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The Defense Health Agency in 2015
COL Scott A SvabekActing Director of Procurement
Defense Health Agency
December 2014
“Medically Ready Force…Ready Medical Force”
Agenda
• MHS Governance Reform
• The Defense Health Agency
• Topics of Interest!
• Current / Pending requirements
“Medically Ready Force…Ready Medical Force” 3
A Changing World
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“We are only beginning to see the dramatic shifts underway that will define our future and shape our interactions in the world … and require our national security institutions to adapt and to adjust…
We will need to more efficiently match our resources to our most important national security requirements. We can do things better. We must do things better – and we will.”
Secretary HagelCenter for Strategic & International Studies
November 2013
“Medically Ready Force…Ready Medical Force”
Translation: Adapt or Perish!
Continued cost increases within MHS are unsustainable over time
Includes Normal Cost contributions to the Medicare Eligible Retiree Health Care Fund (MERHCF)
“Medically Ready Force…Ready Medical Force” 5
Medical as Percent of DoD Budget
*Source: FY 2012 President's Budget position for DHP O&M
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Governance Reform: Influencing the Big Rocks
Management Activities represent a small part of DoD’s health care costs
Opportunities exist for a properly organized management HQ to effect change with shared services
“Medically Ready Force…Ready Medical Force” 6
DHA Vision and Mission
Key Mission Aspects A Combat Support Agency supporting the military services Supports the delivery of integrated, affordable, and high quality health services to beneficiaries
of the Military Health System (MHS) Executes responsibility for shared services, functions, and activities of the MHS Serves as the program manager for the TRICARE Health Plan, medical resources, and as the
market manager for the National Capital Region (NCR) enhanced Multi‐Service Market Manages the execution of policy as issued by the Assistant Secretary of Defense for Health
Affairs Exercises authority, direction and control over the inpatient facilities and the subordinate clinics
assigned to the DHA in the NCR Directorate.
VisionA joint, integrated, premier system of health, supporting those
who serve in the defense of our country.
“Medically Ready Force…Ready Medical Force” 7
MTFs
ArmyOperational
Units
NavyOperational
Units
ArmyMEDCOM
MTFs MTFs
MarineOperational
Units
Air ForceMAJCOMs
Air ForceOperational
Units
CNO CMC
NavyBUMED
CJCS
Secretary of Defense
Sec Army Sec Navy Sec Air Force
CSAFCSA
MHSERUSD(P&R),Vice Chiefs
ASD(HA)SGs, JSS
MDAG
MPOG MOG MBOG
PDASD, Deputy SGs, JSS,DD, DHA
Personnel Operations Budget
MDAG, DASDs, JSS
PAC
SMMAC
USD(P&R)
ASD(HA)
Defense Health Agency
NCR Directorate
MTFs
USUHS
Combat Support Agency
Responsibilities
Policy & OversightExecution
Army SG
Navy SG
Air Force SG
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Military Health System
Defense Health AgencyMHS Governance Service Medical Organization
Procurement DirectorateDirector
COL Scott Svabek
COD-FC ChiefAndrew Carrington
COD-A ChiefRichard Van Dorn
COD-NCR ChiefMAJ Owen Roberts
COD-SA ChiefKenneth Helgren
Chief Policy & Comp. Advocate
Genesta Belton
Chief of Staff-Vacant-
Deputy DirectorEric Thaxton
Senior Contracting
OfficerJake Lewis
Executive Assistant:
GPC
Systems
DoP Organizational Structure (as of 2 October 2014)
Business Operations Division (BOD)
Ken Helgren
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BLUF: DHA as a Combat Support AgencyTranslation: DHA is to medical as DLA is to logistics or as DISA is to communications
USD(P&R)ASD(HA)
Defense Health Agency Director
Deputy Director Sr. Enlisted Advisor
POLICY DEVELOPMENT & OVERSIGHT
POLICY EXECUTION Combat Support Agency Responsibilities
Admin & Mgt EEOO
TRICARE Health Plan Facility Planning
Medical Logistics
Budget & Resource Management
Walter Reed NationalMilitary Med Center
Ft. BelvoirCommunity Hospital
Joint Pathology Center
Comptroller
DHA OGC
Special Staff
Manpower
EHR Functional Champion
METC HQ
DMRTI
Program Integrity
Portfolio Mgmt and Customer Relations
Innovation and Advanced Technology Dev (CTO)
Infrastructure & Operations
Solution Delivery
JMESI
Defense Health Agency Director
Deputy Director Sr. Enlisted AdvisorIPO PEO DHMS
Defense Health Service System (DHSS)
Defense Health Clinical Systems (DHCS)
Information Delivery
Secretary of Defense
Chief of Staff
Component Acquisition Executive
Analytics
Communications
Prog Integration
Small Business
Def Health BoardStrategic Mgt
HA / DHA Liaison
Procurement
Innovation
DoD/ VA PCO
Cyber Security
CJCS
NCR MedicalDirectorate
Business Support Directorate
Health IT Directorate (CIO)
Research Development & Acquisition Directorate
Healthcare Operations Directorate (CMO)
Education & Training Directorate
Defense Health Agency
Academic Review& Oversight
Prof Development , Sustainment, & Prog Mgmt
Pharmacy
Clinical Support
Public Health
Readiness
Warrior Care Program
Advanced Development
Science & Technology
Clinical Infrastructure Program
Veterans Affairs R&D Liaison
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Our Leadership Team
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Lt Gen Douglas RobbDirector
Mr. Allen MiddletonDeputy Director
CMDCM Terry PrinceSenior Enlisted Advisor
MG Richard ThomasDirector
Healthcare Operations
RADM Bruce DollDirector
Research & Development
Brig Gen Robert MillerDirector
Education & Training
RADM Raquel BonoDirector
NCR Medical
Mr. David BowenDirector
Health IT
Mr. Joseph MarshallDirector
Business Support
“Medically Ready Force…Ready Medical Force”
Defense Health Agency:Global Support
TRO West TRO SouthMETCHealth IT
DHA - Aurora
TRO NorthDefense Health Agency
TRICARE PacificTRICARE Europe:
“Medically Ready Force…Ready Medical Force”
10 Shared Services
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1
TRICARE Health Plan
2
Pharmacy Programs
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Medical Education & Training4
Research, Development & AcqHealth Information Technology
Facilities Budget & Resource Management
Medical Logistics Procurement/Contracting
Public Health
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“Medically Ready Force…Ready Medical Force”
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Shared Services SavingsFive Year Defense Plan (2015‐2019)
Shared Service IOC FY14 Net Savings FY15-19 Savings
FACILITIES 1 OCT 13 $537 M
MEDICAL LOGISTICS 1 OCT 13 $189 M
HEALTH IT 1 OCT 13 $265 MHEALTH PLAN 1 OCT 13 $456 MPHARMACY 1 OCT 13 $1,224 MCONTRACTING 1 MAR 14 $136 MBUDGET & RESOURCE MGMT 1 FEB 14 $279 MMEDICAL RESEARCH & DEV 1 JUN 14 $98 MMEDICAL EDUCATION & TNG 10 AUG 14 $ 5 MPUBLIC HEALTH 1 OCT 14 $293 M
TOTAL $3.482 BILLION
“Medically Ready Force…Ready Medical Force” 15
Shared Services SavingsFive Year Defense Plan (2015‐2019)
Shared Service IOC FY14 Net Savings FY15-19 Savings
FACILITIES 1 OCT 13 $18.4 M $537 M
MEDICAL LOGISTICS 1 OCT 13 $13.5 M $189 M
HEALTH IT 1 OCT 13 $33.1 M $265 MHEALTH PLAN 1 OCT 13 $25.5 M $456 MPHARMACY 1 OCT 13 $160.5 M $1,224 MCONTRACTING 1 MAR 14 ($2.9 M) $136 MBUDGET & RESOURCE MGMT 1 FEB 14 $0 M $279 MMEDICAL RESEARCH & DEV 1 JUN 14 $0 M $98 MMEDICAL EDUCATION & TNG 10 AUG 14 $0 M $ 5 MPUBLIC HEALTH 1 OCT 14 $0 M $293 M
TOTAL $248.1M $3.482 BILLION
“Medically Ready Force…Ready Medical Force” 16
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)
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“Medically Ready Force…Ready Medical Force”
Enhanced Multi‐Service Market (eMSM) Performance Overview
Medical Modernization:Match medical resource allocation to demand signal
• DoD Comptroller initiated study in fall 2012: Focus on lessons learned from 13 years of war Right‐size MHS to align with restructuring of active force Reevaluate how to best maintain ready medical forces
• Core Priorities: Quality of care Patient safety Clinical skills of uniformed medical professionals
• Adapt to changing American medical practices: Migration to outpatient/ambulatory care Shorter inpatient lengths of stay Technology and telehealth
• Approach: Department‐wide, data‐driven study with civilian and military, line and medical leaders involved
• Question: Does business plan support readiness plan or does readiness plan support business plan…the answer is yes!
“Medically Ready Force…Ready Medical Force” 19
DHA in 2014
• Put the pieces in place• All shared services “in” as of September 30, 2014• All senior leaders are permanent, not “acting”• Multi‐Service Markets are functioning; business plans
approved
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DHA in 2015
• Maturation and focus on increasing synchronization, reducing variation across the enterprise• Not everything that is an enterprise issue requires a “shared service”• This is not about taking people or products – it’s about a process by
which we identify opportunities for enterprise standardization; examples include:• Analytics• Credentialing• Telehealth system
• Sustaining momentum on process efficiencies, service delivery, service improvement, and cost savings (in FY15 our proposed savings are booked into the budget)
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Final Thoughts
• This is a once‐in‐a‐generation opportunity to shape the future of military medicine
• Local health delivery and Multi‐Service Markets are central to our strategy and a core element of our reform efforts
• There are millions depending on us to get this right
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DHA Current Acquisitions
∎ T2017 (re‐compete of the Managed care support contracts)
∎ Information Management (Capabilities, Analysis & Governance Support (CAGS))
∎DHMS Engineering, Cybersecurity and Configuration (ECCM) currently under Protest
∎Assessment & Authorization (previous CA)∎Other Health Insurance ∎ Performance & planning Management for (DHA IT I/O division)
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DHA Current Acquisitions (CONT)
∎Marketing and Education Support Services ∎Audit Readiness (financial support)∎ALTHA/ CHCS sustainment ∎ Rx Refill ∎ Privacy & Civil Liberties (PM Support)∎ Joint Outpatient Experience Surveys (JOES)∎Web based Inpatient clinical support∎Next Gen USAF “SME” support for clinical workflow
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DHA Current Acquisitions (CONT)
∎ Tricare Claims Review Services (TCRS)∎ Clinical Quality Support Services (CQSS)∎ Tricare Overseas Program∎ Tricare Dental Program ∎DHA Global Service Center ∎DHITS GEN 1∎Army AHLTA Trainers∎ Service Oriented DOD Enterprise management Ctr∎ Enterprise Virtualization Solution
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