SEMBACH, Germany -- As the new director of the Defense Health Agency, Lt. Gen. Ronald J. Place will oversee one of the largest organizational changes within the U.S. military when military hospitals and clinics consolidate under the DHA.

He laid out the DHA's transition plan during a recent visit to Europe.

"For a long time now, each of the services were responsible for ensuring a ready medical force and for ensuring a medically ready force," Place said. "Unfortunately, there hasn't been any standardization of processes (across the Services) along the way, so there is a lot of variation. The standardization process we can deliver through the DHA, will be applied across all aspects of healthcare and will ensure more consistency throughout the services."

The transition of MTFs to the Defense Health Agency began in October 2018, when the DHA started operating eight hospitals and their associated clinics in Virginia, North Carolina, South Carolina, Florida and Mississippi. On Oct. 1, the Army, Navy and Air Force begin the final two years of a multi-year transition to shift administration and management of their medical facilities to the Defense Health Agency by October 2021. That transition is scheduled to take place here in Europe sometime in 2020.

Throughout the transition, the DHA will focus its resources on readiness and high-quality patient care, according to Place.

"This consolidation strengthens our ability to provide ready medical forces to support global operations and improves the medical readiness of combat forces," Place said.

He also emphasized that throughout the transition, the agency's top priority is to ensure that service members, retirees and family members continue to receive high-quality health care.

"Every single beneficiary is important to us," Place said. "Whether their health care is delivered in one of our military treatment facilities or by utilizing the managed care support contractor [TRICARE], the DHA will continue to deliver the same high-quality healthcare they've come to expect from the military healthcare system.

"People shouldn't have to worry about where they receive that care, nor should they have to worry about the quality of care. We should do all that work for them."

While the availability of care at military MTFs ebbs and flows based on availability of resources, Place says that beneficiaries can rest assured that the DHA is working hard to ensure quality health care through its extensive network of TRICARE providers.

"Far and away, our most important priority is great outcomes, not only for our uniformed personnel, but also for our family members and retirees," Place said. "However, we need to get away from this idea that if we're being seen in the MTF we're important, and that if we have to receive care from the managed care system, we're not important. Our goal is to help every single beneficiary optimize their health using every tool that we have available to us, and do it in the most effective, efficient way possible.

"We have to collaborate with the managed care support contractor such that the experience of care for every beneficiary is an extraordinary experience."

Place also gave kudos to the military medical community, while providing assurance that the transformation process wasn't an indicator of the service branches' ability to provide health care.
"The reason for this transformation has nothing to do with this idea that Army Medicine, Air Force Medicine, or Navy Medicine weren't doing a good enough job," Place said. "That's not what this is about. This is about taking the great work that people have been doing and finding those best practices across the entirety of the military healthcare system and bringing everyone up to that level. We have to find ways to make the process user friendly, irrespective of service, for every single beneficiary that we have."

Place says the key to that effort is the standardization and integration of medical resources across the military health care system.

"We have to standardize, where standardization makes sense, and eliminate unwanted variability such that we get good standardized outcomes and we are using good standardized administrative processes," Place said. We have to make it easier for our patients to use our system and for them to be their best advocates for their own healthcare."

The DHA's vision for an integrated military healthcare system will also likely mean greater opportunity for joint assignments for medical personnel.

"Based on our market concept, when there are multiple services in a geographic footprint, there will certainly be opportunities for multiple services to work together in the same location," Place said. "For example, in the Tidewater, Va. area, we have Portsmouth Naval Medical Center, Langley Air Force Base Hospital, and Fort Eustis Army Health Clinic. So if you're an Army neurosurgeon, for example, you could potentially be assigned to the Fort Eustis Army Health Clinic, with duty at Portsmouth Navy Medical Center.

Military medical personnel should not see a major change in how they are trained and educated to ensure a ready medical force, according to Place.

"I don't expect to see significant changes to how we train and educate our military workforce. For the most part it should look the same, although there will likely be some opportunities for collective training among the services," Place said. "The follow-on military medical education that happens in hospitals or clinics, for example, that will still continue, but the requirements for that will be delivered to the DHA by the service components. So whether they're individually managing those educational programs inside the hospitals or not, the requirements are the same."

A key priority of the transformation process is the smooth transition of the civilian workforce from the service components to the DHA, and Place says the DHA is working diligently to ensure a smooth transition for the 10,000+ civilian employees who will be affected.

"We are currently working to show how this effort truly is a transfer of function," Place said. "What that means is that if the components are performing a function that the DHA does not currently perform, we are trying to find a way to transfer both the employees and the work into the agency. At the MTF level, we believe that's a complete transfer of function. For example, the medical work at Stuttgart Army Health Clinic is going to change from an Army mission to a DHA mission, therefore the entire mission is a transfer of function from the Army to the DHA. That means all the employees and the medical mission can transfer from the Army to the DHA."

Place says that the DHA's other responsibility is ensuring a smooth transfer of employees from the service components to the DHA.

"Because the systems at each component are slightly different, each employee will have to be individually managed to ensure they don't lose benefits," Place said. "Because we are talking about tens of thousands of employees, we don't anticipate that being a fast process, but we do anticipate it will be an effective transition.

Throughout the entire process, Place says the overall goal is for the military health system to become more effective.

"Every single person in senior leadership across the services, everyone in Congress who is writing these laws, fundamentally understands the great work that is happening in military medicine, and the whole idea behind this is how to take that great work and make it better, he said. "Our ultimate goal is to strengthen our ability to provide ready medical forces to support global operations and improve the medical readiness of combat forces."