MHS Strategy Update : Quality is Job 1! Presenter: Dr. Mike Dinneen, MD, PhD

1. MHS Strategy Update : • Quality is Job 1! • Presenter: Dr. Mike Dinneen, MD, PhD • Director, Office of Strategy Management • OASD(HA) • michael.dinneen@ha.osd.mil

2. Goals for our four hours together • Obtain your agreement that: • There is a compelling need to change • The MHS is performance based organization but, it could function much better • We need a practical, actionable, MHS Strategic Plan understood and embraced by everyone • Help you see the similarity between clinical diagnosis and treatment planning and MTF business planning so you can feel more comfortable in building your annual plans • Have you recognize how you support the outcomes desired by the MHS through specific and measurable actions at your MTF and have you commit to spreading that knowledge within your work area

3. Managing in a Time of Crisis - Change Driven by External Forces • Unexpected Challenge—Coordinated Support for Wounded, Injured and Ill • Re-examine the way we do business • We are inundated with input from organizations that want to help Independent Review Group Army Medical Action Plan (AMAP) President’s Commission TBI GAO DOD-VA Sharing PTSD

4. Dole Shalala Commission Recommendations • Immediately Create Comprehensive Recovery Plans to Provide the Right Care and Support at the Right Time in the Right Place • Completely Restructure the Disability and Compensation Systems • Aggressively Prevent and Treat Post-traumatic Stress Disorder and Traumatic Brain Injury • Significantly Strengthen Support for Families • Rapidly Transfer Patient Information Between DoD and VA • Strongly Support Walter Reed By Recruiting and Retaining First-Rate Professionals Through 2011

5. Bottom Line We must master diagnosis and effective, compassionate care for TBI and PTSD

6. The Case for Change: The Rate of Increase in DoD Health Care Expenditures is Unsustainable – We need to find a way to manage health care expenditures more effectively. (Billions of 2005 dollars) DoD 2005 Projection Source: Congressional Budget Office (2004); OSD (2005) • Health budget rising rapidly: $18B-2001, $36B-2005, $50B by 2010-2011 (est.) • Due to new benefits (TRICARE For Life for over 65 population), very rich benefit with insufficient cost shares or indexes, Congressional expansions (TRICARE For Reserves), retirees under 65 opting for TRICARE vs. employer plans • Aggressive effort to manage costs—New TRICARE private sector contracts ($45B over 5 years), pharmacy formulary, pharmacy federal prices, closure/merger of military hospitals, improved business practices. • Required—Benefit structure adjustments, to include indexed premiums/co-pays for long term control of cost growth; Health Savings Accounts must also be pursued.

7. The Case For Change – Because we are not functioning as a health care system with effective processes, we are failing to achieve quality outcomes • Care costs are unevenly distributed • The top 1% of population spends 35% of health dollars • 50% of population spends only 3% of health dollars • Chronic disease states drive 70% of all health spending • Care linkage deficiencies abound • Paper records don’t facilitate communication or identification of best practices • Care silos abound • Economic incentives significantly influence health care • RVU reimbursement scale drives unhealthy behavior • We do not reimburse for coordination of care or outcomes • Systems thinking is almost never on the health care radar screen • Thinking is focused almost entirely on single care units • Comparative and concurrent data are not part of the American health care culture • We have to be agile but our bureaucracy holds us back

8. Our Quality Focus: Managing and Preventing Chronic Diseases • MHS Imperatives • PTSD • TBI US Healthcare Imperatives • Congestive Heart Failure • Asthma • Diabetes • Coronary Artery Disease • Depression • Then why are we spending so much effort on obesity, activity, alcohol use and tobacco use?

9. What do we need to do? • Support the Warfighters during the long war and support the Military Strategy • Fit, healthy and protected force • Casualty care and humanitarian assistance AND • Create Healthy Individuals, Families, and Communities • Manage chronic diseases in a systematic manner • Prevent them from occurring in the first place

10. SWOT Analysis - MHS Strengths Best team of medical professionals in the world Mission orientation and strong core values Battlefield care Clinical data Health education Weaknesses Care discontinuity, inefficient support processes Clinical and business information Customer relationship management Aging hospitals and clinics Ambiguous governance Opportunities National focus on electronic health information Congressional support for wounded warrior care BRAC law as lever for change Pay for performance New mission – humanitarian assistance and stability operations Threats Loss of confidence by American people, Congress Scrutiny by OSD, OMB, Congress regarding financial performance Increasing competition for healthcare professionals

11. Key Tactical Imperatives • Quality Medical Care – achieving and documenting excellence • Wounded Warrior Care…more than just medical care on the battlefield or at the bedside, but the comprehensive levels of coordination, communication and caring. • Conducting Diplomacy Through Health…and how our military health system is an indispensable global asset that serves our national security interests and saves lives. • Making AHLTA work for us, not the other way around. • Medical Recruitment and Retention…superb medical outcomes result from years of preparation, training and execution; we need to sustain this medical quality through continued focus on quality people. • Advancing Medical Research…for the people we serve, and for people around the globe. • Communicating…freely, transparently with the people in the system, the people served by the system and the public. • Improving our aging hospitals and clinics and building the healing environment of the future. • Working together with more jointness and interoperability.

12. Components of the MHS Strategy • Mission - Approved • Global Statement • Core business • Vision – • Destination • Big Hairy Audacious Goal • Values – Draft • The attitude, behavior and character of our organization • Strategy • Our game plan • The high level goals and objectives that we will leverage to make lasting positive change • Measures of mission success • How we will know that we have succeeded

13. Fit, Healthy And Protected Force Casualty Care & Humanitarian Assistance Information and Technology Our People, Our Values, Our Culture Education and Training Research and Innovation Healthy Individuals, Families And Communities Military Health System Mission Statement - Our team provides optimal health services in support of our nation’s military mission - anytime, anywhere. Customers: Wounded Warriors, the American public, the world stage and Congress When: During and after operations Where: Everywhere Customers: Combatant Commanders When: During entire career: before, during and after deployments Where: Everywhere Customers: All beneficiaries When: Through our entire lifetime; from cradle to grave Where: Everywhere

14. MHS Vision Statement Our nations healthcare and workplace of choice …. A team of health professionals ready to meet any challenge… Conducting education, training, and research to ensure… Premiere care for America’s heroes and their families.

15. MHS Core Values and Culture Selfless & Courageous Service - We are honored to serve those who serve, the warfighters and beneficiaries who trust us to always meet their needs, anytime, anywhere. Our high calling demands the courage to take risks, do what is right and go into harm’s way in unison with the warfighters. Caring, Healing & Creating Health - We are healers who have a life-long obligation to the health and well-being of all those entrusted to our care. We are compassionate and committed to doing the right thing for our patients to eliminate disease and achieve health. Developing Leaders - We lead with passion, respect, and loyalty because this is the best way to achieve our goals and meet our high expectations. We work jointly in close collaboration with line leadership to meet our operational and health support mission.

16. Creating Value for our Stakeholders: The American People, MHS staff, and those who rely on us for care • A fit, healthy and protected force • The full spectrum of casualty care to include evacuation, recovery, rehabilitation and coordinated care transition to VA and other services • Humanitarian & civil assistance • Healthy and resilient individuals, families and communities • Restoration of health and effective care coordination across all elements of the Military Health System • Premier health education and training • Innovative health research

17. MHS Mission: Our team provides optimal health services in support of our nation’s military mission - anytime, anywhere. Fit, Healthy And Protected Force Healthy Individuals, Families And Communities Casualty Care & Humanitarian Assistance Primary Execution Structure Major Multi-Service Market MTFs (NCA, SA, SD, Tidewater, Madigan, Tripler) Community Hospitals And Ambulatory Clinics Tricare Network of Providers Operational Medicine Support Structures Shared Services (IM/IT, Contracting, Logistics, HR Mgmt, Facilities, Fin Mgmt, etc) Health Plan Management (TMA/HPA, TROs, MCSCs) Education and Training (METC, GME, USUHS) Research and Development Resource Perspective

18. MHS Tactical Objectives Enhance warrior care TBI/PTSD Case Management Disability Processing Improve patient centered evidence based medicine Health Promotion - TOBESAHOL Disease Management Focus on quality Improve AHLTA usability Speed, reliability Implement clinical prompts to support providers Quality Incentives Implement Continuous Performance Improvement Team STEPPS, LSS Business plan critical initiatives (Quality, safety, access, patient flow, IMR) P4P – Expand PBAM Concept Develop our people Military Education and Training Center curriculum integration Continuous Process Improvement Training Improve Recruiting and Retention NCR and San Antonio Market Implementation Create healing environment Improve governance Building New Capabilities to Adapt to a Changing World Improving What We Do Each Day

19. Performance Based Organization • A high performance organization is: • Employer of choice – (staff) • Provider of choice – (customers) • Best value for investors (stakeholders) • What is required to create a high performance organization: • A strategic plan that describes how value is created for each of the three groups above • Business plans for each business unit that link with the strategic plan • Well understood objective measures of success and targets for accountability • A workforce provided with incentives and tools to innovate (including continuous process improvement)

20. Now – we need to get the word out! • Communications must improve!