TO REDEFINE MILITARY HEALTHCARE

FROM: U.S. DEPARTMENT OF DEFENSE

Fort Belvoir Hospital Aims to Redefine Military Healthcare

By Donna Miles
American Forces Press Service

FORT BELVOIR, Va., July 8, 2013 - When the Fort Belvoir Community Hospital opened its doors in August 2011, it represented a long list of "firsts." It was the nation's newest, most technologically advanced military treatment facility, the first one to receive gold-level LEED "green" construction certification, and one of just two joint hospitals in the Military Health System


Less than two years later, the staff at the Defense Department's newest treatment facility is implementing another first: an ambitious new strategy that its commander hopes will help redefine military healthcare.

One of the most striking things about the gleaming new hospital is that despite its 1.3-million-square foot footprint, it has only 120 inpatient beds. Most of the facility is built around 440 examination rooms and 55 clinics that concentrate on outpatient care and preventive medicine, Army Col. Chuck Callahan, the hospital commander, told American Forces Press Service.

"The outpatient arena is where healthcare takes place in 2013," he said. "Good healthcare is focused on prevention, which means you don't need to get hospitalized."

With that goal in mind, the hospital staff is working to keep patients healthy and, when they need medical care, to make it the most positive experience possible.

This is the foundation of the new strategy Callahan began rolling out last year. Tapping the hospital staff and patients directly, he incorporated almost 700 of their suggestions into a plan designed to improve the care provided.

"This strategy we have embraced really belongs to the staff and patients of the organization, and we are now in the process of beginning to implement them," Callahan said.

Early indications are positive, he said. Making appointments is easier than ever before. Parking is convenient. The facility itself is inviting. And most important of all, Callahan said, everything about the hospital operation is focused directly on patients and their families.

People who have tried to see a doctor when they are sick probably know the pitfalls of a reactionary healthcare system. Getting squeezed in for a same-day appointment can be difficult, at best. If a condition requires a visit with a specialist, that draws treatment out even longer and often requires multiple appointments.

"The notion of patient- and family-centered care means we look at the way care is delivered from the perspective of the patient, both individually and as a population," Callahan said. It's a proactive approach that boils down to "'What health care do you need and how do we provide it to you?' rather than the opposite, 'Here is what we have and sorry if it is not what you need,'" he said.

The centerpiece of this model is an ongoing relationship between patients and their providers.

Patients are assigned to a "medical home" -- a team of doctors, nurses and specialists who oversee their care. "This is a group that puts their arms around that group of patients and manages their health -- not just treats their disease," Callahan said.

As a result, patients know who to call when they have health issues or questions. When they need to make an appointment, they can feel confident that they'll get one, and be seen by providers who know their conditions and medical histories.

Patients with complex medical issues also have ready access to the "medical neighborhood" within the hospital, Callahan said. No longer do they need to schedule multiple visits with a series of specialists who may never communicate with each other. Instead, providers from across the "neighborhood" coordinate through medical home to provide interdisciplinary care.

"That's all the providers, plus the patient and family, in the same room, talking through the treatment and management plan," Callahan said. "It's the model we are evolving as a hospital."

The facility itself incorporates what Callahan called "evidence-based design" that supports healing. Design decisions were made to be therapeutic, incorporating natural light, outside views, healing gardens and pavilions inspired by nature: Eagle, River, Sunrise, Oak and Meadow.

Sections of the hospital are color-coded so visitors can quickly get their bearings. All in-patient rooms have just one bed, and a pull-out sofa that family members can sleep on. The design team tapped the Disney Corporation's concepts of "on-stage" versus "off-stage" operations, relegating non-medical services to back hallways or non-prime hours.

While improving access to care when patients are sick and making the hospital experience as positive as possible are major goals of the new strategy, a foundation of the medical home concept is taking care of patients when they are healthy, Callahan said.

Instead of waiting for patients to call, he said, providers reach out to initiate required tests and procedures. They also rely heavily on social media and a secure Internet-based messaging system to answer patients' health-related questions and provide healthcare information aimed at promoting health and well-being.

"The focus is on managing the patients so they get what they need and what they don't even know that they need," Callahan said. "It's not just a matter of 'What are you here for today?'

The goal is to keep you out of the hospital and keep you healthy. That's much better than waiting until you are sick."

Making these investments up front changes the paradigm in delivering healthcare, creating healthier beneficiaries and improving their quality of life, Callahan said.

As the Defense Department struggles with tough budget choices amidst skyrocketing medical costs, this proactive approach makes financial sense, he added.

"Treatment of disease is almost always more expensive than screening for and preventing disease. Almost always," Callahan said. "So we are making the investment up front. As we move toward health and well-being, we are not only providing better healthcare to our beneficiaries. We are also going a long way toward saving healthcare costs in the long run."

Callahan said he expects the new strategy to be fully in place within the next five years, but emphasized that he doesn't anticipate a point where the staff will ever fully declare "mission accomplished."

"Performance improvement is a journey. It is not a destination," he said "Getting better as an organization is a journey, so we are going to continue to evolve our strategy to adapt to healthcare changes and better ways to provide for our patients.

"So there is never going to be a point of 'arriving,'" he said. "In terms of healthcare, there will always be traveling."

MILITARY HEALTH CARE REFORM

T

he following excerpt is from a Department of Defense American Forces Press Service e-mail:

Health System Seeks Savings While Retaining Excellence

By Jim Garamone
American Forces Press Service

WASHINGTON, March 9, 2012 - Iraq and Afghanistan have been dangerous places over the past decade, but deployed troops often passed a saying on to new arrivals: "If you've got to get shot, this is the best place to do it."

The saying spread because the medical care for wounded service members was state-of-the-art, with the survival rates significantly higher than in previous conflicts.

Dr. Jonathan Woodson, assistant secretary of defense for health affairs, told the House Appropriations Committee's defense subcommittee yesterday that he wants to retain this excellence while controlling spiraling costs.

"Over the last 10 years, the men and women of the Military Health System have performed with great skill and undeniable courage in combat," Woodson said. "Their contributions to advancing military and American medicine are immense. The Military Health System's ability to perform this mission and be able to respond to humanitarian crises around the globe is unique among all military and nonmilitary organizations on this globe."

All department leaders are committed to sustaining this precious resource, Woodson said. But he acknowledged that military health care is now more than $51 billion of the yearly defense budget. The 2011 Budget Control Act calls for $487 billion in defense cuts over the next 10 years, and the health care system is not immune, he said.

Military health System officials are taking four roads to savings, Woodson told the panel. The first is to find efficiencies inside the system. The second is a continuation of efforts to appropriately pay for private-sector providers. A third initiative promotes healthy lifestyle choices while seeking to reduce illnesses, injuries and hospitalizations. The last is proposed changes to beneficiary cost-sharing under the TRICARE military health plan.

The fiscal 2013 defense budget request includes this recommended path to reorganize the military health system, Woodson said. "We have learned a great deal from our joint medical operations over the last 10 years," he added, "and we recognize that there is much opportunity for introducing even a more agile headquarters operation that shares common services and institutes common clinical and business practices across our system of care."

Woodson noted that the recommended changes to TRICARE fees came about only after officials had explored other avenues of potential savings. "Before we even considered TRICARE fees, there were a number of initiatives and considerations taken," he told the committee.

DOD health affairs is looking to control headquarters costs, Woodson said, and it has had some success eliminating 780 full-time equivalent positions from the headquarters. Other efforts, he added yielded further savings.

"We put in a number of management reforms that have yielded very positive results in reducing costs, including a robust fraud and recuperative program that has yielded $2.6 billion over the last four years," he said.

In addition, Woodson said, a pharmacy management program has saved $ 3.4 billion, medical supply and acquisition standardization has saved $31 million, and an amalgamation of other efficiencies that saved about $1 billion.
 

REVIEW OF MILITARY HEALTHCARE FOCUSES ON SLOWING GROWTH OF COSTS

The following excerpt is from the Department of Defense American Forces Press Service:

"Chairman's Corner: The Military Health System

By Army Gen. Martin E. Dempsey
Chairman of the Joint Chiefs of Staff

WASHINGTON, Feb. 21, 2012 - I spent last week on Capitol Hill with our Secretary of Defense. The questions about our defense budget were tough — as they ought to be. The stakes are high.

There are no easy answers in cutting $487B from the budget, but we're not the first generation to face difficult budget challenges. We'll figure it out. The nation's counting on us.

Health care costs generated a lot of attention. I welcomed the opportunity to speak about this important part of the budget, to express my concerns about further cuts that could come due to sequestration, and to explain how we intend to keep faith with our armed forces — not just through pay and benefits but by ensuring we remain the best trained, best equipped, and best led military in the world.

In forming this budget, we looked at all cost variables. Many of you will know that pay and benefits account for more than 1/3 of the budget and that health care costs in particular have increased from $19B in 2001 to $48B today. We had to act to slow this growth.

I want those of you who serve and who have served to know that we've heard your concerns, in particular your concern about the tiered enrollment fee structure for TRICARE in retirement. You have our commitment that we will continue to review our health care system to make it as responsive, as affordable, and as equitable as possible."