As the largest single employer in the federal government, the Department of Defense (DoD) has a huge and diverse obligation to provide medical care from home bases in the United States to the front lines of America’s overseas battlefields. Every soldier, sailor, airman, Marine, Guard member, reservist, DoD civil servant, and dependent is affected by the health care systems managed by the department, and the challenges have grown almost exponentially since the attacks of 9/11 nearly a decade ago. With more than 2.1 million personnel to care for, the job of managing this huge health care enterprise is the responsibility of the Office of the Assistant Secretary of Defense for Health Affairs and director, TRICARE Management Activity.
Like many other federal agencies, the Senior Executive Service position of assistant secretary of defense for Health Affairs and director, TRICARE Management Activity is presently vacant, following the departure of Dr. Charles Rice for other duties within DoD. Presently filling the position pending the confirmation of a presidential appointee by the Senate is Lt. Gen. George Peach Taylor, Jr., M.D., who was kind enough to answer some questions from The Year in Defense about the massive DoD health care enterprise.
John D. Gresham: Can you please give us some background about yourself, and the career path you took to your present position as assistant secretary of defense for Health Affairs; and acting director of the TRICARE Management Activity?
Lt. Gen. George Peach Taylor, Jr., M.D.: For starters, I am a physician with board certification by the American Board of Preventive Medicine. I graduated from Rice University in 1975 with degrees in physics and Russian. Then in 1978, I graduated from Baylor College of Medicine in Houston, Texas, and interned in Greenville, S.C. In 1984, I earned a master’s in public health from the Harvard School of Public Health and completed a residency in aerospace medicine in 1985 at Brooks Air Force Base [Texas]. I then entered active duty as an Air Force flight surgeon in 1979 and rose through the ranks to become the 18th surgeon general of the U.S. Air Force [USAF], and retired from the USAF in October 2006. After retiring from the Air Force, I served as a managing director of Federal Government Practice at PricewaterhouseCoopers, and later as a vice president at Northrop Grumman Information Systems. There I was responsible for large-scale transformation projects, innovative electronic business solutions, independent program management oversight, mission-critical enterprise-wide health applications, interoperable architecture, and large-scale information technology systems integration. I am presently performing the duties of the assistant secretary of defense for Health Affairs and acting director of TRICARE Management Activity. Following this assignment, I will return to my role as deputy assistant secretary of defense for Force Health Protection and Readiness.
Can you tell us something about the portfolio of duties and responsibilities that you currently have as assistant secretary of defense for Health Affairs and acting director of the TRICARE Management Activity?
In my current role, I administer the Military Health System [MHS] and serve as principal adviser to the secretary of defense for health issues. The MHS currently comprises approximately 133,000 military and civilian doctors, nurses, medical educators, researchers, health care providers, allied health professionals, and health administration personnel worldwide. As such, they provide our nation with an unequalled integrated health care delivery, expeditionary medical, educational, and research capability. We provide expert care for more than 9.6 million beneficiaries worldwide, including active-duty service members, retirees, National Guard, reservists, families, and uniformed members of the Coast Guard, Public Health Service, and National Oceanic and Atmospheric Administration.
In any given week, the MHS experiences approximately 21,800 inpatient admissions; 1.6 million outpatient visits; 2,300 births; 2.5 million prescriptions filled; and 3.5 million claims processed. These figures represent a combination of care received through the MHS Direct Care System – which includes our 59 Army, Navy, and Air Force military hospitals, and 364 health clinics – and our Purchased Care System – our TRICARE-managed network of civilian providers administered by regional health care support contractors in the continental United States and overseas.
In addition to providing care at the home front, the MHS also provides care on the battlefield. Our medics, corpsmen, medical air crews, physicians, nurses, and even behavioral health care providers provide care at every level – from point of injury during or immediately following enemy engagement to fully operational hospitals in war zones and evacuation back to the United States. For our medical staff, the first “golden hour” of care has become the first “15 minutes.” Frankly, we are saving lives that would have been lost in earlier conflicts. The MHS also plays an integral role in homeland defense; pandemic influenza preparedness; and humanitarian assistance and disaster relief around the globe. The MHS is a leader in pandemic influenza planning, working closely with the Department of Health and Human Services. We can and do respond rapidly and effectively to disasters, public health emergencies, and mass casualty events involving military personnel, DoD employees, and beneficiaries, and provide support to civil authorities and the general public when requested.
On and off the battlefield, in times of peace and war, the MHS’ goal is to ensure that the highest standard of care is delivered. Whether this is done by treating the wounded, teaching the world’s future doctors, researching new ways to treat old diseases, or discovering innovative ways to prevent the spread of new ones, the MHS is a prominent institution within the global medical community – and its priority is to provide the best health care possible to every soldier, sailor, airman, and Marine.
What was the state of mental and physical health with the personnel/patient base that your offices service when you arrived in your present position? And what trends has your office seen over the past decade in terms of health trends within your personnel/patient base, given health developments here at home as well as battlefield conditions around the world?
During this past decade, this country has been at war on two fronts, in Afghanistan and Iraq, resulting in multiple challenges for the MHS. We have been responsive to these challenges while implementing numerous initiatives to protect the health and fitness of service members and their families. Applying lessons learned from the first Gulf War [in 1991] and throughout the current conflicts, the MHS has developed and implemented policies and programs to protect the health and safety of service members and their families before, during, and after deployment. This includes optimizing health and fitness through the prevention of disease, controlling deployment-related exposure to environmental and occupational hazards, global surveillance, individual medical readiness, and health risk assessment and management. We also try to examine all the factors which stress the deployed force, and seek to improve the success of the service member within the psychological, physical, and ethical behavior domains both on the battlefield and between deployments. We work closely with each military service, including their leaders and medical services and personnel offices, to put in place the appropriate policies and programs to support fielding and sustaining a fit and healthy force.
Clearly, one health trend resulting from being a nation at war has been a marked increase in reported post-traumatic stress disorder [PTSD] and traumatic brain injury [TBI]. In response, we have directed greater resources into the prevention and early detection of these injuries. In particular, we have implemented both pre- and post-deployment health assessment tools to help determine the individual health of our service members. During the post-deployment health assessment, we review each service member’s current physical and mental health, psychosocial issues commonly associated with deployments, special medications taken during the deployment, possible deployment-related occupational and environmental exposures, discuss deployment-related health concerns with the member, and provide needed medical care. Unfortunately, TBI is not always immediately apparent following a blow to the head. New policies require service members who sustain any head injuries, even those presenting no symptoms, to be thoroughly evaluated before they can return to their unit. The increased focus on TBI has increased the awareness and knowledge at the individual and unit level, resulting in more service members reporting head injuries to a physician and receiving the care they need.