The Defense Health Agency in 2015 COL Scott A Svabek Acting Director of Procurement Defense Health Agency December 2014 Medically Ready Force Ready Medical Force
The Why 1
the Why Not 2
Agenda MHS Governance Reform The Defense Health Agency Topics of Interest! Current / Pending requirements Medically Ready Force Ready Medical Force 3
A Changing World We are only beginning to see the dramatic shifts underway that will define our future and shape our interactions in the world and require our national security institutions to adapt and to adjust We will need to more efficiently match our resources to our most important national security requirements. We can do things better. We must do things better and we will. Secretary Hagel Center for Strategic & International Studies November 2013 Translation: Adapt or Perish! Medically Ready Force Ready Medical Force 4
Medical as Percent of DoD Budget Continued cost increases within MHS are unsustainable over time Includes Normal Cost contributions to the Medicare Eligible Retiree Health Care Fund (MERHCF) Medically Ready Force Ready Medical Force 5
Governance Reform: Influencing the Big Rocks Management Activities represent a small part of DoD s health care costs Opportunities exist for a properly organized management HQ to effect change with shared services *Source: FY 2012 President's Budget position for DHP O&M Medically Ready Force Ready Medical Force 6 6
DHA Vision and Mission Vision A joint, integrated, premier system of health, supporting those who serve in the defense of our country. Key Mission Aspects A Combat Support Agency supporting the military services Supports the delivery of integrated, affordable, and high quality health services to beneficiaries of the Military Health System (MHS) Executes responsibility for shared services, functions, and activities of the MHS Serves as the program manager for the TRICARE Health Plan, medical resources, and as the market manager for the National Capital Region (NCR) enhanced Multi Service Market Manages the execution of policy as issued by the Assistant Secretary of Defense for Health Affairs Exercises authority, direction and control over the inpatient facilities and the subordinate clinics assigned to the DHA in the NCR Directorate. Medically Ready Force Ready Medical Force 7
Military Health System Secretary of Defense USD(P&R), Vice Chiefs MHSER CJCS USD(P&R) Sec Army Sec Navy Sec Air Force ASD(HA) SGs, JSS PDASD, Deputy SGs, JSS, DD, DHA SMMAC MDAG, DASDs, JSS MDAG PAC USUHS Combat Support Agency Responsibilities ASD(HA) Policy & Oversight Execution Defense Health Agency CSA Army SG Army MEDCOM CNO Navy SG Navy BUMED CMC CSAF Air Force MAJCOMs Air Force SG MPOG MOG MBOG NCR Directorate MTFs MTFs MTFs Personnel Operations Budget Army Operational Units Navy Operational Units Marine Operational Units Air Force Operational Units MTFs MHS Governance Defense Health Agency Service Medical Organization 8
DoP Organizational Structure (as of 2 October 2014) Procurement Directorate Director COL Scott Svabek Executive Assistant: Deputy Director Eric Thaxton Chief of Staff -Vacant- Chief Policy & Comp. Advocate Genesta Belton Business Operations Division (BOD) Ken Helgren Senior Contracting Officer Jake Lewis Systems GPC COD-FC Chief Andrew Carrington COD-A Chief Richard Van Dorn COD-NCR Chief MAJ Owen Roberts COD-SA Chief Kenneth Helgren 5
BLUF: DHA as a Combat Support Agency Translation: DHA is to medical as DLA is to logistics or as DISA is to communications 10
Defense Health Agency POLICY DEVELOPMENT & OVERSIGHT CJCS Secretary of Defense USD(P&R) ASD(HA) POLICY EXECUTION IPO Combat Support Agency Responsibilities PEO DHMS Defense Health Agency Director Defense Health Agency Director Deputy Director Sr. Enlisted Sr. Enlisted Advisor Advisor DHA OGC EHR Functional Champion Special Staff Chief of Staff HA / DHA Liaison Strategic Mgt Component Acquisition Executive Communications Def Health Board Innovation DoD/ VA PCO Admin & Mgt EEOO Manpower Comptroller Prog Integration Procurement Analytics Small Business Healthcare Operations Directorate (CMO) Research Development & Acquisition Directorate Health IT Directorate (CIO) Education & Training Directorate Business Support Directorate NCR Medical Directorate TRICARE Health Plan Advanced Development Innovation and Advanced Technology Dev (CTO) METC HQ Facility Planning Walter Reed National Military Med Center Pharmacy Science & Technology Portfolio Mgmt and Customer Relations DMRTI Medical Logistics Ft. Belvoir Community Hospital Clinical Support Clinical Infrastructure Program Infrastructure & Operations JMESI Budget & Resource Management Joint Pathology Center Public Health Veterans Affairs R&D Liaison Solution Delivery Academic Review & Oversight Program Integrity Readiness Information Delivery Prof Development, Sustainment, & Prog Mgmt Warrior Care Program Cyber Security Defense Health Service System (DHSS) Defense Health Clinical Systems (DHCS) 11
Our Leadership Team Mr. Allen Middleton Deputy Director Lt Gen Douglas Robb Director CMDCM Terry Prince Senior Enlisted Advisor MG Richard Thomas Director Healthcare Operations RADM Bruce Doll Director Research & Development Mr. David Bowen Director Health IT Brig Gen Robert Miller Director Education & Training Mr. Joseph Marshall Director Business Support RADM Raquel Bono Director NCR Medical Medically Ready Force Ready Medical Force 12
Defense Health Agency: Global Support DHA - Aurora TRICARE Europe: TRO West TRO South METC Health IT TRO North Defense Health Agency TRICARE Pacific Medically Ready Force Ready Medical Force
10 Shared Services 1 Facilities 6 Budget & Resource Management 2 Medical Logistics 7 Procurement/Contracting 3 Health Information Technology 8 Research, Development & Acq 4 TRICARE Health Plan 9 Medical Education & Training 5 Pharmacy Programs 10 Public Health Medically Ready Force Ready Medical Force 14
Shared Services Savings Five Year Defense Plan (2015 2019) Shared Service IOC FY14 Net Savings FY15-19 Savings FACILITIES 1OCT 13 $537 M MEDICAL LOGISTICS 1OCT 13 $189 M HEALTH IT 1 OCT 13 $265 M HEALTH PLAN 1OCT 13 $456 M PHARMACY 1OCT 13 $1,224 M CONTRACTING 1 MAR 14 $136 M BUDGET & RESOURCE MGMT 1 FEB 14 $279 M MEDICAL RESEARCH & DEV 1 JUN 14 $98 M MEDICAL EDUCATION & TNG 10 AUG 14 $ 5 M PUBLIC HEALTH 1 OCT 14 $293 M TOTAL $3.482 BILLION Medically Ready Force Ready Medical Force 15
Shared Services Savings Five Year Defense Plan (2015 2019) Shared Service IOC FY14 Net Savings FY15-19 Savings FACILITIES 1OCT 13 $18.4 M $537 M MEDICAL LOGISTICS 1OCT 13 $13.5 M $189 M HEALTH IT 1 OCT 13 $33.1 M $265 M HEALTH PLAN 1OCT 13 $25.5 M $456 M PHARMACY 1OCT 13 $160.5 M $1,224 M CONTRACTING 1 MAR 14 ($2.9 M) $136 M BUDGET & RESOURCE MGMT 1 FEB 14 $0 M $279 M MEDICAL RESEARCH & DEV 1 JUN 14 $0 M $98 M MEDICAL EDUCATION & TNG 10 AUG 14 $0 M $ 5 M PUBLIC HEALTH 1 OCT 14 $0 M $293 M TOTAL $248.1M $3.482 BILLION Medically Ready Force Ready Medical Force 16
Multi Service Markets: 2 or more Services, large beneficiary population, 45% direct care dollars, large GME & readiness platforms Puget Sound, Washington (Army) National Capital Region (DHA) Colorado Springs, Colorado (rotate Air Force/Army) Tidewater (Navy) San Diego (Navy) Ft. Bragg (Army) Oahu, Hawaii (Army) San Antonio, Texas (rotate Air Force/Army) = emsm = Single Service The Eight Largest Markets (and Service/Department Leads) 17
Enhanced Multi Service Market (emsm) Performance Overview Medically Ready Force Ready Medical Force
Medical Modernization: Match medical resource allocation to demand signal DoD Comptroller initiated study in fall 2012: Focus on lessons learned from 13 years of war Right size MHS to align with restructuring of active force Reevaluate how to best maintain ready medical forces Core Priorities: Quality of care Patient safety Clinical skills of uniformed medical professionals Adapt to changing American medical practices: Migration to outpatient/ambulatory care Shorter inpatient lengths of stay Technology and telehealth Approach: Department wide, data driven study with civilian and military, line and medical leaders involved Question: Does business plan support readiness plan or does readiness plan support business plan the answer is yes! Medically Ready Force Ready Medical Force 19
DHA in 2014 Put the pieces in place All shared services in as of September 30, 2014 All senior leaders are permanent, not acting Multi Service Markets are functioning; business plans approved 20 Medically Ready Force Ready Medical Force
DHA in 2015 Maturation and focus on increasing synchronization, reducing variation across the enterprise Not everything that is an enterprise issue requires a shared service This is not about taking people or products it s about a process by which we identify opportunities for enterprise standardization; examples include: Analytics Credentialing Telehealth system Sustaining momentum on process efficiencies, service delivery, service improvement, and cost savings (in FY15 our proposed savings are booked into the budget) 21 Medically Ready Force Ready Medical Force
Final Thoughts This is a once in a generation opportunity to shape the future of military medicine Local health delivery and Multi Service Markets are central to our strategy and a core element of our reform efforts There are millions depending on us to get this right 22 Medically Ready Force Ready Medical Force
DHA Current Acquisitions T2017 (re compete of the Managed care support contracts) Information Management (Capabilities, Analysis & Governance Support (CAGS)) DHMS Engineering, Cybersecurity and Configuration (ECCM) currently under Protest Assessment & Authorization (previous CA) Other Health Insurance Performance & planning Management for (DHA IT I/O division) 23
DHA Current Acquisitions (CONT) Marketing and Education Support Services Audit Readiness (financial support) ALTHA/ CHCS sustainment Rx Refill Privacy & Civil Liberties (PM Support) Joint Outpatient Experience Surveys (JOES) Web based Inpatient clinical support Next Gen USAF SME support for clinical workflow 24
DHA Current Acquisitions (CONT) Tricare Claims Review Services (TCRS) Clinical Quality Support Services (CQSS) Tricare Overseas Program Tricare Dental Program DHA Global Service Center DHITS GEN 1 Army AHLTA Trainers Service Oriented DOD Enterprise management Ctr Enterprise Virtualization Solution 25
the Why Not 26
BACK UP Medically Ready Force Ready Medical Force 27