rather than disruptive, to health care beneficiaries around the nation.

"From the patient's perspective, the way I like to describe it is that at first it should be very transparent to them," she said. "They won't see any real visible changes."

What will eventually change, Bono said, is that things across all military treatment facilities will become easier for patients.

A pregnant woman sits on an exam table and speaks to a female health care provider.
William Beaumont
A health care provider meets with a patient at William Beaumont Army Medical Center on Fort Bliss, Texas, March 17, 2017.
Photo By: Marcy Sanchez, Army
VIRIN: 170317-A-EK666-046C

For example, Bono said, as the military treatment facilities and the markets continue to evolve under the DHA, beneficiaries will find that how they make an appointment in the Tidewater area  of Virginia will be the same way they make an appointment at Brooke Army Medical Center in San Antonio or at a facility in San Diego.

A move to joint electronic health records also is part of the Military Health System transformation, making the movement of beneficiary health records between different facilities seamless, Bono said. This will them to be treated anywhere, including at facilities run by the Department of Veterans Affairs, she added.

"This is one of those efforts we've been trying for some time now to accomplish," Bono said. "Being able to share the medical data in a seamless way and make it actionable is a very big step in the right direction. And it's a direction that private health care or commercial health care is also trying to do, ... making the data about patient and patient care more visible not only to the patient, but also to other people that are providing care to that individual."

That data sharing, she said, means patients won’t have to retrieve their records and make copies of them and bring them to their provider. This makes things easier for patients and also ensures that different providers don't run tests multiple times because they can't access existing results, the admiral noted.

A uniformed health care provider removes medication from a metal drawer.
Walter Reed
Army 2nd Lt. McKenzie Smith, a nurse at Walter Reed National Military Medical Center in Bethesda, Md., pulls medicine for a patient, April 26, 2019.
Photo By: Mark Oswell, DOD
VIRIN: 190426-D-II189-004C

Bono retires next month, and she said she hopes her successor will be able to keep the changes and improvements happening at the same pace they are already moving.

"Going forward, what I'd like for all the folks to bear in mind is that we've built a head of steam," she said. "We've got now some momentum. More and more people are becoming more informed about the reasons for why we are doing this in the first place, and I think it's easier for them to see now the role that they have in being able to make these changes happen. I think this is a real pivotal time. I think we are at a major inflection point for military health."

Phase 3 of DHA's transformation of the MHS is slated for October 2020, and includes bringing the rest of U.S.-based military treatment facilities under its purview. Overseas facilities will move under DHS during Phase 4 in October 2021.

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