Late Breaking News
AF General Named to Head Defense Health Agency in New MHS Governance Model
By Sandra Basu
WASHINGTON - A new Military Health System governance model expected to be in place by Oct. 1should result in cost savings, according to DoD officials.
The new model entails the creation of the Defense Health Agency as its centerpiece and aims to unify the governance procedures across the office of the Secretary of Defense and the three military departments.
DoD spokesperson Cynthia Smith told U.S. Medicine that the plans “remain on track” and that the Office of the Assistant Secretary of Defense (Health Affairs), the TRICARE Management Activity and the offices of the services’ surgeons general “have been working closely together to implement this transition.”
“We have initiated a comprehensive internal communications effort to ensure medical staff throughout the organization, officer and enlisted, are aware of the changes underway; understand how they can engage with the new organization; and are able to ask questions and suggestions for how the organization can better serve them,” she said in a written statement. “These changes are intended to improve support to our front-line providers, to improve the health of our population and to reduce overall costs to the taxpayer.”
In a recent step toward creation of the DHA, DoD announced this spring that Air Force Maj. Gen. Douglas J. Robb would serve as the new DHA director. Robb has been serving as the Joint Staff Surgeon in the Office of the Chairman of the Joint Chiefs of Staff.
The transition to the new governance model comes after years of debate and study into how the Military Health System could be best reorganized. Based on a task force’s analysis in 2011 that evaluated options for governance, as well as other considerations, DoD leaders said last year that they had endorsed the creation of the Defense Health Agency as the new governance model.
This way forward is less drastic than the Defense Business Board’s recommendation in 2006 to eliminate separate medical commands for the Army, Navy and Air Force and establish a Unified Medical Command.
Deputy Secretary of Defense Ashton B. Carter stated in a memo last year that, under the new governance model, DHA will operate under the authority of the Assistant Secretary of Defense for Health Affairs ASD (HA). The entity will be a combat support agency with oversight by the chairman of the Joint Chiefs of Staff.
Once established, the DHA will assume responsibilities currently undertaken by the TRICARE Management Activity, except for those assigned to the ASD (HA). In addition, DHA will also assume responsibility for shared services, function and activities in the MHS.
Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, stated in written testimony submitted this spring to a House Appropriations subcommittee, that the centerpiece of this reform “is the establishment of shared services for 10, high-profile and high-cost components of our system: the TRICARE health plan, health facilities, health information technology, medical logistics, pharmacy, medical education and training, medical research and development, public health, resource management, and contracting.”
He further explained that a “more integrated approach to health services delivery” in local healthcare markets would be introduced.
“In those military communities served by more than one service branch, we are providing enhanced authorities for designated senior military medical officials to direct resources and establishing unified business performance plans to ensure we further improve access, service and avoid unnecessary duplication,” he wrote.
Under the plan, the Joint Task Force National Capital Medical Region will transition to a medical directorate within the Defense Health Agency and will direct the development of a single, five-year business plan encompassing all medical facilities in the National Capital Region, he further explained.
Carter’s memo noted that these reforms are based on a belief that “there are opportunities to realize savings in the MHS through the adoption of common clinical and business processes and the consolidation and standardization of various shared services.”
The task force’s 2011 report pointed out that “DoD needs to operate the most efficient health system possible, elevating cost containment as a priority objective and increasing unity of effort as an implementation capability.”
More Streamlined Care
DoD Spokesperson Cynthia Smith told U.S. Medicine that “beneficiaries will not notice any differences in care or access as a consequence of the planning efforts underway” between now and when the DHA is stood up.
“As we stand-up the Defense Health Agency and introduce more integrated approaches, particularly in our multi-Service healthcare markets (healthcare communities where more than one Military Department operates military hospitals and clinics), we expect that beneficiaries will see improvements -- more streamlined, common approaches to appointing, referrals and care coordination that will improve service and access to care,” she said in a written statement.
In its report, the task force pointed to the ease of implementation as a strength of the DHA model it favored in comparison to other potential governance models under consideration.
“This organizational construct would retain those elements of the existing MHS governance structure that do not require major organizational upheaval, (as would any Unified Medical Command model or more comprehensive DHA option),” the task force wrote.