National Health Policy Forum

1. National Health Policy Forum William Winkenwerder, Jr., M.D. Assistant Secretary of Defense (Health Affairs) January 28, 2004

2. Overview • Military Health System • Battlefield Medicine • Accomplishments and Advances in Integration • Council Structure • Joint Strategic Plan • Business Process Improvements • IM/IT Initiatives

3. Military Health System • 8.9 million beneficiaries • 4 million enrolled to the military’s health plan – TRICARE Prime • $27.3 billion healthcare system • 75 Military hospitals • 461 Military health clinics • 131,065 Personnel • TRICARE Support Contractors

4. Battlefield Medicine • A continuum of healthcare for service members wherever assigned and under all operational situations – anyone, anywhere, anytime. • The battlefield hasn't changed – it's still a very dangerous place. Our response to it, however, is significantly different. • Medical assets are configured to support health promotion, health hazard assessment, implementation of countermeasures, the provision of essential care of the ill and injured, and the rapid evacuation to definitive medical care.

5. Key DoD/VA Accomplishments • Establishment of a Joint Council Structure • Joint Executive Council • Health Executive Council • Benefits Executive Council • Joint Strategic Plan • Approved April 2003 • Managed Through Council Structure • Improved Business Processes • Supported by Electronic Exchange of Information

6. Joint Executive Council • Oversee Development/Implementation of Joint Strategic Plan • Oversight of Health & Benefits Executive Councils • Identify Opportunities (Policy, Operations, and Capital Planning) to Enhance Mutually Beneficial Coordination Joint Executive Council Benefits Executive Council Health Executive Council

7. Health Executive Council • Development & Implementation of VA/DoD Joint Strategic Plan Initiatives • Leadership Oversight of VA/DoD Health Care Collaboration • Health Care Related Policies, Procedures, and Practices that Promote Mutually Beneficial Coordination • Further Opportunities for the Coordination and Sharing of Health Related Services and Resources

8. Benefits Executive Council • Opportunities to Expand and ImproveInformation Sharing • Process of Records Retrieval and Identify Procedures to Improve Benefits Claims Process • Transition Issues from Military to Veteran

9. Joint Strategic Plan • Mission - To improve the quality, efficiency, and effectiveness of the delivery of benefits and services to veterans, service members, military retirees and their families through an enhanced VA and DoD partnership. • Vision - A world-class partnership that delivers seamless, cost-effective, quality services for beneficiaries and value to our nation.

10. Joint Strategic Goals 1. Leadership Commitment and Accountability 2. High Quality Health Care • Seamless Coordination of Benefits • Integrated Information Sharing • Efficiency of Operations • Joint Contingency/Readiness Capabilities

11. Business Process Improvements • Capital Asset Planning • Joint Capital Asset Planning and Coordination (CAPC) Steering Committee developed • Serves as the clearinghouse for DOD/VA collaboration activities • Joint Contracting • 2004 Federal Acquisition Conference on April 6-8 • Web-based medical catalog • Joint national pharmaceutical contracts • Shared contracting for high cost medical equipment and maintenance services

12. Business Process Improvements • Standard Reimbursement Rate • CHAMPUS Maximum Allowance Charge (CMAC) less 10% • Implementation for Outpatient Services began 2003 • Joint Incentive Fund • Each Department Contributes $15 million annually • Implementation began October 2003 • Proposals must meet a business case analysis • Final approval through the council

13. Current IM/IT Initiatives • Federal Health Information Exchange • Transfers electronic health information on individuals separating • 56M messages transmitted on 1.78M unique Service members • DoD data available to VA providers nation-wide • Healthcare Standards -- Consolidated Health Informatics Initiative • Improves the quality of care by ensuring federal entities use common standards to facilitate information exchange • Lab Data Sharing & Interoperability • Facilitate electronic order entry and results retrieval between DoD, VA, and commercial reference labs • Pilot successfully tested in Hawaii • Further implementation in selected sites in 2004

14. Future IM/IT Initiatives • DoD/VA Interoperable Electronic Health Records • A two-way exchange of health information between DoD and VA • Interoperability between DoD’s Clinical Data Repository and VA’s Health Data Repository in 2005 • Prototype for outpatient pharmacy data, allergy information, and patient identification and demographics in 2004 • Credentialing • Integrated credentialing solution for the DoD Centralized Credentialing Quality Assurance System and the VA VetPro system • 3 DoD/VA sites selected

15. Summary Through focused collaboration, and the initiatives DoD and the VA have undertaken together … -- Establishing Council Structure -- Joint Strategic Planning -- Information Sharing … we are realizing our shared vision in service to our servicemembers, our veterans, and their families.