December Message to the Military Health System Team from the Assistant Secretary of Defense for Health Affairs, HON Thomas McCaffery
Earlier this month, I joined many of you at the annual convening of AMSUS (the Society of Federal Health Professionals) at National Harbor, Maryland, to discuss the status of the Military Health System: what we’ve achieved, where we’re going as an organization, and how we will get there. Directly following AMSUS, I testified before the House Armed Services Committee alongside the Military Department Surgeons General, Joint Staff Surgeon, and the Director of the Defense Health Agency. Each engagement provided an important opportunity – and critical audiences – to share our steps in carrying out reform across the military medical enterprise to better meet the Department’s needs, and to reaffirm the MHS’s collective vision for the future.
I underscored the new challenges an ever-changing security environment presents to our military and, more specifically, to military medicine – challenges requiring our organization to adapt and evolve to best serve the combatant commands and the Military Departments as we together advance the National Defense Strategy. This period of MHS reform is a time to embrace change and forge an improved system of military health that delivers on our readiness mission to ensure that troops are fit to fight, and that medical professionals are ready to support them in training and on the battlefield.
To better deliver on our mission, the MHS is laser focused on three key areas of organizational reform. First, consolidated management of the direct care and purchased care systems. Second, a reinvigorated focus on readiness within the direct care system. And third, optimizing the size and composition of the military medical force, including the recruitment, education and training, and sustainment of skills to deliver on our readiness mission. For the most current updates on our MHS reform areas of focus, I’m attaching the prepared statement that the DHA Director LTG Place and I provided to the HASC at the recent hearings.
I would like to thank Army Surgeon General LTG Dingle for inviting me to speak at the MEDCOM Leadership Lecture Series on 10 December. This event afforded me the opportunity not only to speak about my leadership philosophy and approach, but also to hear MEDCOM leaders’ thoughts and perspectives on the various changes underway in the MHS.
In the weeks ahead, I hope many of you are able to enjoy some well-deserved time with friends and families over the holidays. For those deployed or unable to take R&R due to serving our warfighters and patients: thank you for your selfless service to the Nation. Each of you across the MHS is playing a part in significant change in our enterprise – helping to inform those changes, making them real, and dedicating your talent and expertise to our mission. I am grateful for your contributions and look forward to our continued work together in the New Year.
Army Surgeon General’s Leadership Lecture Series: HON McCaffery, Assistant Secretary of Defense for Health Affairs
Here’s a link to a 1 hour video on leadership from the Assistant Secretary of Defense for Health Affairs:
On October 25, 2019, Deputy Secretary of Defense David L. Norquist signed a memo officially directing the transfer of authority, direction, and control of Military Treatment Facilities across the United States to the Defense Health Agency. While this formal directive marks an important milestone in the MTF transition process, it is only the most recent. The Military Health System’s work to date has resulted in significant progress to implement key provisions of the Fiscal Year 2017 National Defense Authorization Act. We transitioned the first phase of hospitals and clinics to the DHA last October and published more than 100 standardized policies since January 2018, with 29 more projected for publication by the end of the year. This progress reflects great momentum toward standardizing performance measures across the military medical enterprise and eliminating unnecessary variability, while moving to a more integrated system of readiness and health care delivery.
Earlier this month, I joined DHA Director LTG Ron Place and the Service medical leadership to share updates on MHS reform efforts with the Military/Veterans Service Organizations (MSO/VSO) Executive Council – a key stakeholder group that has long provided the MHS with invaluable insights into our beneficiaries’ experience within the health system. In recent months, MHS senior leadership has tackled head-on many of the issues MSO/VSOs have raised on behalf of beneficiaries. We reaffirmed to the MSO/VSO group that we’ve put in place a conditions-based, direct-support framework to ease the transition of MTFs to the DHA, which will help us to ensure we continue to provide our beneficiaries with access to quality care during this period of change.
I commend the teams across the MHS – at all levels – for your continued commitment to successfully implement the multiple reforms we have launched. Across Health Affairs, the Military Departments, DHA, the Uniformed Services University and the Office of the Joint Staff Surgeon, we recognize that success is a collective endeavor; our partnership to expeditiously solve problems, address gaps, and communicate successes and challenges remains key. A special thanks to senior leadership for forging this collaboration, and a warm welcome to Rear Adm. Bruce L. Gillingham, the Navy’s new Surgeon General and Chief of the Bureau of Medicine and Surgery. We look forward to your contributions in your new role – welcome to the team!
Outside of reform, military medicine continues to advance the Department’s three lines of effort in support of the National Defense Strategy. Earlier this month I had the opportunity to witness this first-hand when I visited the USNS Comfort in Haiti as part of its five-month deployment to provide medical assistance in support of regional partners across the USSOUTHCOM AOR. It was an honor to join USSOUTHCOM Commander Adm. Craig Faller, Task Force 49 Mission Commander Capt. Brian Diebold, USNS Comfort MTF Commander Capt. Patrick Amersbach, and the entire USNS Comfort team as they carried out this critical medical mission. This mission is a great example of the strategic role military health care plays in advancing the NDS’s focus on building relationships with our partners and allies.
Looking ahead, I anticipate seeing many of you at next month’s AMSUS (the Society of Federal Health Professionals) annual convening at National Harbor, Maryland, where I’ll join other senior leaders to discuss our progress to date implementing significant organizational change across the MHS and to outline what’s ahead for the system.
For those who are able to take some R&R for Thanksgiving, I hope you are able to spend time with friends and family and return refreshed. As I reflect on this uniquely American holiday, I’m grateful for the men and women who protect and defend our freedom and for the families who support them, and I thank all of you for what you do to sustain the health system that supports them.
As the Defense Health Agency formally assumes responsibility for management
of MTFs across the United States, I commend your continued commitment and
hard work across all levels of the MHS to ensure our warfighters maintain
the military medical combat support capabilities we provide, our patients
see no disruption of quality or access to the healthcare delivery services
they depend on, and our collective efforts to deliver on an implementation
plan to make this transition a success. You are part of an historic
transformation in military medicine – thank you for your service to the
nation during this pivotal period of change. While we have accomplished much
to date, much work remains, and I know you will continue to deliver at the
same high level as this work continues.
In addition to business reform, the MHS continues to build critical
partnerships to advance readiness and operational support. Recently, I
joined Acting Commissioner Dr. Ned Sharpless and his staff at the Food and
Drug Administration for the FDA-DoD semi-annual meeting to discuss our
continued, close partnership to ensure delivery of critical battlefield
medicine to our service members downrange. Over the past two years of
enhanced collaboration between the DoD and FDA, we’ve achieved a number of
successes to advance warfighter readiness and improve overall battlefield
trauma response. We’ve established Emergency Use Authorization for
freeze-dried plasma in initial hemorrhage control efforts as part of
battlefield trauma care, approved drugs for battlefield pain control and
infectious disease threats, and increased the Department’s access to
platelets for injured warfighters in theater. These successes are already
yielding dividends in building a better prepared, better protected, and
better cared for force, equipping the U.S. warfighter with the best possible
military medical support. A special thanks to Dr. Terry Rauch and the DoD
team for your hard work on this critical partnership – including LTC
Colacicco-Mayhugh, RADM (Ret) Carmen Maher, Ms. Kathy Berst, Mr. Nathan
Pawlicki, COL Jennifer Kishimori, Mr. Jeremiah Kelly, Ms. Emily
Badraslioglu, and Ms. Jennifer Dabisch.
Our partnership efforts within the MHS continue to develop as well. I had
the opportunity to join the National Intrepid Center of Excellence (NICoE),
the 10 Intrepid Spirit Centers (ISC), and the Center for the Intrepid (CFI)
to discuss progress and areas of focus as the MHS continues to develop the
best care and treatment for the more than 172,000 patient encounters – seen
this year alone – related to traumatic brain injury and associated health
conditions. With new improvements for treatment and care, including NICoE’s
TBI Portal – which, in collaboration with the Defense Health Agency and the
ISCs, consolidates TBI patient data to better inform clinical decision
making and treatment – the MHS is building a collaborative network of TBI
research, education, and care to enhance warfighter readiness. Special
thanks to NICoE Director CAPT Walter Greenhalgh, NCR Director Brig. Gen.
Anita Fligge, Intrepid Fallen Heroes Fund Honorary Chairman Mr. Arnold
Fisher, Walter Reed National Military Medical Center Director COL Andrew
Barr, and our talented colleagues across the University and the Defense and
Veterans Brain Injury Center for advancing the MHS’s partnership and best
practices that are putting military medicine at the global forefront to
prevent and respond to TBI.
On a final note, we bid farewell to Vice Adm. Forrest Faison as the 38th
surgeon general of the Navy, as he retires after 39 years of service to the
Nation. On behalf of the entire MHS, thank you for your passionate
commitment to the military medical enterprise and to the soldiers, sailors,
airmen, Marines, Coast Guard members and the families who the MHS supports
and cares for.
from the Assistant Secretary of Defense for Health Affairs, HON Thomas McCaffery
It’s a momentous time for the Military Health System. Earlier this month, the Defense Health Agency held its Change of Responsibility ceremony to bid farewell to VADM Rocky Bono and welcome LTG Ron Place as the DHA’s new leader. VADM Bono’s leadership during her four years with the DHA prepared the Agency for significant organizational reform that will enhance our integrated system of readiness and health and deliver on our mission to support the warfighter and care for the patient.
LTG Place brings 29 years of outstanding leadership and expertise including extensive surgical training, combat surgical experiences in Afghanistan, deployments during Operation Iraqi Freedom and Kosovo, commanding Army hospitals at all levels, and most recently as the National Capital Region medical director. His experience leading the transitional Intermediate Management Organization to oversee MTFs that transitioned to the DHA last year will be invaluable in helping foster the critical relationships between the DHA and Military Treatment Facilities.
I also would like to welcome Brig Gen Paul Friedrichs as the new Joint Staff Surgeon. Brig Gen Friedrichs has a wealth of experience as well. In his last assignment as Command Surgeon, Headquarters, Air Combat Command at Joint Base Langley-Eustis, he was responsible for organizing, training, equipping and sustaining combat-ready medical forces for rapid deployment. He was also responsible for the health care of 81,000 active duty and civilian personnel located at 12 bases and more than 300 operating locations worldwide.
And congratulations to MG R. Scott Dingle for his nomination for promotion to lieutenant general and assignment as the U.S. Army Surgeon General.
On the subject of change, years of planning are coming to fruition as we reach historic MHS milestones this month and next. These achievements are a direct result of your diligent work and commitment to delivering on key initiatives to support readiness and quality health care delivery. On September 7, the MHS’s new electronic health record, MHS GENESIS, went live at four new sites: Travis AFB, Presidio of Monterey, and Naval Air Station Lemoore in California, and Mountain Home AFB, Idaho. Together, these four sites make up “Wave Travis” – the first wave of post-Initial Operating Capability (IOC) full-scale deployment as we roll out this state-of-the- art integrated electronic health record system-wide.
MHS GENESIS is transformative for our enterprise, for our providers, and for our patients – enabling access to robust information about patients and better management of chronic, complex, and time-sensitive conditions. It also provides real-time clinical decision support, increases patients’ direct communication with providers, and helps the Military Health System better target and tailor resources to meet readiness requirements both for the medical force and the warfighter.
The Wave Travis deployment reflects a strategic and deliberate application of lessons learned during IOC testing in the Pacific Northwest, including improvements to our training strategy, change management process, and infrastructure support. With plans underway to complete worldwide MHS GENESIS deployment by 2024, we are already seeing this complex effort contribute to the broader MHS reform vision – including enhanced cybersecurity, standardized workflows, and improved patient engagement through the MHS GENESIS Patient Portal. A big shout-out to the teams at Travis, Presidio of Monterey, Lemoore, and Mountain Home, for your agility, preparation, and commitment to a successful deployment of MHS GENESIS!
A quickly approaching milestone for MHS transformation is the transfer of authority, direction and control of U.S. Military Treatment Facilities to the DHA on October 1. This pivotal change consolidates the management of MTFs under the DHA, thus advancing standardization, improving readiness, enhancing consistency in patient access and experience, reducing operating costs, and strengthening performance management systems. The end result will be a better system of military medicine – a truly integrated enterprise that optimizes medical readiness and patient care. While this is a big change, there should be no disruption to the daily routine at MTFs both for patients and staff. The conditions-based, direct-support framework that the DHA and the services will use to support MTFs as DHA stands up its headquarters capabilities will ease the transition.
Switching gears, on the topic of support to our warfighters, earlier this month I had the pleasure of meeting with VADM Tim Szymanski, Deputy Commander, U.S. Special Operations Command. We discussed DoD’s Comprehensive Strategy for Warfighter Brain Health, which aims to promote and protect the health and well-being of our forces, including optimizing cognitive performance and enhancing the Department’s capabilities to prevent, diagnose, and treat Traumatic Brain Injury. I’m so impressed with the initiative SOCOM has taken to be more preemptive in their approach, specifically, their Cognitive Surveillance Program, which is designed not only to identify injuries earlier, but also to track individual trends and assist in developing comprehensive treatment plans for a warrior’s recovery. In addition to taking a more deliberate approach to increasing awareness of potential cognitive issues, SOCOM provides initial baseline screening to its special operators, and retests them every two years to determine if there are significant changes. It’s the cognitive equivalent of a routine dental exam or audiogram. Cognitive Surveillance is actively driving the science through blast-exposure research efforts. By determining heavy weapons/breaching exposure levels, they can determine mitigation requirements. SOCOM’s approach is similar to what the Navy did when it created dive tables, which regulate scuba divers’ time underwater to prevent them from absorbing too much nitrogen and getting decompression sickness. With our operational commanders focused on brain health, I know that together, we can leverage innovation, research and development, and enhanced clinical programs to ensure our forces remain both lethal and resilient.
Lastly, I want to take a moment to recognize National Suicide Prevention Month and encourage you to come together to prevent and respond to the devastating trend of suicide. We all have a role to play in creating environments that empower each other to seek support early. Learn about the resources available if you or a friend needs help, and together, commit to build a culture of connectedness. I was heartened to read an inspiring story just last week about Airmen 1st Class Brittany Wright and Tiffany Duffus, two dental lab technicians at Peterson Air Force Base, Colorado. They stepped in to support a friend in need, embodying the team approach to resiliency and suicide prevention necessary to combat this tragedy in our ranks. Senior leadership across the MHS and the Department are committed to fostering a community and culture of support and access to the right help at the right time. For suicide prevention resources, visit https://health.mil/Military-Health-Topics/Conditions-and-Treatments/Mental-Health/Suicide- Prevention.
Earlier this month, the Senate confirmed my nomination as the Assistant Secretary of Defense for Health Affairs. The time I have spent in the principal deputy position has given me valuable perspective on the unique role the Military Health System (MHS) plays in national security and in American medicine. I’m deeply grateful for the opportunity to serve in the ASD role and alongside such a talented team that makes up the MHS.
As I told the Senate Armed Services Committee last November, it will be a great privilege to lead the MHS during this period of unprecedented transformative change. With readiness of our service members as our first priority, we are implementing a historic transition in how we manage our Military Treatment Facilities. We are also conducting comprehensive reviews of the Direct Care System to enhance MTF operations as training platforms to support medical readiness, and identifying the optimal military medical manpower requirements to meet operational requirements. As you know, we continue the deployment of a truly modern electronic health record that will support the provision of integrated, standardized care across the MHS enterprise. Next month, MHS GENESIS will go live at Travis AFB, Mountain Home AFB, NAS Lemoore, and the Presidio at Monterey. This next deployment has been informed by the hard work of the teams at Fairchild Air Force Base, Naval Health Clinic Oak Harbor, Naval Hospital Bremerton and Madigan Army Medical Center during the Initial Operating Capability (IOC) rollout. Earlier this month I had the opportunity to visit COL Thomas Bundt, Commander, Madigan Army Medical Center (MAMC), and his team. Their passionate embrace of the opportunity to be one of the IOC sites has paid off for the entire enterprise. Their contributions to our strategy for future deployment – informed by their lessons learned on the ground – has positioned us for a successful next phase of MHS GENESIS implementation. Thank you, COL Bundt and the entire MAMC team.
In addition to the major reform efforts underway, our day-to-day successes continue to support the Department’s priorities. Earlier this week, I joined the more than 3,000 researchers and scientists from across the Department, interagency, industry, academia, and partner nations at the annual Military Health System Research Symposium (MHSRS).
I spoke to participants about the critical role of military medical research and development in advancing the MHS’s integrated system of readiness and health. From strengthening Traumatic Brain Injury clinical and research capabilities, addressing mental and behavioral health issues among injured service members, vaccines and countermeasures for infectious diseases, to the developments in medical technologies to advance enroute patient care, the MHS’s research and development initiatives enable the U.S. military to remain at the forefront to protect and defend the U.S. homeland and the shared interests of our allies and partners. I encourage you to review the innovative findings coming out of this year’s conference at www.health.mil/mhsrs.
I had the pleasure to recognize a number of MHSRS award winners – awardees like CDR Ian Valerio, who has made pivotal contributions to research on preemptive treatments for phantom and residual limb pain; and the Zika Purified Inactivated Virus WRAIR team, who helped develop a Zika vaccine candidate for clinical trial; and Dr. Amy Adler, whose research in military behavioral health has led to improved outcomes in health, resilience, and performance of service members. It is abundantly clear how the MHS’s commitment to innovation and partnerships is yielding new technologies, processes, and services that help ensure a more prepared, stronger and more resilient force.
A big thank you to Dr. Terry Rauch and the Health Affairs team, RADM Mary Riggs and the R&D team at DHA, Dr. Richard Thomas and his team at USUHS, the Services, and the thousands of scientists and researchers across the MHS who contributed to MHSRS. Thank you for your continued work in advancing the incredibly important mission we are privileged to carry out.