Military health system works to slow cost growth
January 31, 2012
WASHINGTON (Jan. 31, 2012) -- The $50 billion military health system will plan for its future by slowing the growth rate of health care costs, strengthening partnerships and focusing on prevention, primary care and chronic disease management, the Defense Department's top health official said this morning.
Jonathan Woodson, assistant secretary of defense for health affairs and director of the TRICARE Management Activity, addressed some of the 3,000 attendees at the 2012 Military Health System Conference here.
The military health system includes more than 133,000 military and civilian doctors, nurses, medical educators, researchers, health care providers, allied health professionals and health administration personnel around the world.
"The federal government, the Department of Defense and the military health system are at an inflection point," Woodson said. "We must begin to plan for how our system will operate in the long term."
In the background of everything that will be discussed at the conference this week, the vascular surgeon said, is the question of resources and prioritization.
Slowing the growth rate of health care costs, Woodson added, "will require a new commitment to collaboration among the services, where joint interests exist to reduce redundancy and waste."
The military health system, he said, will expand partnerships and implement major initiatives addressing patient-centered medical homes, tobacco and obesity reduction, patient safety improvements and system-wide innovation.
A patient-centered medical home is a team-based way to care for a patient led by a personal physician who provides coordinated care throughout the patient's life, Woodson explained.
"We are in the second full year of implementing the patient-centered medical home," he said. "The early returns, with two million beneficiaries enrolled in medical homes, are very encouraging."
Fully functional medical homes are improving the delivery of preventive services, reducing inappropriate emergency room use and hospitalizations, and improving patient care experiences, he added.
Woodson said he will announce a new multi-year program this year to help service members deal with tobacco use and obesity.
"Our service members are using tobacco and tobacco products at a much higher rate than their peers in the civilian sector," he said, and entry-level service members and retirees tend to develop weight problems.
"We have the legal, statutory, moral and financial responsibility for care of retirees," Woodson said, "and we must ensure that they maintain their health."
This month, Woodson said, he will announce the implementation of a new comprehensive safety model for the military health system, establishing a performance model that is the best in the country.
"We have already shown on the battlefield that we have the ability to rapidly process information, understand best practices and disseminate them into the worldwide medical community," he said. "We need to do the same in patient safety practices."
Innovation is not a new concept in the Defense Department or in the military health system, Woodson said, "but we've got to undertake the process of innovation in a more strategic manner."
To that end, he added, "I've tasked our innovation team with responsibility for finalizing and disseminating the knowledge sharing system within the military health system, open to the entire community and easily accessible so we can communicate across the enterprise and across silos."
Providing better care at reduced costs with improved outcomes and a focus on prevention, primary care and chronic disease management is not the role of doctors, nurses and pharmacists alone, Woodson said, but requires the work of the entire military community.
"We have engaged Gallup and Healthways to look at measures of overall community wellness and their insights into how communities can change behaviors," he said. "We will move from health care to health by involving a larger set of partners."
Strengthening partnerships is one way the military health system is preparing for the future.
"With the Department of Veterans Affairs, we have one overarching committee called the Joint Executive Committee," said Jo Ann Rooney, acting undersecretary of defense for personnel and readiness.
"That's where we address the large issues facing us between the two departments," she added, "not only involving health care, but also how we continue to support service members and their families."
One issue involves facilities, Rooney said, in determining "how the Defense Department can best use its resources and dollars to jointly develop facilities that take us into the future focused on the idea of health as well as health care."
Other issues include how to streamline disability and evaluation processes and how to best address pharmacy use.
"It's not just about specific formulary or nonformulary drugs," Rooney said. "It's about shaping behavior so that we can best use our resources in pharmacy and pharmaceuticals to support warfighters and their families."
Army Surgeon General Lt. Gen. Patricia D. Horoho, a registered nurse, said the Army has executed the health care mission with remarkable success through trying times, but that's not good enough.
Despite a 90.1 percent survival rate in Afghanistan and 2011 investments of $315 million in enhanced behavioral health programs and $50 million in patient-centered care, Horoho described Army health problems still to be addressed.
In 2011, she said, more than 21,460 Army Soldiers were medically nondeployable, 2,290 sexual assaults -- which Horoho considers a medical problem -- occurred, 278 Soldiers committed suicide, and one Soldier died from rabies, a preventable disease.
"My challenge and my personal belief," she said, "is that we can be better. We absolutely must be better."
The Internet and social media also will play a role in improving health, not just health care, for service members and their families, Horoho said.
In the future of military medicine, Horoho said she sees the support of military leadership, family and friends and outreach to patients through the Internet and social media with health care apps for vital signs, behavioral health and chronic disease management.
"Should we continue to invest in brick and mortar to enable our 100 minutes of health care," she said, "or should we arm our beneficiaries with a Bluetooth-enabled scale and blood-pressure cuff for their home?"
Such technology will become more and more influential, she said.
"World class health care is what we do. We do it well, and we have international recognition for that," the Army surgeon general said. "But we have to focus on health" -- what Horoho calls the 99 percent of a patient's life that occurs when they're not spending 100 minutes at their annual medical appointment.
For military health patients, health happens between the 100-minute medical visits, Horoho said, "and that is where we as individuals, we as the military health system and we as a nation absolutely must go."