Enhanced Multi-Service Markets: Integrated Healthcare Readiness Focus Paul Toland, FACHE CAPT, MSC, USN Chief Operating Officer Hawaii enhanced Multi-Service Market
Disclosures The presenter has no financial relationships to disclose. This continuing education activity is managed and accredited by Professional Education Services Group in cooperation with the MedXellence Program. Neither PESG, MedXellence Staff, nor any accrediting organization support or endorse any product or service mentioned in this activity. PESG and MedXellence Program staff have no financial interest to disclose. 2
Learning Objectives: At the conclusion of this activity, the participant will be able to: 1. Describe the purpose of the enhanced Multi-Service Markets (emsms) 2. Describe the governance structure for the emsms 3. Understand what success looks like for the emsms 3
Influencing the Big Rocks Direct Care $8,149M Management Activities represent a small part of DoD s health care costs Source: DHA briefing Overview of MHS Reformation Governance reform focus is to design incentives to influence better health, better healthcare, and reduce costs 4
MHS Governance Reform Journey Historical MHS Governance Studies DoD Task Force on MHS Governance DepSecDef Planning Memo DepSecDef Nine Commandments Memo 1949-2006 September 2011 March 2012 March 2013 17 studies over 57 years 8 recs for unified service/unified joint command 6 recs for added central authority 3 recs keep separate Service lines 18th study over 62 years 7th rec added central authority DHA model for MHS governance Directed I-Planning for MHS Governance Reform OASD(HA) DHA Shared Services JTF-CapMed transition emsms Directed implementation of MHS Governance Reform OASD(HA) & TMA transition DHA (as CSA) Shared Services NCR Directorate emsms 5
MHS Governance Reform Journey 2017 National Defense Authorization Act (1) Beginning October 1, 2018, the Director of the Defense Health Agency shall be responsible for the administration of each military medical treatment facility, including with respect to (A) budgetary matters; (B) information technology; (C) health care administration and management; (D) administrative policy and procedure; (E) miliary medical construction; and (F) any other matters the Secretary of Defense determines appropriate. (2) The commander of each military medical treatment facility shall be responsible for (A) ensuring the readiness of the members of the armed forces and civilian employees at such facility; and (B) furnishing the health care and medical treatment provided at such facility. 6
Enhanced Multi-Service Markets (emsms) Locations: 1. National Capital Region (Defense Health Agency) Enrollees: 223,884 5 2. Colorado Springs, Colorado (rotate Air Force/Army) Enrollees: 116,270 3. Tidewater, Virginia (Navy) Enrollees: 172,137 4. San Antonio, Texas (rotate Air Force/Army) Enrollees: 125,716 6 2 4 1 3 5. Puget Sound, Washington (Army) Enrollees: 145,174 6. Oahu, Hawaii (Army) Enrollees: 107,515 emsms Provide Over 40% of all MHS Healthcare Delivery Impact much larger: 890,000+ enrolled to emsm MTFs 66.8% of ICU Bed Days 55% of Inpatient Admissions 7
Hawaii emsm AOR Services: Army, Air Force, Navy Eligible Population: 157,341 Op Forces 10,452 MTF Enrolled: 104,781 MTFs-Enrolled Population Army- 63,724 Tripler Army Medical Center- 23,994 SCMH-25 th ID Schofield- 15,631 Schofield Barracks AHC- 17,536 Warrior Ohana Med Home- 6,563 Navy- 27,518 NHCH JBPHH- 17,636 BMC K-Bay- 7,309 NBHC Camp Smith- 883 NBHC NCTMS Wahiawa- 1,690 Air Force- 13,539 15th Med Group JBPHH- 13,539 Note: Hawaii MHS Open Enrollment Policy, dated Jan 14 8 Source: M2 Data, date 11 Jul 16
Average Day in Direct-Care - Hawaii emsm Outpatient Care 39 Procedures 248 Rounds 6,793 Clinic Encounters 7,211 Laboratory Services 5,487 Outpatient Pharmacy Prescriptions Filled 1,437 Radiology Services Inpatient Care 154 Beds Occupied 60 Dispositions 55 MS-DRG RWPs 7 Births Dental 1,425 Procedures OR Surgeries 14 Inpatient 25 Outpatient 9
MHS Governance ASD(HA) Senior Military Medical Action Council (SMMAC) HA/Service SGs Medical Operations Group (MOG) Service Medical Department Healthcare Directors Medical Deputies Action Group (MDAG) DSGs/DHA Dep. Director San Antonio emsm Chairs Group as of 1 Oct 2016 emsm Leadership Group (Market Managers) Manpower and Personnel Operations Group (MPOG) Service Medical Department HR & Manpower Directors Medical Business Operations Group (MBOG) Service RM Medical Directors emsm Hawaii Army lead emsm San Antonio AF/Army rotate Lead emsm Puget Sound Army Lead emsm Tidewater Navy Lead emsm Colorado Springs AF/Army rotate lead emsm NCR DHA Lead BG Bertram Providence Maj Gen Bart Iddins BG Ronald Stephens RDML Anne Swap COL Patrick Garman RDML David Lane 10
Hawaii Enhanced Multi-Service Market Governance Hawaii emsm Joint Executive Council Chief, Analysis and Evaluation Chief, Clinical Operations Chief, Business Operations Joint Executive Steering Committee Oahu Pharmacy & Therapeutics Committee Primary Care Working Group Behavioral Health Working Group Marketing / Strategic Communication Working Group Specialty Access to Care (ATC) Working Group Ad Hoc Groups: Data Analytics & Metrics WG Medical Management WG Physical Therapy WG Working Groups Attended by emsm Team: Island Wide Exceptional Family Member WG (Lead RHC-P) Joint Public Health WG (Lead TAMC) Referral Management WG (Lead TAMC) Joint Products Review Board (Lead TAMC) 11
emsm Purpose Adopt common clinical/ business practices Optimize readiness Direct movement of workload and workforce between/among the MTFs Source: emsm CONOPS 12
emsm Goals Integration & Standardization Promote Healthy/ Resilient Community Ease of access Bringing healthcare to the patient System of health Value to Line Leadership Medically ready force Ready medical force Source: emsm CONOPS 13
emsm Core Metrics Readiness Experience of Care Patient satisfaction (rating hospital) Patient satisfaction (recommend hospital) Per Capita Costs Prime enrollment Total purchased care Private sector cost per Prime enrollee Primary care leakage to network PMPM growth rate Retail pharmacy spending (%) OR performance and case load Provider productivity Population Health Prime enrollment OR performance OR case load 14
FY16 Q2 - emsm Performance Review Source: MHS Dashboard (20 July 2016) Notes: Access to Care measures are included in this brief with market observations for performance. PMPM, Private Sector Care Cost Per Enrollee and Secure Messaging are calculated at the Parent DMIS level. Non-eMSM MTFs are included in the calculations. Q1 data are impacted by DEERs challenges in the MDR/M2. Working with the Business Analytic Council to obtain an emsm view of performance. MHS Dashboard does not produce measures at the emsms level for following : Total Purchased Care emsm Heatmap Report for comparison of performance across the markets as the above table. 15
emsm as a Military Health System: Success Reduced Purchased Care Costs Referral Management Timely, Appropriate Access to Quality Care emsm Maximizing Resources Leveraging Technology Bringing Healthcare to the Patient Standardized Processes emsm Success = Better Health 16
Hawaii emsm Successes Physical Therapy Initiative The Hawaii market realized a $ 1M purchased care savings from FY14 to FY15 as a result of adding a physical therapy team $4,500,000.00 $4,000,000.00 $3,500,000.00 HI emsm Physical Therapy $2,500,000.00 $2,000,000.00 Based on available FY16 data the Hawaii market expects a 5% decrease in purchased care cost from FY15 as a result of market collaboration The Hawaii market projects an annual $3M savings by acquiring 3 physical therapy teams over the next fiscal year Purchased Care Cost $3,000,000.00 $2,500,000.00 $2,000,000.00 $1,500,000.00 $1,000,000.00 $1,500,000.00 $1,000,000.00 $500,000.00 $0.00 Savings $500,000.00 $0.00 ($162,544.59) $127,973.29 FY14 FY15 FY16 FY17 FY18 ($500,000.00) Purchased Care Cost Savings The data reflect beneficiaries who ages range between 13 and 64. This is the Market s targeted group for recapture. 17
18 Hawaii emsm Successes Transfer Center Initiative
Hawaii emsm Successes Reduction of Market Network Enrollment Jan 2014 implemented Market policy to allow Open Enrollment to Market MTFs Sharp decreases in Network enrollment since Oct 2013 thru present Consistent increase in Retiree/Retiree Family member enrollment with Direct Care Market MTFs Market Outlook: Able to maintain steady Prime enrollment numbers while experiencing decreasing active duty footprint Data Source: M2 TRICARE Enrollment, TRICARE Relationship Detail, DEERS Person Detail ( August 2016) 19
20 Hawaii emsm Successes - Retail Pharmacy Spend Formulary Management is Key Identify and promote use of safe and most costeffective and drug therapies Ensure access to care Non-formulary request provision Early adoption of breakthrough therapies Economics Contract compliance, brand-to-generic transitions Recapture Prevent leakage Leverage Oahu P&T Committee Creates standardization across Market Enables Patient Satisfaction
What does success look like? Beyond DoD Market Collaboration Beyond DoD Master Sharing Agreements High-Acuity Patients Access to Quality Healthcare Joint Venture with VA Pacific Islands Health Care System Market Support to VA access stand-down 6,750 outpatient specialty consults FY15 in Hawaii 21
Summary Markets provide a path ahead for the MHS Primary readiness and care platforms Collaboration - sharing challenges and best practices Coordination and integration Realizing efficiencies Improving readiness and access to care 22
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Enhanced Multi-Service Market Presentation Questions? 24