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Date: February 18, 2020
Title: VADM (Ret.) Raquel Bono on Government Matters
Source: Government Matters
Francis Rose: The Secretary of the Army Ryan McCarthy wants to put a hold on
transferring the Army’s medical treatment facilities to the Defense Health
Agency, at least for now. He says he’s concerned about a lack of performance
and planning. Vice Admiral Raquel Bono, U.S. Navy retired, former Director
of the Defense Health Agency, Rocky, welcome back, it’s great to have you.
VADM Bono: Thank you.
Rose: What do you see when you look at the reports about Secretary McCarthy,
his concerns about the DHA, based on your experience from inside the
Bono: I think the most important thing Francis, is the people are continuing
to work together towards the end goal. It’s very clear where Congress wants
us to go and the work that the Defense Health Agency — with the Services
— has already put in place quite a few changes.
Rose: What are the changes that are happening? What are the changes that
it’s your takeaway that Secretary McCarthy wants that he hasn’t seen yet?
Bono: Yes, so I believe that as I was leaving, we had already transferred
some of the MTFs to the Defense Health Agency, and with the beginning of
this new calendar year there were going to be some new military treatment
facilities that were going to be rolling over. And so, I believe that in
that, we already had an established set of metrics that we wanted to use to
monitor the progress. I think it’s wise to be able to stop and assess those
metrics and make sure that the progress that we wanted to achieve is
Rose: A Federal News Network reports say that Secretary McCarthy wants to
halt the transition until a detailed budget strategy and plan to transfer
functions from the Services is delivered. What has to happen – I know you’re
not inside the Agency now, but based on your knowledge how far along is that
effort and what does that look like? Does that answer the concerns do you
think that Secretary McCarthy and other military leaders maybe in the other
branches might have if how this shift of MTFs is happening?
Bono: Well, I think the nice thing about it before I left, is that we had
the conversations with the Services to understand how best to undertake a
transfer of function that would include not only the capabilities, but the
personnel involved. So, I believe that that conversation has already been
put in place, those plans have already been laid out, and what is probably
of merit is going over and perhaps doing a rehearsal of capability, and
being able to show how that actually plays out.
Rose: What did you find were the major differences among the branches and
the way they provided care to their members?
Bono: There are always differences in delivery, also differences in how
appointments are made, and so what the overall goal for the Defense Health
Agency was to make the experience of care for our patients similar, no
matter where they went to get their care.
Rose: That strikes me as kind of back office stuff, that’s not the way, the
type of care that maybe an airman needs to receive compared to the way that
the type of care that a soldier needs to receive. I imagine there are some
differences, but not major differences… maybe I don’t know what I’m talking
about, I’m not a medical professional, but you are. Are there major
differences between what a cohort of airmen need, versus a cohort of
sailors, versus a cohort of Marines, versus a cohort of soldiers?
Bono: Well, there’s always going to be unique nuances, depending on the
Service, but you’re right, most of the care that we give is primary care,
preventive care and when needed, specialty care, and all of that is pretty
Rose: What do you think are the major milestones that we should watch coming
out of DHA, not necessarily just pertinent to the concerns that the Army
has, but also more broadly?
Bono: You’ll continue to see more of the MTFs coming under the Defense
Health Agency. You’ll also probably see identification of markets where
there are collections of military treatment facilities in certain geographic
areas that will also start migrating to the Defense Health Agency, and in
the backdrop of that you’ll also see coordination and parallel movement with
the deployment of the electronic health record, MHS GENESIS, and then you’ll
also see refinement of the TRICARE health plan.
Rose: When you mentioned the movement of places where there are a number of
facilities, everybody hates the word consolidation, but it strikes me, the
quantity of care that DHA provides will have to equal the quantity of care
that’s provided, so consolidation isn’t necessarily a dirty word in this
case, is it?
Bono: No, as a matter of fact, that’s where a lot of the efficiencies will
be realized, by consolidating as you mentioned previously, those back-office
Rose: The back-office function consolidation, what does that look like? How
is that continuing and what are the gains that the person who is seeking
care from DHA will see? Will it make a difference to that person?
Bono: It shouldn’t make an obvious difference. Where they will probably
experience a difference, and this is actually the goal, is in their
experience of care. So how they make an appointment on the east coast should
be the same as they make an appointment on the west coast.
Rose: GENESIS is the backbone of that, right?
Bono: GENESIS has a very large role to play in that, exactly.
Rose: What are the markers we should watch for on GENESIS moving forward?
Bono: GENESIS is actually moving really nicely now. And now that we
understand what some of our challenges are in the infrastructure area and
what we needed to do, the Defense Health Agency is continuing that, and then
as the migration of medical devices and user devices to that new network, as
well as the adoption of workflows.
Rose: Was the big game changer for the GENESIS rollout the shift in the way
that you trained providers how to use it?
Bono: That had a big, big impact on that.
Rose: The big change there from, I believe that last time we talked before
you retired was that you were training people before how to use software and
you kind of shifted that mindset to get them to understand this is just a
facilitator to provide the care, here’s how you provide care in the context
of this new thing, is that a fair statement?
Bono: Yes, absolutely.
Rose: Admiral Bono thanks very much for coming on, it’s great to have you
Bono: My pleasure thank you.