The Bayonet

Thursday, Jan. 09, 2014

Agency works to lower costs, maintain top medical care

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WASHINGTON — The Defense Department’s goal to save medical dollars and deliver the best health care possible has made strides in its first 100 days, the director of the new Defense Health Agency said.

Air Force Lt. Gen. Douglas J. Robb said the agency — which stood up Oct. 1 in Fairfax, Va. — has been on a “journey” to make the military health care system more viable.

A concept that has been studied 17 times since 1942 resulted in DHA after defense leaders three years ago organized a task force to look at how to make military medicine more efficient, more effective and more affordable, Robb said.

As an agency of the umbrella Military Health System organization, DHA manages three major cost-saving areas for Army, Navy and Air Force medicine: standardized medical practices, six “multiservice markets,” and 10 of the military services’ health-related functions, called “shared services,” such as health information technology and the TRICARE health plan network.

“We looked at the next five years, which is expected to save $2 billion in (just) the 10 shared services,” Robb said, adding that DHA already has saved DOD money in its first three months.

Avoiding redundancy creates immediate savings, Robb said, which is “extremely important in the tight fiscal environment we’re in today.” Military treatment center leaders are “driven” to save money to build a better military health system, he added. Standardization in medical care, which cuts waste and duplication, is another critical element in cost-saving goals for all three services, he said.

Even as it works to get the most out of available dollars, DHA’s priority is its medical readiness mission and quality medical care in a deployed environment, Robb said.

“What 10 to 12 years of conflict has taught us is we can deliver incredibly efficient and high-quality health care in combat,” he said. “We did that through a joint effort, practicing side by side in a deployed environment in Iraq and Afghanistan. We were able to deliver joint (service) and coalition health care that’s never been seen in the history of conflict.”

As a result of that teamwork, he said, military medical standards stem from the “best practices” extracted from all the services’ procedures used in wartime medicine and surgery. That data was then put in the hands of the “best and the brightest” people from across the services to compile.

Combat trauma care from point of injury to surgery and hospital recovery is an example of best medical practices, he said. “We’ve changed the way America does trauma care delivery,” Robb said. “The beauty of our system is that we have not just active duty, but Guard and Reserve (medical personnel) who take back the best practices to [the hospitals where they work in civilian life] and change the way they do business there.”

And critical to medical professionals maintaining their skills in addition to cutting health care costs is to “recapture patients back into our direct-care system,” Robb said. Caring for patients in military medical treatment facilities can be done less expensively compared to civilian contract care, he said. “But what’s more important is the more patients we see, the more we bring … the tough cases to our large medical centers,” he added. “That drives up our competency, so it makes a better professional environment (to allow medical personnel) to practice medicine in a deployed environment.

In the meantime, Robb said, “as we wind back down from 12 years of conflict, we get a more stable, professional medical population that will be able to serve our beneficiaries.”

Military medicine during the war effort had “incredible focus,” he said, and as a result, the lowest disease and death rates in the history of warfare. “We’re going to use that same focus on garrison-based care.”

DHA oversees six multiservice areas to handle the largest DOD populations of its 9.7 million beneficiaries — service members, Families and veterans, Robb said. The multiservice areas are the Tidewater area of Virginia, the national capital region; Colorado Springs, Colo.; San Antonio; the Puget Sound area of Washington; and Hawaii.

“Those (markets) comprise about 45 percent of our direct-care costs — what we spend on our health care delivery inside our medical treatment facilities,” Robb said. Historically, the most populated areas of beneficiaries have medical care available from more than one of the services. In Colorado Springs, for example, the Army and Air Force each have hospitals and several bases.

In what Robb called a fundamental change, DHA’s multiservice areas will share a single existing hospital and a joint-service staff.

“It won’t be the Army, Navy or the Air Force by itself,” he said. “The services will work to bring those resources (together) to better serve the market through decreased redundancy, increased standardization, (with) better outcomes (and) better quality.”

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