MHS Transformation/TRICARE Pediatric Report to · PDF fileMHS Transformation/TRICARE Pediatric...
Transcript of MHS Transformation/TRICARE Pediatric Report to · PDF fileMHS Transformation/TRICARE Pediatric...
MHS Transformation/TRICARE Pediatric Report to Congress
MG Richard Thomas, Director, Healthcare Operations and Chief Medical Officer, DHA
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Agenda
∎Military Health System (MHS) strategic landscape
∎Defense Health Agency (DHA) overview
∎ TRICARE Transformation and T2017
∎ SECDEF directed MHS Review
∎ TRICARE Kids Matter topics
∎Background
∎Current initiatives
∎Hot topics
∎Way ahead
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MHS Spending Over Time
Includes Normal Cost contributions to the Medicare Eligible Retiree Health Care Fund (MERHCF)
Military Health System Expenditures
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DHP Funding
MHS cost growth unsustainable
Opportunities to generate cost savings without compromising quality, access and safety of care
ASD(HA) Quadruple Aim and Supporting Lines of Effort
1. Eliminate unnecessary duplication of effort, inefficiency and suboptimal performance by modernizing enterprise management
2. Continually improve medical capabilities and capacity to provide contemporary health care
3. Ensure that a ready medical force is balanced to meet Combatant Commanders’requirements
4. Develop and support strategic partnerships5. Reform the Tricare Benefit program to
ensure the program’s long term viability6. Better define and develop the MHS core
resources and competencies needed to support Global Health Engagement
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MHS Organizational Overview
MHS Governance
PDASD,
Deputy
SGs, JSS
ASD(HA)
SGs, JSS
Personnel Operations Budget
USD(P&R),
Vice Chiefs
CJCS
USD(P&R)
ASD(HA)
Policy
Execution
MDAG,
DASDs,
JSS
MTFs
Defense Health Agency
NCR Directorate
MTFs
ArmyOperational
Units
NavyOperational
Units
Combat Support
Agency
Responsibilities
USUHS
Sec Army
CSA
Sec Air Force
CSAF
ArmyMEDCOM
Army SG
MTFs MTFs
Secretary of Defense
PAC
MPOG MBOGMOG
MDAG
MHSER
SMMAC
Sec Navy
MarineOperational
Units
Air Force SG
Air ForceMAJCOMs
Air ForceOperational
Units
CNO CMC
C2
Coordination & Assistance
NavyBUMED
Navy SG
USD(P&R)ASD(HA)
DHA Director
POLICY DEVELOPMENT & OVERSIGHT
POLICY EXECUTIONCombat Support Agency Responsibilities
Admin & Mgt EEOO Comptroller
DHA OGC
Special Staff
Manpower
EHR Functional Champion
METC HQ
DMRTI
JMESI
IPO PEO DHMS
Secretary of Defense
Chief of Staff
Component Acquisition Executive
Analytics
Communications
Prog IntegrationSmall Business
Def Health BoardStrategic Mgt
HA / DHA Liaison
Procurement
Innovation
DoD/ VA PCO
CJCS
NCR MedicalDirectorate
Business Support Directorate
Health IT Directorate (CIO)
Research Development & Acquisition Directorate
Healthcare Operations Directorate (CMO)
Education & Training Directorate
Defense Health Agency
Academic Review& Oversight
Prof Development , Sustainment, & Prog Mgmt
Shared Service
TRICARE Health Plan
Pharmacy
Clinical Support
Public Health
Readiness
Warrior Care Program
Advanced Development
Science & Technology
Clinical Infrastructure Program
Veterans Affairs R&D Liaison
Portfolio Mgmt and Customer Relations
Innovation and Advanced Technology Dev (CTO)
Infrastructure & Operations
Solution Delivery
Defense Health Service System (DHSS)
Defense Health Clinical Systems (DHCS)
Information Delivery
Cyber Security
Facility Planning
Medical Logistics
Budget & Resource Management
Program Integrity
Walter Reed NationalMilitary Med Center
Ft. BelvoirCommunity Hospital
Joint Pathology Center
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Multi-Service Markets
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The Eight Largest Markets (and Service/Department Leads)
= eMSM
= Single Service
National Capital Region (DHA)
Tidewater, Virginia (Navy)
Ft. Bragg (Army)
San Antonio, Texas (rotate Air Force/Army)
Oahu, Hawaii (Army)
San Diego (Navy)
Puget Sound, Washington (Army)
Colorado Springs, Colorado (rotate Air Force/Army)
Shared Services SavingsFive Year Defense Plan (2015-2019)
Shared Service IOC FY14 Net Savings FY15-19 Savings
FACILITIES 1 OCT 13 $18.4 M $537 M
MEDICAL LOGISTICS 1 OCT 13 $13.5 M $189 M
HEALTH IT 1 OCT 13 $33.1 M $265 M
HEALTH PLAN 1 OCT 13 $25.5 M $456 M
PHARMACY 1 OCT 13 $160.5 M $1,224 M
CONTRACTING 1 MAR 14 ($2.9 M) $136 M
BUDGET & RESOURCE MGMT 1 FEB 14 $0 M $279 M
MEDICAL RESEARCH & DEV 1 JUN 14 $0 M $98 M
MEDICAL EDUCATION & TNG 10 AUG 14 $0 M $ 5 M
PUBLIC HEALTH 1 OCT 14 $0 M $293 M
TOTAL $248.1M $3.482 BILLION
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How We Got Here: History of TRICARE Program Development
Civilian Health &
Medical Program of
the Uniformed
Services
(CHAMPUS)
CHAMPUS
Reform Initiative
Birth of 1st
TRICARE Region
TRICARE Prime enrollment portable across Regions;
TRICARE Management Activity;
Retiree Dental Program
TRICARE Retail
Pharmacy Program;
Regions Consolidated
TRICARE Mail
Order Pharmacy;
TRICARE Global
Remote OverseasTRICARE For Life;
TRICARE Senior
Pharmacy;
Dental ProgramTRICARE Reserve Select;
Extended Care Health Option
TRICARE Overseas Program;
TRICARE Retired Reserve
Birth of Medicare
and Medicaid
3 Domestic Regions & 1 Overseas Region
2004
12 Domestic Regions & 3 Overseas Regions
1965 1995 1999 2001 2003 2005 200720062004200220001997/981988/921967 20102008/09 2011
TRICARE
Young Adult
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The TRICARE Program
∎ Comprehensive, worldwide medical / dental health benefit program
∎ Optimize the Military Department’s healthcare structure – military treatment facilities – as the primary healthcare delivery system 56 hospitals and medical
centers 361 ambulatory care clinics 249 dental clinics
∎ Augmented by civilian sources of care in the private sector
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TRICARE & TRICARE Transformation
∎ TRICARE Prime
∎ TRICARE Standard
∎ TRICARE Extra
∎ TRICARE Overseas
∎ TRICARE For Life
∎ TRICARE Reserve Select
∎ TRICARE Retired Reserve
∎ TRICARE Young Adult
∎ TRICARE Pharmacy
∎ TRICARE Dental Plans
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∎ Optimize purchased care contracts
∎ Align incentives with health outcomes
∎ Change how we "buy care"
∎ Standardize definitions and metrics
∎ Tricare Regional Office (TRO) governance
∎ Data sharing
∎ eMSM best practices
∎ Emerging Technologies and Treatment (E2T)
∎ Referral Management Reform (RMR)
SECDEF Memo Timeline
90
Days
45
Days
30
Days
15 Jul
2015
30 Sep
2015
• MTF Access
Outlier Action
Plans
• MHS Plan to
add MTF Stats
on health.mil
• MHS Plan for
Stakeholder
Engagement
*Timeline Not to Scale
• MTF Safety/
Quality Outlier
Action Plans
• DHA Plan to
Assess Quality and
Safety
• DHA Performance
Management
System
• Plan to Implement
MHS Review
Recommendations
• PMS
Capability
Report
• TRICARE
Purchased
Care Access
Study
SECDEF
Memo
Release
1 Oct 2014
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Ms. Theresa Hart, RNC, MS Perinatal and Special Medical Needs Nurse Consultant, Health Care Operations, DHA
TRICARE Pediatric Report to Congress
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Background
Through the direct and purchased care systems, the Military Health System (MHS) provides access and high quality health care to:
∎ 9.5M eligible MHS beneficiaries
∎ 2.4M beneficiaries from newborn to 21 years old
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Current Initiatives
∎ The Pediatric Report to Congress based on National Defense Authorization Act (NDAA) 2013 Section 735.
∎ Pediatric Integrated Project Team (IPT) has been directed by Dr. Jonathan Woodson, ASD(HA) to review gaps, findings and areas for considerationIncludes representatives from the Services, DHA and the
DoD Office of Special Needs
Chartered through the Medical Operations Group, Service Representatives at the Deputy Surgeon Generals level
Time limited and focused on the NDAA 2013 S. 735. Final report due the end of 2015.
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Medical Necessity; Safe and Effective Care
∎ Medically or psychologically necessary care: The frequency, extent, and types of medical services or supplies which represent appropriate medical care and that are generally accepted by qualified professionals to be reasonable and adequate for the diagnosis and treatment of illness, injury, pregnancy, and mental disorders or that are reasonable and adequate for well-baby care.
∎ Safe and Effective Care defined based on a strict standard requiring review under the “hierarchy of reliable evidence,”(32 C.F.R. §199.2(b)), which includes only published research based on well-controlled clinical studies, formal technology assessments, and/or published national medical organization policies/positions/reports.
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TRICARE Well Child
∎ TRICARE Well Child Care guidelines based on statute, provided to children from birth through age five:Routine newborn care,
Health supervision examination
Routine immunizations
Periodic health and Developmental screening
∎ Pediatric IPT will review the difference in American Academy of Pediatrics, Affordable Care Act and Medicaid’s Early and Periodic Screening, Diagnostic, and Treatment program.
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TRICARE Negotiated Rates
The discount is called the TRICARE negotiated rate and is optional for providers to accept.
∎ This discount is an integral part of the TRICARE Prime Program
∎No requirement for a provider to agree to, or accept, a discounted rate
∎ Authorized providers who do not agree to the discounted rate may still treat TRICARE beneficiaries, and may receive the full CMAC for the care provided.
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Way Ahead
∎ Emerging Technologies and Treatment (E2T)
∎Working Group review TRICARE data on utilization of preventive care benefits by beneficiaries ages 6 to 21 years. Any change in preventive care benefits would require Congressional approval.
∎ Strategic engagement and outreach by the DHA to stakeholders and communities of interest
Expansion of TRICARE Program Report to Congress
Leverage health.mil and social media platforms to more broadly share information and solicit input
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Additional Resources
∎ Theresa Hart, RNC, MS Perinatal and Special Medical Needs Nurse Consultant ([email protected])
∎ Pediatric Report to Congress: http://www.tricare.mil/tma/congressionalinformation
/downloads/TRICARE%20Program%20Effectiveness%20(FY%202014)%201.pdf
∎ Military Health System Review, Final report to Secretary of Defense August 2014: http://www.defense.gov/pubs/140930_MHS_Review
_Final_Report_Main_Body.pdf
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