Health Care Transition Looks to Improve Processes for Wartime Missions, Beneficiaries

By DOD News Release - April 11, 2019

Dr. Gregory Johnson, Tripler Army Medical Center Concussion Clinic medical director, has U.S. Army Spc. Andrew Karamatic follow his finger with his eyes during a neurologic exam March 20, 2014. The Defense and Veterans Brain Injury Center reports that more than 375,000 service members have suffered a traumatic brain injury since 2000. U.S. Air Force photo by Staff Sgt. Christopher Hubenthal

Since 2001, the military medical establishment has learned much about caring for trauma.

Many American service members alive today who have fought since 9/11 would have died in previous wars. Thousands more have benefitted from state-of-the-art care and the experience that military medical providers have learned in 18 years of war.

The lessons of the battlefield were learned through experience and repetition, and DOD and Congress want to ensure those lessons are not forgotten.

At the direction of Congress, the military health care system is going through a substantial set of changes in its structure and how it will operate, said Robert Daigle, the Defense Department’s director of cost assessment and program evaluation.

“Our No. 1 priority … is to maintain the quality of care for both the wartime mission and the beneficiary population,” Daigle said in a recent interview. “Our goal … is to improve the readiness of the military health care personnel for the wartime mission.”

From Capitol Hill to the Pentagon to military treatment facilities around the world, all are working together to make the transition as seamless as possible, the director said.

Management of the military treatment facilities will transition from the services to the Defense Health Agency. The agency will focus on providing high-quality care for beneficiaries, enabling the services to focus entirely on medical readiness for the wartime fight.

The military treatment facilities will move to the agency over a three-year period. Officials will be able to examine the changes, assess how the transition is working and make changes as needed, Daigle said. Currently, the facilities at Walter Reed National Military Medical Center in Bethesda, Md., and those at Fort Belvoir, Va.; Fort Bragg, N.C.; Jacksonville, Fla.; and Keesler Air Force Base, Miss., come under the Defense Health Agency. This transitions more than 1,000 headquarters medical staff from the services to DHA.

“The second major muscle movement in this is to reshape the military medical force for the wartime mission,” Daigle said. “In some specialties, we have too few providers – emergency medicine for example. In other cases, we have more than we need.”

The latest budget request calls for more than 100,000 active-duty military medical professionals, with more than 60,000 in the reserve components.

The budget reallocates 14,000 positions from medical specialties into other critical shortfalls in the services’ operational force structure, Daigle said. If the service needs cyber, infantry or aircraft maintenance personnel, it will be able to apply these slots to those fields, he added, noting that most of the slots reassigned will be personnel who seldom deal with patients directly.

Improving Readiness for the Wartime Mission

Finally, he said, the initiative is intended to ensure the medical force improves its readiness for the wartime mission.

This is more complicated. The question is to ensure medical personnel get the patient load they need to develop and maintain qualifications. The number of times a surgeon performs a specific surgical procedure is directly tied to the outcome, Daigle explained. “Higher reps, better outcomes,” he said.

One of the challenges from a medical readiness perspective is relatively low workload levels per provider. “We just don’t have enough patients of certain types to generate the readiness levels we need,” Daigle said. “In some cases, we are going to want to remove some people from hospitals so the amount of workload that remains, divided over fewer providers, will give them the opportunity to hone their procedures.”

This mirrors the trends in the civilian world, where surgeons specialize in certain procedures. Some surgeons do only knee replacements, and may do hundreds of them per year. Those surgeons have seen the range of complications that can arise from a procedure and are best equipped to deal with them when they arise. They certainly would be better equipped to handle a complication than a surgeon who might do one a month, Daigle said.

Daigle emphasized that all of this process will be studied and assessed even as the process continues forward, and that there is time to make changes as needed in the process.

The director also said he hopes that standardization of the administrative processes in the military treatment facilities will make moving among the facilities easier for service members and beneficiaries.