Transforming the Military Health System

Dr. Butler, Assistant Director, Health Care Administration at DHA, described his organization’s work in the context of the Secretary of Defense’s three lines of effort for DOD: Increasing readiness and lethality, strengthening alliances, and bringing business reform to DOD.  DHA’s work to consolidate health care and the surrounding business services aligns with the Secretary’s goals of increasing readiness and reforming business practices.

MHS is unique in that it acts as a provider, payer and health plan for 9.5 billion beneficiaries. No other organization has all three components. MHS includes of 55 military medical centers and hospitals, 373 health clinics, 245 dental clinics, 300 navy ships and 169 forward deployed sites.

DHA’s mission states, “As a combat support agency, the DHA leads the MHS integration of readiness and health to deliver Quadruple Aim:  increased readiness, better health, better care, and at lower cost.” DHA aims to provide a ready medical force and a medically ready force with the following goals:

• Empowering and caring for its people
• Optimizing operations across the MHS
• Co-creating optimal outcomes for health, well-being and readiness
• Delivering solutions to combatant commands

MHS is currently in the process of transitioning Military Treatment Facilities (MTFs) to centralized management under DHA. They are taking a phased approach to the transition.  Phase one was completed October 1, 2018 with the move of eight MTFs under the central management structure.  Phase two is set to finish by the end of FY 2019 and consists of the Eastern Region MTFs. Phase three will be completed by the end of FY 2020 and includes Western MTFs.  The final phase will be completed by the end of FY 2021 and consists of MTFs outside of the U.S.

Dr. Butler stated that value comes from increased readiness, better health, and better care at lower costs. DHA Director, Vice Admiral Bono, identified seven critical initiatives that will measure success during the transition:

• Increase Deployability
• Improve medical force readiness
• Encourage health behaviors
• Optimize & standardize access
• Improve condition abased quality care
• Achieve zero patient harm
• Improve effectiveness and efficiency

MHS Genesis is a fundamental component of the military health transition, according to Dr. Butler. They’ve divided the implementation effort into three areas of responsibility: Program Executive Office (PEO) under direction of Stacy Cummings, Functional Proponent headed by Maj. Lee Payne, and IT run by Patrick Flanders.

Dr. Butler concluded his presentation with a look at 2019 top innovations in health care, many of which DHA would like to take advantage of in the future. 

2019 Top Innovations in Health Care 

• Payer-Provider Analytics/Data Software
• Artificial Intelligence
• Blockchain
• Internet of Medical Things (IoMT)
• Robotic Surgery
• Telehealth
• Gene Therapy
• 3D Printed Products/Devices
• Therapies for Pain Management
• Virtual and Mixed Reality

Dr. Butler highlighted blockchain stating that it holds promise because it is transparent, distributed, and immutable. He cited example of access and ID management that OPM is doing with Federal Employee Digital Record.  He sees potential benefit in blockchain for MHS for clinical trials, patient records, and drug/device tracking. Blockchain could aid in secure data exchange and information transparency across DHA, VA and network providers.