Financing Army Medicine: Driving the System for Health COL Anthony S. Cooper, CDFM, FACHE, DFMCP3 MAJ Deepak J. Mathew, CDFM, DFMCP2 Slide 1 of 15 Purpose and Outline Purpose: To describe the journey of the U.S. Army Medical Command s paradigm shifts in its resourcing model and the impact to our system for health. Outline: 1. Army Medicine 2. Our Environment 3. Integrated Resource and Incentive System 4. Impact of Budget Methodologies 5. Final Thoughts Slide 2 of 15 1
Army Medicine Military Medicine Mission Areas -- Priorities Combat Casualty Care: Medical personnel, services, and doctrine that save Service members and DoD Civilians lives and maintain their health in all operational environments. Readiness and Health of the Force: Medical personnel and services that maintain, restore, and improve the deployability, resiliency, and performance of Service members. Ready & Deployable Medical Force: Military personnel who are professionally developed and resilient, and with their units, are responsive in providing the highest level of healthcare in all operational environments. Health of Families and Retirees: Medical personnel and services that optimize the health and resiliency of Families and Retirees. Health of Families & Retirees Readiness of the Force Casualty Care Readiness of the Medical Force An interdependent and overlapping mission set An effective integrated system of comprehensive care Providing many services not found in private sector healthcare Driven by service, not profit Slide 3 of 15 United States Army Medical Command Slide 4 of 15 2
AMEDD at a Glance Personnel AMEDD Total OTSG/MEDCOM Total AC 53,879 27,178 Civilian (All Medical) 50,849 42,219 Contractors ~7,784 ~5,554 Compo 2/3 43,650 1,391 Total 156,162 76,342 *MEDCOM Appr Funds Only (No LN/NAF), OTSG CS-W00LAA, and All Army CP53 Resourcing FY15 Funded: $11.7B (all appropriations) Beneficiaries Active Duty (AD) 546K Family Members (AD) 856K Dependant Survivor 229K Eligible NG/RC 128K Family Members of NG/RC 202K Retired 775K Family Members Retired 909K Inactive G/R 89K Family Member IGR 140K Other 29K Total 3.90M Army TDA Facilities Medical Centers 8 Community Hospitals 15 Health Centers 10 Primary Care Clinics 110 Occupational Health Clinics 29 Dental Clinics 137 Veterinary Facilities 77 Research & Development Laboratories 24 Laboratory Support Activities 5 Over 1000 individual administrative and healthcare buildings totaling over 24 million square feet FY14 SRC08 EAB TOE Units Active / Reserve Combat Spt Hosp (CSH) 10 / 16 FWD Surg Tm (FST) 16 / 22 Other Active Units 90 / 0 Other Army NG Units 0 / 52 Other Army AR Units 0 / 134 AC / NG / AR Deployable Units 116 / 52 / 172 (340 Total) Slide 5 of 15 Average Day in Direct Care - MEDCOM Outpatient Care 30,851 Clinic Visits Babies 42 Births Inpatient Care 706 Beds Occupied 234 Patients Discharged Vaccines 5,140 Immunizations Laboratory 33,792 Lab Services RX 30,749 Prescriptions Dental 13,816 Services Veterinary Services (FY14) 1,583 Veterinary Outpatient Visits $38.7 Million of Food Inspected 328 Food Safety Visits Radiology 7,339 Rad Services Personnel Deploying 100s of Soldiers and Civilians Includes all global engagements: Kuwait, Afghanistan, Africa, Germany, Pacific, others. Slide 6 of 15 3
What is our Environment National Strategic Guidance Congressional Calendar POM Per Capita Cost DHA Congressiona l Action President s Budget Operating Company Model emsms Small Hospital Study SecArmy Priorities CSA Priorities TSG Guidance What! Why! IRIS Special Programs Hiring CAP TDA/PSM DMHRSi Service Lines UBO MEPRS SOO Where is my Core! IRIS Service Lines Special Programs UBO Hiring Cap SOO TDA/P SM Performance Plan DMHRSi MEPRs Core AM2020CP Assessment MEDCOM TNG Key Leader Engagement - Smaller Army, Personnel Reductions, Fiscal Uncertainty - MHS, though losing flexibility, is still well resourced Labor a constraint - Military Compensation & Retirement Modernization Commission (2015) - Stakeholders want change; Willing to be innovative & even radical Slide 7 of 15 Management Framework Performance Planning Lifecycle Strategy: Objectives, Initiatives, Measures Performance MTF Budget RADaR MTF Business Plan Campaign Assessment Campaign Synchronization MTF Execution Readiness Access Quality Patient Safety Satisfaction Enrollment Efficiency Data Quality. Productivity Service Lines Performance IRIS FARMs Camps RADaR Slide 8 of 15 4
Historical Resourcing Method Medical Care Composite Unit (MCCU) (up to 1990) Gateway to Care (1991-1993) The Years Adrift (1994-2001) The Early War Years (2002-2004) DoD Perspective Payment System (PPS) (2004-2012) Performance Based Budgets (PBB) (2004-2006) Performance Based Adjustment Model (PBAM) (2006-2013) Integrated Resourcing and Incentive System (IRIS) (Oct 2013-present) Slide 9 of 15 Integrated Resourcing and Incentive System Slide 10 of 15 5
Execution Tracking Dashboards Slide 11 of 15 Why we use IRIS PMPM is comparing FY14Q2 to FY15Q2 with No Retail RX Increase Readiness Cost Capture Capture and show scattered Readiness data within work centers Established Framework to have dimensional look of efforts towards Readiness + 18% Continuity + 7 HEDIS + 7% TRISS +1% Improve Population Health Improved IPSRs by 267 additional per month. Average HEDIS compliance improved by 7 throughout MEDCOM Enhance Experience of Care APLSS considerably increased thought the enterprise. TRISS improved within enterprise. Reduce Per Capita Cost Standardized unit price set stage for defining unit of allocation. Accounting accuracies are improved considerably. Controlled PMPM drastic negative shift of PMPM PMPM + 24% + 267 MILPAY IPSRs + 6% APLSS Data based on 2010 to 2015 PBAM/IRIS trends Slide 12 of 15 6
Impact of Performance-based Budgeting TROSS: Satisfaction with Healthcare PMPM by Service HEDIS Performance Over Time HEDIS Performance over time Slide 13 of 15 Final Points Massive organizational paradigm and culture shifts to performance based budgeting. Paying for performance works. Education/Knowledge of our staff. Cultivâtes an entrepreneurial culture that enhance a positive patient expérience. Slide 14 of 15 7
Guidance Slide 15 of 15 8