WASHINGTON, DC—DoD health officials told a House subcommittee that the president’s proposed $50.7 billion for the FY 2011 budget for the Unified Medical Budget will fully fund the DoD healthcare budget.

Charles Rice, MD, who is performing the duties of the DoD assistant secretary of defense for Health Affairs, said that the FY 2011 budget request “provides realistic funding for projected healthcare requirements.”

In his written testimony he also said that costs for defense healthcare have more than doubled since 2001 from $10 billion to $50.7 billion in FY 2010. TRICARE costs are expected to grow from 6% of the department’s total budget in FY 2001 to more than 10% in FY 2015.

House Armed Services Military Personnel Subcommittee Chairwoman Susan Davis, D-CA, told DoD officials that she felt the budget proposed by the president for FY 2011 lacks many of the “objectionable proposals of years past.” She pointed out that the budget request does not include TRICARE fee increases that have been proposed in the prior years, nor does it include proposed conversions of military medical positions to civilian medical positions.

However, she also said that there was “little if any evidence of a comprehensive, multifaceted strategy for moving the military health system forward.”

Addressing Healthcare

Davis wanted to know how MHS is transforming the care it provides patients. Rice spoke about the Managed Care Support Services Contracts. The transition to new regional contracts, known as “T-3,” was scheduled to be completed by April 1, 2010, but was delayed due to protests filed with the Government Accountability Office by two of the current contractors. These contracts provide managed care support services for each of the three TRICARE regions.

Rice said that discussions have already begun on what the fourth generation of these contracts will look like in order to incentivize patients to take responsibility for their health, and to make care more efficient and patient centered within DoD’s direct care and the purchased care system.

Rice said that the department has adopted “The Quadruple Aim” as a foundation for its strategic plan in the coming years. The Quadruple Aim borrows from the Institute for Healthcare Improvement’s “Triple Aim” and is made up of four components of focus that include readiness, population health, experience of care, and cost.

Rep Vic Snyder, D-AR, asked what the military is doing to decrease smoking among its servicemembers. Rice responded that a 2009 Institute of Medicine report examined smoking in the military and VA and made recommendations about how to address smoking. He said that DoD is evaluating that report to see which recommendations it can undertake on its own and which ones would need the assistance of Congress.

He added that one of the challenges is that tobacco products in the military exchanges are less expensive than in the civilian market. Another challenge is that servicemembers see their leaders smoking. “Basic training is already a tobacco free environment, but as soldiers, sailors, airmen, and marines transition to their first assignment they see older officers smoke, and by implication believe it is okay for them.”

Subcommittee ranking Republican Rep Joe Wilson, R-SC, asked about the effectiveness of the neurocognitive screening tools that the military is using.

Army Surgeon General Lt Gen Eric Schoomaker, MD, responded that the military is emphasizing evaluating servicemembers suspected with potential brain injuries as close to the time of injury as possible.

Schoomaker said that one of the first tools the military turned to for screening brain injuries was the Automated Neurocognitive Assessment Metric (ANAM) test. That tool, however, was never designed as a screening tool, but as a tool for prospective ongoing evaluation for those with neurocognitive problems. The tool was found by the Army to be insensitive and nonspecific as a screening test. “We have turned away from using the ANAM as a simple screening tool.”

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