Feb 18 2010
Observations on The Military’s Health System
Recently, I had the opportunity to attend the annual Military Health System (MHS) Conference held here in Washington DC. This occurred only a few days before the “Blizzard of 2010″, and as I have reflected on what I saw and heard there, I wanted to offer some observations from that excellent and informative conference.
As I listened to some of the plenary speakers, which were principally the service Surgeon Generals, senior Health Affairs officials, and guests such as the Chairman of the Joint Chiefs of Staff and other healthcare industry notables, I was struck with the sheer vastness, mission complexitiy, and the actual impact that the MHS is charged with performing. For contextual purposes, it is worthy to note a few statistics of this system which is composed of over 9.5 million beneficiaries.
Consider that in one week the following occurs:
- There are 21,800 hospital admissions and 1.6 million outpatient visits
- There are 25,800 behavorial health outpatient visits
- 2.48 million prescriptions filled
- and 2,380 babies are birthed
Not to mention that simultaneously the deployed medical staff support our wounded servicemembers in theatre resulting in a 54% return to duty within 72 hours and the lowest disease and nonbattle injury rates ever reported. This, along with a battlefield survival rate that now stands at 97% which is the highest in history. I could not imagine any other “health system” responsible for and able to, achieve so much. How does it remain focused to achieve these complex objectives which seem to be at odds with each other?
We learned that in order to get an arm around all of the vast array of needs in the military medical community and to remain on target, TRICARE and the MHS have adopted the concept of the “Quadruple Aim”. This is an adaptation to a frequently discussed phrase in the healthcare community known as the “Triple Aim”. It is an idea that refers to the three integral factors that determine the overall quality of healthcare: population health, positive patient experience, and per capita cost. The MHS has taken this paradigm and added a necessary fourth determinant - readiness. Thus, to remain “on target” it is imperative that the MHS achieve objectives within these four foundational goals.
During the course of the Conference we had ample opportunities to hear how these goals were being achieved. For instance, it is well known that readiness has steadily grown in the total force for four consecutive quarters. There was initially a great deal of concern beginning in 2007, with an increase in mental health diagnoses. The MHS responded with a 20% surge in mental health providers, the establishment of behavioral health locator lines and tele-health initiatives also added capacity.
The MHS is making significant progress in the preventative health realm. The Enrollee Preventive Health Quality Index which tracks population health shows that MHS health outcomes have been on a steady rise since 2007. Notable areas where the military is ahead of target are in colo-rectal and breast cancer screenings, as well as a reduction in smoking.
There were perspectives offered on the many medical advances that have made a difference both on the battlefield and off. Since 2001, there has been remarkable progress in prosthetics, implants, hand and limb transplantation, skin therapies and in many other areas of regenerative medicine. Other advancements have been made in bandages to stop bleeding, drugs to treat or prevent chronic pain, robotic support for tele-surgery, cranial reconstructions, and the detection and treatment of traumatic stress and traumatic brain injuries. The majority of these advances have improved the lives of service men and women and ultimately can be translated to all Americans.
After attending this for a week, I came away gratified that the MHS, with all of its moving parts, people and missions, can continue to evolve and meet the healthcare needs of the active force, their families, and retirees - day in and day out. No easy feat.
