August 1, 2013  

Integrating military health care

In your June issue, Col. (Dr.) Arthur Eisenbrey suggests that the Department of Defense tackle the issue of greater consolidation of military medical forces [“Unified medical command: An old idea whose time has come”]. “It’s time to have the discussion again and, this time, do something about it,” he wrote.

The good news is that we — the Department of Defense — did have this discussion: a four-month, intensive task force met throughout the summer and fall of 2011. And, we did something about it.

The deputy secretary of defense has directed a major transformation of how the Military Health System is organized and will deliver services to our active-duty service members and all 9.6 million beneficiaries we serve around the world.

The specific path the department leadership chose differs from the model that Col. Eisenbrey recommended. Yet the ends are the same: the value in creating a more joint and integrated health system, a focus on common clinical and business processes across the services, and the elimination of unnecessary redundancies.

On Oct. 1, the Defense Department will stand up a Defense Health Agency — an entity charged with integrating a number of “shared services” functions under one organization that includes a common approach to the operation of the Tricare health plan, pharmacy programs, medical logistics, health facilities, health information technology, public health, medical education and training, medical research and development, and budget and resource management.

In addition, the Defense Health Agency will be designated as a Combat Support Agency, providing the chairman of the Joint Chiefs and the combatant commanders with an important oversight role to ensure the agency is meeting our principal mission: the needs of our war fighters.

It’s important to note that this transformation has been driven by a recognition of our successes in military medicine, rather than a response to shortcomings. As Col. Eisenbrey intimated in his article, the performance of the Military Health System on the battlefield over the last 10 years has been historic, with the lowest “died of wounds rate” ever witnessed in war, and the lowest incidence of disease rates. This happened through highly integrated, joint medical teams that closely coordinate the delivery of health care from the point of injury through an 8,000-mile lifeline that extends to our medical facilities here at home. We are taking the lessons learned from this experience and using them here at home.

We know there is not an Army way, a Navy way or an Air Force way to remove gallbladders or perform vascular surgery. There is a right way — supported by the best medical evidence. And our approach is built on the bedrock belief that there are opportunities to both improve the care we deliver every day and achieve savings through common approaches to how that care is delivered.

In local military communities where more than one service operates a military hospital or clinic, we are also driving much greater commonality and coordinated service delivery, and giving local commanders the authority to drive change in ways that best serve their patients.

Our approach, however, recognizes that there is tremendous value in what the individual service medical departments bring to the mission. We are not creating a single uniform or a single medical department.

This country’s military health system is one of the most indispensable instruments of our national security and is unique in the world. As we implement these changes to military medicine, we will be stronger, better and even more relevant to the war fighter and our national leaders in the future.

Finally, readers should recognize that functional, combatant commands often add redundant headquarters staff. In our analysis this ranged from 1,500 to 2,500. The DoD is currently undergoing a process to reduce the number of flag and general officers billets and commands. This was demonstrated by the disestablishment of Joint Forces Command. The establishment of the Defense Health Agency will result in a decrease in full-time equivalent staffing.

In establishing a more efficient management process for the Military Health System, we should demonstrate the careful business-case analysis that our strategy adds value, and we have done that. Additionally, we should not throw the baby out with the bathwater. The Army, Navy and Air Force each have unique contributions to make in preparing for delivery of health care during land-based (Army), aerial (Air Forces) or sea-based (Navy) operations. Under our plan, what is good about the unique service traditions is preserved while we deliver on the promise of a more efficient military health care system that is stronger, better and more relevant to the future of the defense of this great nation.

Dr. Jonathan Woodson

Assistant Secretary of Defense (Health Affairs)

Woodson is a vascular surgeon and holds the rank of brigadier general in the Army Reserve.