V E TE R AN S AFFAI R S & M I LITARY M E D I CI N E O UTLO O K
MILITARY HEALTH SYSTEM TRANSFORMATION
Administration and management of all U.S. military medical facilities are shifting to the Defense Health Agency. By J.R. Wilson
n IN THE MOST SIGNIFICANT DEVELOPMENT in military health care since its founding in 1775, the National Defense Authorization Act of 2017 (NDAA 2017) directed the Defense Health Agency (DHA) to bring all U.S. military medical treatment facilities for all service branches together under a single Department of Defense (DOD) organization. It was an action that had been recommended by several studies since World War II to reduce duplication and redundancy and increase proficiency and health care solutions. Until NDAA 2017, each service was responsible for ensuring a ready medical force and its own medically ready force. As a result, there were no inter-service standardization processes, just a great deal of variation. The transition to DHA is intended to standardize all aspects of health care and ensure consistency throughout the U.S. military. That transition began on Oct. 1, 2018. A year later in October 2019, an article on the Military Health System’s official website by DHA’s director, Army Lt. Gen. Ronald J. Place, addressed what the transition means to Army, Navy, and Air Force hospitals and clinics. “Many are questioning what this change really means. Let me first tell you what it’s not about: It’s not about ownership. It’s not about control. It’s not about one Service is better than another. As a matter of fact, it’s because of the great work the Services have done to advance and elevate the quality of care for our warfighters and their families that bring us to this day,” he wrote. “This is all about the patient. It’s about harvesting decades of best practices from across the Army, Navy, and Air Force – along with what we can learn from the civilian community – to build a global standard with one focus: Make our system better to improve health outcomes that matter to our patients.” DHA originally was stood up on Oct. 1, 2013, as the nation’s military medical combat support agency – a joint, integrated organization enabling the services to provide a medically ready
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force and ready medical force to combatant commands in both peacetime and war. Working with the Joint Staff Surgeon and military department medical organizations, DHA maintains a global network of military and civilian medical professionals at nearly 450 military hospitals and clinics, supporting health care delivery to 9.5 million active-duty service members, retirees, reservists, National Guardsmen and women, and their families. The movement of all military health care delivery to DHA – both CONUS and OCONUS – is scheduled for completion by October 2021. A primary goal is to standardize the business side of health care delivery while improving patient experiences, such as making the process for scheduling appointments or getting a referral for specialty care the same across all facilities. DHA has assigned military health care facilities to individual markets, based on size: 21 large markets; 16 small markets; and 66 facilities which, because they do not fit into either of those segments, are being designated as a “stand-alone” segment and will be managed by the same office that manages the small markets. Some 75 U.S. military treatment facilities (MTFs) in Europe and the Indo-Pacific region eventually will be placed into similar markets and transitioned to DHA no later than Sept. 30, 2021. “Common patient safety and clinical quality policies mean the very best practices in one clinic become the norm within every clinic, raising our performance across the board. A single agency accountable for all the health care we provide – whether in one of our facilities or through a civilian provider in our TRICARE managed care network – means we will be more effective in finding the best possible source for the best care for each patient,” according to Place. “In the months ahead, we’ll set up market organizations in regions across the country, allowing hospitals and clinics in the same geographic area – regardless of Service – to share and target resources where our patients need them. In the next year, our work focuses on getting this right in the United States
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