Soldier Centered Medical Home generates readiness
October 15, 2012
JOINT BASE LEWIS-McCHORD, Wash. -- Laying on his side across an exam table, Spc. Enrique Rivera winced as the metal instrument raked the length of his outer thigh repeatedly. In the hands of Staff Sgt. Adam Lautenschlager, the butter knife-like implement is used for physical therapy.
"This is an instrument-assisted soft tissue mobilization to the ilio tibial band for knee pain. It's an aggressive massage to release adhesions in the fascia muscles," Lautenschlager said.
Rivera comprehends the "aggressive massage," portion and shrugs off the medical terminology, trusting that he's in good hands.
Nearby, Sgt. Joel Kloppel is seated on the floor, rolling a foam cylinder beneath his left leg as part of his own physical therapy regimen. The physical therapy services are available as part of the Army's first Soldier Centered Medical Home, established on Joint Base Lewis-McChord North.
The SCMH is something of an experimental concept, providing medical care for Soldiers assigned to both 555th Engineer Brigade and 17th Fires Brigade, with support from Madigan Healthcare System. The SCMH began treating Soldiers in November 2011.
Rivera, who has been a Soldier for 18 months, has never set foot inside a battalion aid station since 17th Fires Bde. consolidated its medic resources to help form the SCMH.
"I've never had to go to Madigan for treatment, I just come across the street from where I work once a week and it hasn't been a problem. I'm not far, my supervisor knows where to find me if something comes up at work," Rivera said.
Most Soldiers here continue to receive their medical care in one of the 28 actively functioning battalion aid stations throughout JBLM staffed by unit medics and physician assistants.
"Battalion commanders in combat arms units focus on wartime mission, train-up, certifying, exercises, the whole churn of Army forces generation. Establishing a health care facility within their battalion; that should be my job," said Col. Dallas Homas, Commander, Madigan Healthcare System.
When the SCMH opened in November 2011, the workload of two sections, physical therapy and behavioral health, had a marked increase.
"There was a demand. As soon as we built it Soldiers came, and in large numbers," Homas said.
"When you think about the non-deployable force, it's a concern for the Chief of Staff of the Army. The number of medically non-ready Soldiers in the U.S. Army exceeds 60,000 across the force. So this is an effort to get after that problem," Homas said.
Homas developed the concept for the SCMH based on an event that occurred during his time as a brigade surgeon in Hawaii.
There was an exceptional noncommissioned officer who injured his knee and kept receiving pain medications and extended profiles from his unit's battalion aid station, with no improvement. This NCO became ostracized as his unit readied for deployment, became depressed and his performance levels dropped. Months after the initial injury, with some difficulty, he was authorized an MRI (Magnetic Resonance Imaging) that revealed his knee was beyond treatment.
"Had he been able to get proper treatment earlier, we could have provided the necessary surgical procedure, and saved the knee. In the end, he was medically boarded," Homas said.
In the years that followed, Homas conceived of the Soldier Centered Medical Home with the target population as a brigade's worth of Soldiers.
"I took that concept forward, I briefed my contemporaries, and got 17th Fires Bde. and 555th Engineer Bde. to talk about it with the Garrison Commander here at JBLM," Homas said. "I told them I'd like to see an elevated level of care available to Soldiers on a daily basis in their footprint. That way, that NCO who got boarded out of the Army because his knee wasn't treated in a timely manner -- we're going to try to get in front of events like that."
Homas chose the two brigades because of their proximity to one another on JBLM North.
Installation Management Command partnered with the idea, and authorized converting two company operations facilities to build the Army's first SCMH.
"It's a unique partnership between two Forces Command units; one assigned to I Corps, one assigned to 7th Infantry Division," said Col. Kenneth Kamper, Commander, 17th Fires Bde. "With Madigan onboard, that's Medical Command involvement and along with IMCOM this is an initiative that's getting a lot of attention."
Once the location of the SCMH was established, the next step was to decide what level of care the facility would address.
"We wanted primary care, of course, to treat coughs and colds. I've got really smart, board-certified primary care doctors at Madigan that I can send down to the SCMH to provide support. This helps the SCMH medics with collaboration opportunities, so that when their unit deploys they can provide better care downrange," Homas said.
Aside from coughs and colds, Soldiers with injuries that would normally need care at Madigan can be treated at the SCMH. Behavioral health and nutrition issues are other areas addressed by the SCMH.
"The SCMH provides physical therapy. We know that 80% of all Soldier complaints at sick call are muscular-skeletal pain in nature: my back hurts, my neck hurts, my knee hurts -- something hurts because we're in a physical business," Homas said.
While Soldiers still need to be referred out for lab work or radiology, other resources provided by the SCMH are a pharmacy, nurse case management, Physical Examination Board Liason Officers and Military Family Life Consultants.
"We're just very appreciative of all the partners involved because we're ecstatic about the level of care that it's providing for our Soldiers, which in turn provides readiness and health across the force. We're very excited about that," said Kamper.
The SCMH is showing promise in this experimental phase, and Homas is examining ways to measure its success over time. It is a concept that could bring benefits Armywide if adopted at other installations.