military health system: the defense health agency in...
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Military Health System: The Defense Health Agency in 2016
VADM (Dr) Raquel Bono
Director, Defense Health Agency December 1, 2015
“Medically Ready Force…Ready Medical Force”
The Defense Health Agency Fully Operational / Continuity of Mission
1 “Medically Ready Force…Ready Medical Force”
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“The imperative of successful MHS Governance reform requires a sustained
commitment by all components to adapt an enterprise focus, including the renewed
priority of quality, patient safety and access throughout the entire MHS and the challenge
of transitioning to a new, state-of-the-art electronic health record. Jointness, cost effectiveness and healthcare integration
remain the guiding vision.” -DepSecDef Work September 2015
“Medically Ready Force…Ready Medical Force”
The Defense Health Agency Fully Operational / Continuity of Mission
Why We Are Here
• It’s on every slide… • Medically Ready Force
• Ready Medical Force
3 “Medically Ready Force…Ready Medical Force”
Our 2016 Priorities
• Support to the Services
• Support to Combatant Commanders
• Optimizing the DHA for the Future
4 “Medically Ready Force…Ready Medical Force”
Defense Health Agency Leadership Team
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Vice Admiral Raquel Bono Director
Mr. Guy Kiyokawa Deputy Director
CMSgt Vottero Acting Sr. Enlisted Advisor
MG Richard Thomas Director
Healthcare Operations
RADM Bruce Doll Director
Research & Development
Brig Gen Robert Miller Director
Education & Training
MG Jeffrey Clark Acting Director
NCR-Medical Directorate
Mr. David Bowen Director
Health IT
Mr. Darrell Landreaux Acting Director
Business Support
“Medically Ready Force…Ready Medical Force”
6 6
Defense Health Agency Global Operations / Global Support
TRO West TRO South METC Health IT
DHA - Aurora
TRO North Defense Health Agency
TRICARE Pacific TRICARE Europe:
MMSO Great Lakes
“Medically Ready Force…Ready Medical Force” 7
Armed Forces Med Examiner
Armed Forces Hlth Surveillance Center Natl Museum of Hlth and Medicine Walter Reed Natl Mil Med Center Ft Belvoir Cmty Hospital
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DHA as a Combat Support Agency
“Medically Ready Force…Ready Medical Force”
DHA Shared Services
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TRICARE Health Plan FOC 29 Sep 15
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Pharmacy Programs FOC 29 SEP 15
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Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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Pharmacy
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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Note: DHP Compound Pharmacy Expense represented by under age 65 beneficiaries
$0
$100,000,000
$200,000,000
$300,000,000
$400,000,000
$500,000,000
$600,000,00010
/1/2
012
11/1
/201
212
/1/2
012
1/1/
2013
2/1/
2013
3/1/
2013
4/1/
2013
5/1/
2013
6/1/
2013
7/1/
2013
8/1/
2013
9/1/
2013
10/1
/201
311
/1/2
013
12/1
/201
31/
1/20
142/
1/20
143/
1/20
144/
1/20
145/
1/20
146/
1/20
147/
1/20
148/
1/20
149/
1/20
1410
/1/2
014
11/1
/201
412
/1/2
014
1/1/
2015
2/1/
2015
3/1/
2015
4/1/
2015
5/1/
2015
6/1/
2015
7/1/
2015
DHP
MERHCF
Tota
l Spe
nd
11
Compound Drugs Cost Trend and Impact from Screening
Note: DHP Compound Pharmacy Expense represented by under age 65 beneficiaries
$0
$100,000,000
$200,000,000
$300,000,000
$400,000,000
$500,000,000
$600,000,00010
/1/2
012
11/1
/201
212
/1/2
012
1/1/
2013
2/1/
2013
3/1/
2013
4/1/
2013
5/1/
2013
6/1/
2013
7/1/
2013
8/1/
2013
9/1/
2013
10/1
/201
311
/1/2
013
12/1
/201
31/
1/20
142/
1/20
143/
1/20
144/
1/20
145/
1/20
146/
1/20
147/
1/20
148/
1/20
149/
1/20
1410
/1/2
014
11/1
/201
412
/1/2
014
1/1/
2015
2/1/
2015
3/1/
2015
4/1/
2015
5/1/
2015
6/1/
2015
7/1/
2015
DHP
MERHCF
Tota
l Spe
nd
Compound Drugs Cost Trend and Impact from Screening
12
Note: DHP Compound Pharmacy Expense represented by under age 65 beneficiaries
Compound Drugs Cost Trend and Impact from Screening
13
0
0.2
0.4
0.6
0.8
1
1.2
Nov-11
Monthly Compound Expense
June $10.4 MJuly estimated $10.5 at current spend
$0
$50,000,000
$100,000,000
$150,000,000
$200,000,000
$250,000,000
$300,000,000
$350,000,000
$400,000,000
$450,000,000
$500,000,000
$550,000,000
$600,000,000
Nov-11
Jan-12
Mar-12
May-12
Jul-12
Sep-12
Nov-12
Jan-13
Mar-13
May-13
Jul-13
Sep-13
Nov-13
Jan-14
Mar-14
May-14
Jul-14
Sep-14
Nov-14
Jan-15
Mar-15
May-15
Jul-15
Sep-15
May 1-May 11 (Initial Screen): $75M May 12-May 31 (Enhanced Screen) : $5M
Spend peaked in April 2015 - $545M Last week in April alone over $200M
Addressed Fraud; Assisted Criminal Activity Justice Dept will prosecute fraud
14 “Medically Ready Force…Ready Medical Force”
Shared Service: Pharmacy Programs Implementing Home Delivery
• Enterprise effort to move patients to the right source for prescription medications at the lowest cost to the patient and the government • TRICARE For Life – seamless migration to Home Delivery
for chronic medications in February 2014 • All TRICARE beneficiaries – began migration on October 1
of this year • Introduced ability for civilian providers to electronically
request prescription drugs from nearby MTF • Continued to adjust Rx co-pays to incentivize quality, cost-
effective options 15
TRICARE
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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TRICARE 2017
• Comprehensive reassessment of how we deliver / coordinate care -- more than just “the benefit”
• How we organize and administer TRICARE – to include TRICARE contracts • Patient-centered: Modernization and
simplification of contracts and service • Expand contemporary means to access
health services beyond the physical office visit
“Medically Ready Force…Ready Medical Force” 17
Acute Care Campaign April 2015
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DHA: Listening to Our Customers
“Medically Ready Force…Ready Medical Force”
Based on our [NMFA] findings, we ask that the Defense Health Agency and Congress consider the following steps to improve access to acute care for military families:
• Develop and implement metrics that accurately assess acute appointment demand
• Expand clinic hours and the number of acute appointments
• Monitor progress on access initiatives
• Standardize the network urgent care referral process and monitor compliance at the MTF level
• Waive the network urgent care preauthorization requirement for a limited number of urgent care visits
• Limit the policy of directing beneficiaries to MTF emergency rooms
• Re-examine the referral policy
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DHA: Listening to Our Customers
“Medically Ready Force…Ready Medical Force”
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Access 3rd Available Appt - 24hr
1.8
1.0
0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
Target MHS NCRMD
LOW
ER IS BETTER
“Medically Ready Force…Ready Medical Force”
TRICARE Reform Transparency - Internal & External • The Secretary of Defense demanded it; the MHS committed to it; the law
(NDAA 2016) now describes exactly what is expected
• CMS / Hospital Compare requires it • Tied to Medicare reimbursement • VA participates in it, and shares it on its website
• Leading high reliability organizations embody it, even when it is below
benchmarks, and can rapidly drive improvement
• The media has access to the data, without needing to “ask” us (and if they ask, we are obligated to share it)
• Patients expect it
“Medically Ready Force…Ready Medical Force” 21
- 22 -
For Official Use Only
MHS Transparency…It’s Coming!
Health IT
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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Shared Service: Health IT DoD Electronic Health Record
• July: Announcement of next generation Electronic Health Record (Leidos / Cerner / Accenture)
• Strategic enabler for the military medical mission
• Innovation built in to acquisition. Commercial off-the-shelf (COTS) product with 10 years of upgrades at no additional cost.
• Interoperability with federal and private sector health systems – where over 60% of our health care is delivered.
• Research support tool. EHR expands opportunity for DoD to engage in large-scale / big data research
“Medically Ready Force…Ready Medical Force” 24
Shared Service: Health IT DoD Electronic Health Record
• DHA will serve critical role in ensuring infrastructure, security, and clinical needs.
• RADM (Ret) Dr Bill Roberts is Functional Champion -- Important all perspectives are represented in deployment: clinicians, business leaders, support staff, and patients.
“Medically Ready Force…Ready Medical Force” 25
• My focus – ensuring that the EHR supports the clinical practice of medicine and enhances access, quality and safety!
Facilities
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• Standardized demand signal and prioritization process for Medical Construction requirements
• Standardized the Sustainment, Restoration, and Modernization programming models
• Providing facilities support to e-MSMs for future capital requirements
Shared Service: Health Facilities
“Medically Ready Force...Ready Medical Force” 27
• DHA onsite project management of Rhine Ordinance Barracks replacement project (Above right)
• BUILDER implementation (Enterprise-wide Facility Condition Assessment)
MedLog
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
4
Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• Expanding Defense Medical Materiel Standardization Program from supply/consumables to include equipment/medical devices.
• Increasing coordination with Uniformed Services and DLA focused on improved efficiency and lower delivered material costs
• Coordinating with DHMSM Deputy PMO on medical device/equipment interface and standardization policy.
• Reducing purchase card usage, materiel costs, and risk by increasing product lines to DLA’s Electronic Catalog (ECAT).
Shared Service: Medical Logistics
“Medically Ready Force...Ready Medical Force” 29
• Good MEDLOG practices support Services and COCOMS!
Budget & Resource Management
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
4
Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• Implementing ABACUS • Third Party Collections (TPC) for
outpatient and Medical Affirmative Claims (MAC)
• Initial implementation of guidance for a new common cost accounting structure (CCAS) to support consistent & transparent accounting transactions
Shared Service Budget & Resource Management
“Medically Ready Force...Ready Medical Force”
• Standardize medical record coding policies/procedures for all three Military Services & continue development of a HIPAA-compliant remote medical record coding capability
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Procurement/Contracting
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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Shared Service Procurement/Contracting
• Integrated contract service to support the full range of products and services needed throughout the organization
• Key Enablers • Simplified processes for customers • Accelerated timelines for everyone • Increased transparency for vendors • Enhanced professional acquisition workforce
“Medically Ready Force...Ready Medical Force” 33
Research, Development and Acquisition (RDA)
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
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Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• Integrated Joint Program Committees for oversight of $2.2B medical research enterprise
• Established Clinical Investigation Research Office for multiservice clinical studies
• Integrated Armed Forces Medical Examiner System (AFMES) and Natl Museum of Health and Medicine
Shared Service Research Development & Acquisition
“Medically Ready Force...Ready Medical Force” 35
Public Health
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1
TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
4
Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• Standardized Periodic Health Assessment…~$210M annual cost avoidance
• New Joint Staff Surgeon Quarterly Health Surveillance Report… Evolution of DHA/PHD Combat Support Agency role
“Medically Ready Force…Ready Medical Force”
Shared Service Public Health
• Collaborated w/ DLA to redistribute ~ 48.4K Doses of “expiring” Japanese Encephalitis Vaccine to MTFs with immediate need…averted $3M loss
• Armed Forces Health Surveillance Center (AFHSC) became part of DHA in August 2015
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Education and Training
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TRICARE Health Plan FOC 29 Sep 15
2
Pharmacy Programs FOC 29 SEP 15
3
Medical Education & Training * Pending 90-Day Review
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Research, Development & Acq FOC 29 SEP 15
Health Information Technology FOC 29 SEP 15
Facilities FOC 3 March 15
Budget & Resource Management FOC 29 SEP 15
Medical Logistics FOC 3 March 15
Procurement/Contracting FOC 29 SEP 15
Public Health FOC 29 SEP 15
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“Medically Ready Force…Ready Medical Force”
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• One Stop Learning Management System • Joint Knowledge Online (JKO) new home
for on-line tools • Joint Executive Skills Institute complete
• METC Strategic Partnerships • Bridge programs with 43 schools in 23
states that recognize military training for credit (WH Initiative)
• “Military Combat Medic to RN” in 13 months a reality
Education and Training Shared Service Highlights
“Medically Ready Force...Ready Medical Force” 39
Multi-Service Markets: 2 or more Services, large beneficiary population, 45% direct care dollars, large GME & readiness platforms
The Eight Largest Markets (and Service/Department Leads)
= eMSM
= Single Service
National Capital Region (DHA)
Tidewater (Navy)
Ft. Bragg (Army)
San Antonio, Texas (rotate Air Force/Army)
Oahu, Hawaii (Army)
San Diego (Navy)
Puget Sound, Washington (Army)
Colorado Springs, Colorado (rotate Air Force/Army)
40 “Medically Ready Force…Ready Medical Force”
DHA Support to Markets
• Analytic support for decision-making • Dashboard • Performance
• Tools and resources to advance • Access • Quality • Safety
• Important center of gravity for TRICARE Reform
41 “Medically Ready Force…Ready Medical Force”
MHS Performance Dashboard STRATEGIC ALIGNMENT
PERFORMANCE MEASURE DEV. STATUS MHS PERFORMANCE
THRESHOLDS COMPONENT PERFORMANCE
AIM OBJECTIVE RED GREEN BLUE A N AF NCR MD PSC AS OF DATA ENTRY
Readiness
Medically Ready Force (PLS1) Individual Medical Readiness (IMR) I 87% <75% ≥85% 90% 84% 90% 89% N/A N/A Jun 15 Sept 15
Ready Medical Force (PLS2) TBD --- --- --- --- --- --- --- --- --- --- ---
Better Health
Healthy People (PLS3) TBD --- --- --- --- --- --- --- --- --- --- ---
Improve Healthy Behaviors (IP5) HEDIS Cancer Screening Index I 63% 50% 70% 90% 88% 94% 73% 79% 36% May 15 Sept 15
Better Care
Improve Clinical Outcomes and Consistent Patient Experience (PLS4)
▼ Risk Adjusted Mortality (All Cause) E .82 TBD TBD TBD .89 .74 .63 .98 Mar 15 Sept 15 Inpatient: Recommend Hospital (Satisfaction) I 75% <71% ≥73% ≥75% 71% 75% 80% 85% 73% Mar 15 Sept 15
Overall Satisfaction w/Healthcare (Outpatient) I 94% Service Specific Service Specific Service Specific 92% 95% 96% 93% 92% Mar 15 Sept 15
Improve Safety (IP9)
▼ **HAI (CLABSI) I 14 N/A N/A 0 9 4 1 0 N/A Jun 15 Sept 15
▼ **PSI 5 - Retained Surgical Item or Unretrieved Device Fragment Count (Per Year) I 11 N/A N/A 0 10 1 0 0 N/A Dec 14 Jun 15
▼
National Surgical Quality Improvement Program (NSQIP) (30 Day) All Case Morbidity Index I 82% of
MTFs green 10th percentile 11th - 89th percentile 90th percentile Multiple scores per service N/A Dec 14 Sept 15
CAUTI 14 TBD TBD TBD 12 1 1 0 N/A Jun 15 Sept 15 Wrong Site Surgery 11 TBD TBD TBD 7 0 1 3 N/A Jun 15 Sept 15
Improve Condition-Based Quality Care (IP7)
**HEDIS Diabetes Index I 54% 50% 70% 90% 68% 80% 76% 80% 20% May 15 Sept 15 **HEDIS Appropriate Care Index (Low Back Pain, Pharyngitis, URI) I 47% 50% 70% 90% 41% 67% 63% 61% 31% May 15 Sept15
▼ NPIC Post-Partum Hemorrhage* E 3.9% 2σ above NPIC avg.(3.3%)
within 2σ of NPIC avg. (3.3%)
2σ below NPIC avg.(3.3%) 3.8% 3.6% 4.3% 5.6% N/A Dec 14 Sept 15
▼ NPIC Vaginal Deliveries w/Coded Shoulder Dystocia Linked to a Newborn ≥ 2500 grams w/Birth Trauma* I 10.9.% 2σ above NPIC
avg.(12.5%) within 2σ of NPIC
avg. (12.5%) 2σ below NPIC
avg.(12.5%) 11.2% 7.1% 16.7% 0% N/A Dec 14 Sept 15
HEDIS (30-Day) Mental Health Follow-Up I 79% 50th percentile (74%)
75th percentile (81%)
90th percentile (85%) 87% 86% 78% 85% 61% May 15 Sept 15
▼ HEDIS All Cause Readmission E 1.45 50th percentile (0.79)
75th percentile (0.73)
90th percentile (0.68) 1.46 1.39 1.27 1.80 N/A Nov 14 Jun 15
ORYX Transition of Care Index (Asthma, VTE, Inpt Psy(2)) I 50% 60% 75% 100% 44% 56% 50% 63% N/A Sept 14 Jun 15
AHRQ Prevention Quality Indicator (PQI) Index I 94% 70% 80% 90% 94% 94% 94% 94% N/A Dec 14 Sept 15
Improve Comprehensive Primary Care (IP8)
PCM Continuity I 61% 55% 65% 81% 61% 63% 61% 54% N/A Apr 15 Jun 15 PCM Empanelment E <1,100:1 1,100:1 >TBD
▼ Primary Care Leakage I 25.3% >24% 24% to > 20% ≤ 20% 22.8% 26.6% 27.5% 26.3% N/A May 15 Sept 15
▼ **Avg. No. of Days to Third Next Available Future Appointment (Primary Care) I 7.6d >7d 7.0d 2.2d 6.4d 6.8d 8.8d 11.0d N/A Aug 15 Sept 15
▼ **Avg. No. of Days to Third Next Available 24 Hour Appointment (Primary Care) I 1.7d >1d 1.0d 0.8d 1.9d 0.9d 2.0d 2.5d N/A Aug 15 Sept 15
Optimize & Standardize Access & Other Care Support Processes (IP10)
**Percent of Direct Care Enrollees in Secure Messaging I 37% <50% ≥50% ≥60% 29% 45% 42% 40% N/A July 15 Sept 15
**Satisfaction with Getting Care When Needed (Service Surveys) I 86% Service Specific Service Specific Service Specific 83% 90% 91% 83% 90% Mar 15 Sept 15
Lower Cost
Improve Stewardship (PLS5)
▼ PMPM I $370 10.6%
>2.8% yearly growth
2.8% to > 0% yearly growth ≤ 0% yearly growth 13.2% 5.4% 9.4% -3.9% 11.6% Mar 15 Sept 15
▼ Total Purchased Care Cost E $-47.7M -2.5% Service Specific Service Specific Service Specific -7.0% -0.8% 0.3% -3.6% N/A Dec 14 Mar 15
▼ Private Sector Care Cost per Prime Enrollee I $194 17.3%
>2.8% yearly growth
2.8% to > 0% yearly growth ≤ 0% yearly growth 33.0% 22.2% 17.3% 2.8% 13.2% Mar 15 Sept 15
OR Utilization E
**Total Enrollment I 3.58M -0.1% <0% yrly growth 0% to < 5% yrly
growth ≥ 5% yrly growth -0.9% 3.1% -2.0% 1.4% N/A Aug 15 Sept 15
▼ Pharmacy Percent Retail Spend I 54.7% >40% 40% to > 35% ≤35% 57.1% 57.4% 51.3% 41.0% N/A Apr 15 Sept 15 Productivity Targets I 93% Service Specific Service Specific Service Specific 94% 93% 93% 80% N/A Jun 15 Sept 15
Report as of 10 SEPT 2015
Developmental Status: A = Accountability; I = Improvement; E = Exploratory *NPIC calculates + provides the MHS w/ MHS, Service + MTF status relative to the NPIC database average
**Indicates Process Improvement Priority ▼ Lower is better Indicates measure
under development
The DHA in 2016
• Driving Value to Services and COCOMS
• Demonstrable service and support to the mission
• I Need Your Feedback and Input
43 “Medically Ready Force…Ready Medical Force”
Defense Health Agency
44 “Medically Ready Force…Ready Medical Force”
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