July Message from the Principal Deputy Assistant Secretary of Defense for Health Affairs

Posted on July 27, 2019 Updated on July 25, 2019

MHS Team,

The Military Health System (MHS) continues implementing FY17 and FY19 NDAA-directed reforms – planning and executing the most significant changes to the military medical enterprise in decades. These reforms are looking at different areas of the MHS, from the way we manage healthcare services, to the infrastructure and staffing capacity of Military Treatment Facilities (MTFs), to the broader manpower structure enabling the best possible support to the readiness and lethality of the Department and the National Defense Strategy. While each reform area is distinct, together, they will modernize our approach to military medicine to establish an even more effective, integrated system of health and readiness to support the warfighter and care for the patient.

FY17 NDAA Section 702 will enhance the effectiveness of the MHS by transitioning administration and management of the MTFs from the Military Departments to the Defense Health Agency (DHA). In essence, we are merging four separate healthcare delivery systems into one, consolidating for ease of beneficiary access to high-quality care and standardizing processes and procedures. This will ensure a consistent patient experience at any one of our MTF’s – from appointment scheduling to streamlined referral processes, with standardized performance management systems to monitor readiness, health, access, quality, safety, and cost – and, in turn will enhance clinical competency to ensure a ready medical force and a medically ready force. Last October, eight large MTFs and their associated clinics transitioned to DHA. October 1, 2019 is another major milestone as more MTFs will come under DHA.

One of the provisions in NDAA 2017 requires the Department to conduct a review of the Direct Care System to ensure that MTFs are operating in support of their missions as training platforms for military medical personnel and supporting the medical readiness of operational forces. This review is in its final phase and has included on-site evaluations of select MTFs and assessments of the capabilities of local health care systems to absorb care from the MTFs. Conclusions from these evaluations are being reviewed by senior leaders who will make recommendations to the Secretary of Defense for identification of MTFs for transition to increase or decrease capabilities. The Department will submit a report to Congress outlining recommended MTFs for transition. Facilities designated to transition would begin in FY2020 and could extend through FY2022, depending on transition and local healthcare system expansion timelines. Prior to any change, Congressional notification will be completed in accordance with statute. This reform effort is distinct from MTF consolidation; we are looking at the structure and needs to advance the MHS’s highest priority: to ensure medical forces are ready to support combat forces downrange, and that we continue to build and sustain a world-class health care system geared toward ensuring a medically ready force.

Finally, in order to best support the National Defense Strategy, the Department is comprehensively analyzing medical manpower requirements to meet operational requirements. The Military Departments have recommended force changes based on manpower needed to achieve operational needs. Health Affairs, the DHA, and the Military Medical Departments continue to work closely, developing staffing plans that would achieve the highest readiness and quality of care standards for the warfighter and patient. This effort illustrates the MHS’s inextricable link to the Department’s priorities guiding our strategic direction: getting the military medical force structure right means optimizing personnel, resources, and most importantly, building lethality and support of the force in lockstep with the National Defense Strategy.

While MHS reform brings incredible change, it’s not our only area of focus. We also have new tools at our disposal to deliver on our mission. Next week, I’ll be joining hundreds of uniformed, civilian, contract, and vender experts at the Defense Health Information Technology Symposium (DHITS) in Orlando to talk about how the new MHS GENESIS electronic health record advances readiness, with preparation underway for deployment at Naval Air Station Lemoore, Travis Air Force Base, Army Medical Health Clinic Presidio, and Mountain Home Air Force Base this fall. MHS GENESIS remains a key priority, enabling easier monitoring and response to patient health through an enhanced set of tools to capture the readiness of MHS personnel and service members. The EHR also will improve the way we serve our beneficiaries, whether military members, retirees, or family members.

It’s a productive time for the MHS, and I am grateful for your continued commitment to deliver on our mission. Earlier this week, I joined the 120th Veterans of Foreign Wars (VFW) conference in Orlando to speak with beneficiaries about some of the major MHS transformation efforts underway. I reinforced that while change can be difficult, it also provides the MHS great opportunity to identify innovative ways to more effectively carry out our responsibilities. No matter the organizational reform or change developments to the way we do business, our work together as a team is setting up the future military medical enterprise for success. Keep up the great work!

Tom