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Creating the Defense Health Agency is only one of a list of things that Defense officials are doing to try to slow the growth in military health costs. “It will hopefully bend the cost curve,” he said.
The agency is expected to save the department hundreds of million dollars in the first five years, mainly in the areas of logistics and health IT, Middleton said. “We have hundreds of IT systems. … We’ve got to find a more standardized way to do it. … If you went to Kaiser [Permanente] they don’t have dozens and dozens of homegrown [IT] systems.”
Department officials will submit cost savings estimates to Congress on Sept. 30.
While the reorganization represents a significant change for the Military Health System and the Service Medical Departments, officials expect that beneficiaries will see improved services, access and support at their local military-treatment facilities. And, the TRICARE benefit is unaffected by this organizational change.
The idea of creating a single defense health agency or a unified military medical command has been the subject of debate since the close of World War II. Launching the new Defense Health Agency this October is a major milestone and represents one of the largest changes in the organization of the military health system in more than 60 years, Middleton said.
“The Army still has its medical command. The Navy has its structure. And the Air Force still has its structure,” he explained. “Each has unique missions, and important obligations to their line leaders. What we’ve done is say, ‘Let’s bring the right things together in a joint way. This is as far as we’ve ever come in doing any of this.”
A major influence to this transformation was seeing Army, Navy and Air Force medical personnel work more closely together in Iraq and Afghanistan. “If you went to a contingency hospital overseas, you might have a Navy nurse anesthetist, an Army surgeon and an Air Force med tech all working on you. Nobody knows the difference,” Middleton said. “Our medical fight in theater is a joint operation.”
In 2011, then-Deputy Secretary of Defense William Lynn appointed a Task Force on Military Health System Governance to recommend how military medicine might be reorganized – at the headquarters level, in multi-Service military communities, and in the National Capital Region.
The task force reviewed a number of different options and concluded that the creation of a Defense Health Agency offered the best approach to meeting readiness obligations and offering opportunities for savings.
The Department has also moved forward with a new approach to managing healthcare in large, multi-Service markets – those communities where more than one department operates medical facilities. These markets are the National Capital Region, the Tidewater region of Virginia, Colorado Springs, San Antonio, Puget Sound and Honolulu.
The military treatment facilities are “where we really want to see the patients,” Middleton said. “One, it’s high-quality care by all standards. Two, these markets are also where our large medical centers are, it’s where we do our training, and where we keep the clinical readiness skills of our specialists most up-to-date. Three, it’s cost-effective for everyone. We’ve already paid for the brick and mortar and the people. We need to use the facilities and our people to the maximum extent possible.”
“This is where real savings will happen – in how we deliver healthcare,” said Middleton. “Our commanders in these large markets are already working closely together, and we’re going to provide the incentives and the authority for them to coordinate care even more.” The senior medical official will have the authority to move medical personnel among medical facilities to best meet the needs of our patients.
In the Washington, DC, area, the Walter Reed National Military Medical Center and Fort Belvoir Community Hospital will be aligned under the Defense Health Agency as joint hospitals.
“Everything we do is designed to enhance the readiness of the force – the medical force, as well as the fighting force,” he said. “After 12 years of war, we need to ensure we sustain the skills of our medical team in the smartest, most effective way possible. These changes give us the foundation to do this.”