Department of Defense Task Force on the Future of Military Health Care

1. Department of DefenseTask Force on the Future of Military Health Care Col Christine Bader, USAF Executive Secretary Task Force on the Future of Military Health Care

2. Overview Purpose Congressional Charge Task Force Members Task Force Activities Public Meetings/Site Visits Held Next Public Meeting Upcoming Milestones

3. Purpose Update the Defense Health Board on the status of DoD Future of Military Health Care Task Force efforts as of the end of March 2007

4. Congressional Charge to Task Force on the Future of Military Health Care FY07 National Defense Authorization Act, § 711 (c)(1) Submit final report to the SECDEF by December 2007 Make assessments of, and recommendations for, sustaining the military health care services being provided to members of Armed Forces, retirees, and their families Statute listed 10 elements for study Provide interim report to SECDEF, SASC and HASC by 31 May 2007 To describe activities of Task Force Interim findings and recommendations on beneficiary and Government cost-sharing structure, particularly under pharmacy benefits program 10 Key Areas Wellness and disease management initiatives Education programs focused on prevention awareness and patient-initiated health care Ability to account for true and accurate cost of military health care Alternative health care initiatives to manage patient behavior and costs, including options and costs and benefits of a universal enrollments system for all TRICARE users Appropriate command and control structure with DoD Adequacy of military health care procurement systems Appropriate mix of military and civilian personnel to meet readiness requirements and high-quality service requirements Beneficiary and government cost-sharing structure to sustain military health benefits over the long term Programs focused on managing the health care needs of Medicare-eligible military beneficiaries Efficient and cost effective contracts for health care support and staffing services, including performance-based requirements for health care provider reimbursement10 Key Areas Wellness and disease management initiatives Education programs focused on prevention awareness and patient-initiated health care Ability to account for true and accurate cost of military health care Alternative health care initiatives to manage patient behavior and costs, including options and costs and benefits of a universal enrollments system for all TRICARE users Appropriate command and control structure with DoD Adequacy of military health care procurement systems Appropriate mix of military and civilian personnel to meet readiness requirements and high-quality service requirements Beneficiary and government cost-sharing structure to sustain military health benefits over the long term Programs focused on managing the health care needs of Medicare-eligible military beneficiaries Efficient and cost effective contracts for health care support and staffing services, including performance-based requirements for health care provider reimbursement

5. Members of Task Force Department of Defense Members Gen John D. W. Corley, USAF (co-chair) Vice Chief of Staff, Headquarters U.S. Air Force MG Nancy Adams, USA (Retired) Former Commander Tripler Army Medical Center and Former Acting Director, TRICARE Regional Office, North RADM John Mateczun, USN Deputy Surgeon General of the Navy Lt Gen James Roudebush, USAF Surgeon General of the Air Force Maj Gen Joseph Kelley, USAF, the Joint Staff Surgeon Shay Assad, Director of Defense Procurement and Acquisition Policy, Office of the Undersecretary for Acquisition, Technology and Logistics Gen Richard B. Myers, USAF (Retired) Former Chairman of the Joint Chiefs of Staff

6. Members of Task Force Non Department of Defense Members Dr. Gail Wilensky (co-chair), Senior Fellow at Project HOPE; elected member of the Institute of Medicine of the National Academies and its governing council Robert J. Henke, Assistant Secretary for Management, Department of Veterans Affairs Dr. Carolyn Clancy, Director of the Agency for Healthcare Research and Quality, Department of Health and Human Services Robert F. Hale, Senior Fellow at the Logistics Management Institute and member of the Defense Business Board; formerly Assistant Secretary of the Air Force for Financial Management and Comptroller MG Robert Smith, USAR (Retired), Past President of the Reserved Officers Association and Former Global Controller, Ford Motor Company Larry Lewin, Founder of The Lewin Group and currently Executive Consultant on Clinical and Technology Effectiveness, Health Promotion Dr. Robert Galvin, Director of Global Healthcare, General Electric

7. Activities of Task Force Gather Information Task Force meetings and visits Direct and written testimony Subject matter expert briefings Review of reports and studies Draft and Submit Interim Report Until interim report completed, TF decided to act in plenary manner; Work on interim report – outline, research, discussion of guiding principles, initial assessments, drafting Until interim report completed, TF decided to act in plenary manner; Work on interim report – outline, research, discussion of guiding principles, initial assessments, drafting

8. Activities of the Task Force Admin Meeting 21 Dec 06 Public Meetings Held 16 Jan 07 6, 20 Feb 07 7, 28 Mar 07 Information Visit 20 Mar 07 United Mine Workers of America (UMWA) on its health plan operation Initial meeting – personnel/ethics, orientation, background materials Co-Chair was elected by non-DoD members—Dr. Gail Wilensky Initial meeting – personnel/ethics, orientation, background materials Co-Chair was elected by non-DoD members—Dr. Gail Wilensky

9. 16 Jan 07 Public Meeting USD (P&R) and ASD (HA) discussed the military health care system and background for statute directing establishment of task force Informational briefings Current MHS financing MHS cost drivers Overview of Defense Health Program Military health care system developments, immediate future and long view perspective Mr. Middleton briefed on how the MHS is currently financed Mr. Kokulis briefed on MHS cost drivers and legislation that was proposed last year to sustain the benefit Dr. Winkenwerder briefed on the overview of the Defense Health Program, system impression and management issues Dr. Chu briefed on the military health care long view, recent developments and immediate futureMr. Middleton briefed on how the MHS is currently financed Mr. Kokulis briefed on MHS cost drivers and legislation that was proposed last year to sustain the benefit Dr. Winkenwerder briefed on the overview of the Defense Health Program, system impression and management issues Dr. Chu briefed on the military health care long view, recent developments and immediate future

10. 6 Feb 07 Public Meeting Informational briefing regarding Pharmacy Benefits Program, including cost sharing structure by Pharmaceutical Ops Directorate Informational briefing on managed care contracts from Health Plan Ops MG Smith (Ret) back-brief on discussions with advocacy group representatives Beneficiary and Government cost sharing structure required to sustain military health benefits over the long term (briefed by Rear Admiral Thomas J. McGinnis, R.PH. USPHS Chief, Pharmaceutical Operations Directorate) 1a. Cost sharing under Pharmacy benefits program (briefed by Captain Patricia Buss, Medical Corps, USN Tricare, Deputy Chief Medical Office) 2. Managed Care Contracts (briefed by Jean Storck, Chief, Health Plan Operations) 3. Meeting with advocacy groups (briefed by MG (Ret) Smith) Beneficiary and Government cost sharing structure required to sustain military health benefits over the long term (briefed by Rear Admiral Thomas J. McGinnis, R.PH. USPHS Chief, Pharmaceutical Operations Directorate) 1a. Cost sharing under Pharmacy benefits program (briefed by Captain Patricia Buss, Medical Corps, USN Tricare, Deputy Chief Medical Office) 2. Managed Care Contracts (briefed by Jean Storck, Chief, Health Plan Operations) 3. Meeting with advocacy groups (briefed by MG (Ret) Smith)

11. 20 Feb 07 Public Meeting Direct Care System Overview by Surgeons General and Joint Staff Surgeon Military health care system Deployed medicine Back-brief from task force co-chairs regarding meetings with members/staff from SASC and HASC - Dr. Wilensky commented that she and Gen Corley briefed both SASC and HASC personnel subcommittees on the focus of the Task Force and our intent to stay in contact with them as we proceeded forward to make sure that we were carrying out the intent and will of the Congress in our Task Force activities. - Interim report requirement was last minute add-on from House- Dr. Wilensky commented that she and Gen Corley briefed both SASC and HASC personnel subcommittees on the focus of the Task Force and our intent to stay in contact with them as we proceeded forward to make sure that we were carrying out the intent and will of the Congress in our Task Force activities. - Interim report requirement was last minute add-on from House

12. 7 Mar 07 Public Meeting Presentations from industry experts and beneficiary group representatives regarding cost sharing structure to sustain military health benefits over the long term Focus on industry practices for management of health care with emphasis on pharmacy aspects UnitedHealthcare Association of Retail Chain StoresUnitedHealthcare Association of Retail Chain Stores

13. 28 Mar 07 Public Meeting Presentations by regional TRICARE contractors on managed care support contractors Included beneficiary and Government cost sharing structure, and assessments of operations – quality, costs, efficiencies, etc. TriWest – Dave McIntyre Humana – Dave Baker HealthNet – Steve ToughTriWest – Dave McIntyre Humana – Dave Baker HealthNet – Steve Tough

14. 20 Mar 07 United Mine Workers Association of America (UMWA) Information Visit A Group of Task Force members received informational briefing from UMWA regarding management and operation of its health fund for its beneficiaries, with emphasis on the pharmacy benefit and outreach programs for UMWA retirees

15. 9-10 Apr San Antonio Visit Commanders briefing on military markets Elicit military health care benefits feedback from spouses, officers (O-5 and below), Guard/Reserve, retirees, and enlisted Panel formats

16. Upcoming Milestones Interim Report Final Interim Report due to SECDEF, SASC and HASC by 31 May 2007