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AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
AFA DSG Dec 2011
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AFA DSG Dec 2011

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  • 1. Headquarters U.S. Air ForceIntegrity - Service - Excellence Air Force Association AFMS Updates Maj Gen Thomas W. Travis Deputy Surgeon General 9 December 2011
  • 2. Purpose and OverviewPurpose: Provide overview of recent successes and discuss hot topicsOverview Major Transformational Initiatives Hot Topics Human Weapon System Structure Benefits Accomplishments Discussion Integrity - Service - Excellence 2
  • 3. Air Force Medic VideoIntegrity - Service - Excellence 3
  • 4. Integrity - Service - Excellence 4
  • 5. Major Transformational Initiatives EMEDS Health Response Team (HRT) Patient Movement and Casualty Care Patient Centered Medical Home (PCMH) Recapture of Care at Specialty Clinics Military Education and TrainingCenter (METC) USAFSAM Opens at WPAFB Integrity - Service - Excellence
  • 6. Hot Topics: Human Weapon System Resiliency / Suicide Change In Messaging Post-Vention AF Suicide Rate Decrease from CY10 Traumatic Brain Injuries/PTSD Research Initiatives & Investments Deployment Transition Center*Increase in AF Mental Health Providers Integrity - Service - Excellence 6
  • 7. Hot Topics: Structure and BenefitsGovernance Military Health System (MHS) in NCR Entire MHS and Timelines Awaiting SECDEF Decision and COAAF & DoD Healthcare Efficiencies TRICARE Fees/TRICARE Prime No Cost to AD and Their Families Integrity - Service - Excellence 7
  • 8. Why We Need To Address Military Health Costs“Healthcare is eating the Department of Defense alive ” Major Cost Drivers - Secretary Gates, USA Today, 1 Jun 2011 Increases in beneficiaries – Increase of 400,000 since 2007 – Anticipate 250,000 more TRICARE 16% of DoD BA Young Adult 2028 - $109B – Low cost share encourages enrollment Expanded benefits – TRICARE For Life, Prescription benefits, 10% of DoD BA Reserve Benefits, Psychological Health 2012 - $52B / Traumatic Brain Injury Increased utilization – Existing users are consuming more care (ER, Orthopedics, Behavioral Health) – Low co-pays encourage utilization Healthcare inflation How do we “bend the cost curve” without – Higher than general inflation rate compromising readiness? – Consistent with civilian healthcare sector 8 Integrity - Service - Excellence
  • 9. We’re Proud of Our Achievements! - EMEDS HRT/Theater Med Info Prgm successfully exercised/readyREADY - Deployment Transition Ctr sees 2K combat pts; first-ever USMC pts - Eliminated 1K inspection line items to improve Health Services Inspection & decrease MTF document prep time > 50% - Deployed first Tactical Critical Care Evacuation Team (TCCET)BETTER HEALTH - 773K patients now enrolled/104 Clinics implemented PCMH - Tri-Service Workflow awarded CSAF Excellence/Best Practice Award - First Service to offer Group Lifestyle Balance diabetes prevention - Implemented e-Health tools to strengthen/facilitate pt partnershipsBETTER CARE - Centrally archived 1.1M digital images, largest repository in world - Military Education Training Command (METC) awarded Institute for Credentialing Excellence’s Presidential Commendation for service - Fielded vacuum spine board for lighter/leaner Air Evac pt movement - Established and Activated San Antonio Military Health System - 451 HPSP graduates; highest annual number recordedBEST VALUE - 7 Specialty Clinics new programs saw increase in enrollment by 3%; Relative Value Unit up 18%; Relative Weighted Procedures up 15% - Lead Med Equip COE; AFMS best annual purchasing performance; 2658pkgs/$82M and decreased contract award times saving $14M Integrity - Service - Excellence 9
  • 10. “TRUSTED CARE ANYWHERE” Integrity - Service - Excellence
  • 11. BACK UP SLIDESIntegrity - Service - Excellence 11
  • 12. Focus and Alignment) Through the AFMS Framework Strategies OverlappingMission Areas Transform Deployable Capability Rapid Response to Any Worldwide Contingency Fit Force Build Patient-Centered Care Continuity & Prevention to Optimize Health Invest in Education, Training & Research Sustain Our Future Capabilities Strategy Common Practice Culture Integrity - Service - Excellence
  • 13. In Pursuit of Lighter & Leaner Medical ResponseEMEDS Health Response Team (HRT) Lessons learned from humanitarian response Operational results: Immediate Care <20 minutes Emergency Care <2 hours OR/ICU <3 hours Successfully exercised for contingencyPursuing Perfection in Medical Response Capability Integrity - Service - Excellence
  • 14. Continuous Advances in Casualty Care WWII 30% Learning From Coalition Partners, We Leveraged Trauma Registry Data To Build Innovative Solutions > 80 Patients Moved as of Nov 11Combat Mortality Rate Korea 25% Tactical Critical Care Evacuation Team (TCCET) Vietnam 24% INTERFLY AGREEMENT Applying Lessons Learned From the C-17 *AeroSpace Interoperability Council Persian Gulf 24% Creating a “patient staging” continuum Modular Aeromedical Staging Capability (MASC) OIF/OEF New CASF Activated at SAMMC <10% Re-engineering Global Patient Staging Expeditionaryt Operationse Evolving tocSave n c e Globally I n e g r i t y - S r v i c e - E x e l l e Lives
  • 15. AF Medical Home Family Health Initiative (FHI)FHI creates incentives for success AIR FORCEfrom patient perspective MEDICAL HOME Increased continuity QUALITY PATIENT Decreased ER visits MEASURES PATIENT EXPERIENCE Better health outcomes (HEDIS) EXPERIENE Patient Satisfaction PATIENT INFORMATIONObjectives: PHYSICIAN-LEAD MANAGEMENT TEAM Continuity = Healthier Outcomes & TECHNOLOGY Improve access, quality, service PROACTIVE PREVENTIVE HEALTH CARE Encourage Teamwork & Communication Family Health Clinics Implemented – 69 Pediatric Clinics Implemented – 35 Total Population Enrolled –773,887 Creating The Environment To Provide Patient-Centered Care Integrity - Service - Excellence
  • 16. Innovation & Insight to Recapture Care Bringing Patients Back to the Military Treatment Facility Deliver Patient-Centered Care To Our Beneficiaries Create Currency Opportunities To Support Readiness Allow Medics To Practice Full Scope Of Care Tackle Per Capita Cost Through Targeted InvestmentsTravis AFB, CA Langley AFB, VA Nellis AFB, NV Elmendorf AFB, AK Eglin AFB, FL Keesler AFB, MS WPAFB, OH Specialty Hospitals Focused on Currency and Recapture Integrity - Service - Excellence 16
  • 17. Invest in Education, Training and ResearchMilitary Education and Training Center (METC) Joint Medical Training Open for Officer Medical Training CoursesUSAFSAM Opening at WPAFBCSTARS Course Maintains Trauma TrainingGME/DME and Nursing Education Expanded Opportunities Increased Healthcare Provider Numbers Integrity - Service - Excellence 17
  • 18. The Suicidal MindSuicide is a behavior, not a disease How we think and communicate about it affects its rateUsually characterized by desperation, hopelessness Rage: anger and frustration - Impulse Avoidance: legal/financial concerns, guilt Mental illness: Depression, Bipolar IllnessSubstance use often fuels the fireTop risk factors Relationship problems Mental health history Legal/ administrative problems Integrity - Service - Excellence 18
  • 19. Establishing Partnerships to Enhance Capabilities Physician/Dentist Education (GME/DME) Stand alone programs Masters with civilian universities Integrated/affiliated with Federal partners Nurse Education (Transition Program) New sites include: Cincinnati, OH & Scottsdale, AZNurse Enlisted Commissioning Program (NECP) USAF Dental Hygiene Program Research Partnerships are Vital Tools to Build & Sustain Medical Services Integrity - Service - Excellence 19
  • 20. UNCLASSIFIED // FOUO Metric AF Active Duty and AF Total Force Suicides Status: Yellow Objective Track suicides over time to identify trends Metric Owner: AFMSA/SG3OQ Metric POC: Major Michael McCarthy Last Updated On: 25 Nov 11 Metric Definition: Suicide Rate= (Raw Number of Suicides Over the Last 12 Months/End Strength) x100,000 120 24 110 AD Suicides ARC in Duty Status ARC not in duty status 22 100 Civilian Suicides CY AD Rate Total Force Rate CY10 DoD Rate 20 90 18 Red Boundary Rate/100K 80 16Number 70 60 * * 14 12 50 Green Boundary 10 40 8 30 6 20 4 10 2 0 0 2004 2005 2006 2007 2008 2009 2010 2011 * 52 Week Rolling Rate Results Analysis CY10/CY11 #s * Rolling 12 Month Rate AD AF Suicides through 25 Nov: 49/39 13.4 Total Force Suicides through 25 Nov: 89/84 14.1 Improvement Actions/Next Steps - Update AFI 44-154, Suicide and Violence Prevention Education and Training - Suicide Prevention Program Evaluation Grant Proposal Integrity - Service - Excellence 20
  • 21. New Suicide Prevention Initiatives Point of Attack Process Frontline Supervisor Training for at-risk Strategic Communication Plan AFSCs Shift to strengths-based messaging Semiannual Wingman Days RAND social media study Security Forces/JAG initiatives Improved weekly dashboard slide VCSAF Memos Fort Hood Follow-on Review Face-to-face suicide prevention trng Response to DHB DoD TF on the Unit Consultation Tools Prevention of Suicide by Military Comprehensive Post-Suicide Guidelines Members Public Affairs Guidance for Suicide 2011 Community Assessment Expanded use of multimedia tools Increase AD mental health providers by 25% CSAF/CMSAF PSAs Add 70 more to Primary Care “The Air Force’s pioneering suicide prevention program was producing the first empiricalevidence that a comprehensive, public health approach could, in fact, reduce suicide across a population.” – Volpe Report Integrity - Service - Excellence 21
  • 22. Air Force Suicide Prevention Overview Suicide Rates (per 100,000/yr) AD Risk Factors/Stressors (%)10 year Pre-Program 13.5 Relationship Problems 54.210 year Post-Program 9.9 History of Any Mental Health 45.8CY10 Active Duty 16.4 DiagnosisCY11 Active Duty (Rolling Rate) 13.4 Legal/Admin Problems 33.9CY11 Q2-Q3 Active Duty 11.5 Seen by Mental Health in Past 18.6CY11 Total Force (Rolling Rate) 14.1 MonthCY11 Q2-Q3 Total Force 12.9By AD Career Group (CY 10-11) Alcohol in System at Death 17(per 100,000/yr)Security Forces (3P) 33.8 Deployed in the Past Year 12Aircraft Maintenance (2A) 21.8 Financial Problems 10.2Intelligence (1N) 0.0 Security Forces rate down > 30% from Feb ‘11 peakAs of 25 Nov 11 Integrity - Service - Excellence 22
  • 23. Deployed and Non-deployed TBI in the DoD 2010 Facts: TBI Incidence in the AF is lower than other services due to mission differences Most TBI in the AF is mild (mTBI) Most mTBI cases recover quickly Goals: Early diagnosis and treatment Identify Airman with persistent post- concussion symptoms Educate AFMS healthcare teams on TBI diagnosis, management, and resourcesAF accounted for 11% of TBI (deployed/non-deployed) cases Integrity - Service - Excellence
  • 24. Enhanced TBI Screening CapabilitiesAll Warfighters medically evacuated from theater to LandstuhlRegional Medical Center (LRMC) undergo TBI screening regardlessof injury for which they were evacuatedTBI screening on Post Deployment Health Assessment (PDHA), PostDeployment Health Re-Assessment (PDHRA)All clinical medics trained on current concussion managementguidelines in deployed setting Integrity - Service - Excellence
  • 25. Clinical Capabilities and Measures of SuccessServices: Early and appropriate evaluation, diagnosis, and treatment following a potentially concussive event Clinical algorithms standardize careCapabilities: Theater: 332 EMDG, Balad Joint Base Elmendorf-Richardson San Antonio Military Health SystemMeasures of Success: Resolution/control of symptoms Return to duty Medical evaluation board statistics Integrity - Service - Excellence 25
  • 26. Active Duty Airmen with PTSD 3 Month Period Prevalence 1,800 6.000 1,600 5.000 1,400 Rate of AD w/PTSD per 1,000 1,200 4.000 Number of Airmen 1,000 3.000 AD with PTSD 800 AD Rate w/PTSD per 1,000 600 2.000 400 1.000 200 0 0.000 FQ1 FQ2 FQ3 FQ4 FQ1 FQ2 FQ3 FQ4 FQ1 FQ2 FQ3 FY2009 FY2010 FY2011 *2011 FQ3 Data Still ProcessingPTSD diagnosis under 0.5% or 1,300 Airmen; 4-5 times more common in Airmen with combat exposure Integrity - Service - Excellence 26
  • 27. Air Force PTS PreventionAirman Resiliency TrainingTraumatic Stress Response TeamsLeader’s GuideDeployment Transition CenterTelemental Health Integrity - Service - Excellence 27
  • 28. Improved AF Mental HealthIncreased Mental Health providers FY12-FY16Provider Type MH CLINIC BHOP SNC Peds Total/IncreasePsychiatrists: +18 0 0 0 153 (+18)Psychologists: +1 +30 0 0 287 (+31)Clinical SWs: +3 +35 +36 +5 275 (+79)Psych Nurse Pract +22 +5 0 0 42 (+27)Psych Nurses: +15 0 0 0 45 (+15)MH Techs: +169 0 0 0 896 (+169)All MTFs funded for a Mental Health Provider in Primary CareAirmen educated on mental health during Self Aid Buddy CareService member screened 5X face-to-face pre/post deploymentBuilding Mental Health Availability for the Total Force Integrity - Service - Excellence 28
  • 29. Beneficiaries Move Between Direct (MTF) and Purchased Care (Downtown Network) Systems Military Health System (MHS) VHA Benefits Direct Care Purchased (MTF) Care Medicare Employer4.16 million Under 65 Sponsored(Includes 950K 3.42 million InsuranceGuard/Reserve and Over 65their dependents) 1.9 million Active duty Retirees & family & family Approximately 50% of MHS beneficiaries are enrolled in TRICARE Prime, an HMO like benefit set. The rest are in a FFS environment Integrity - Service - Excellence
  • 30. Civilian Employers Share The Burden Of Healthcare Costs With Employees At A Much Greater Rate Than DoDA Sept. 2010 report from the Kaiser Family Foundation found: On average, employees nationally paid $899 for single coverage and $3,997 for family coverage Annual deductible for single coverage for PPOs - $675, HMOs - $601, and POS - $1,048. Also on average these workers paid $22 for a primary care visit and $31 for a specialty care visit. Average copayments per prescription drug were $11 for tier one, $28 for tier two, and $49 for tier three Only 28% of large employers offered health insurance to retireesTRICARE Prime enrollees Active duty and their families pay no enrollment fees and no out-of-pocket costs for any type of care as long as care is received from the PCM or with a referral All other beneficiaries including retirees < 65 pay annual enrollment fees ($230/year for individuals or $460/year for families), and the cost for care is based on where the care is received, MTF outpatient and inpatient no visit fees and for network providers outpatient $12 per visit Military Treatment Facility (MTF) Pharmacy: $0 copayment for all tiers; TRICARE Pharmacy Home Delivery: $3 tier one, $9 tier two, and $22 tier three; and TRICARE Retail Network Pharmacy: $3 tier one, $9 tier two, and $22 tier three Integrity - Service - Excellence 30
  • 31. A Number Interventions Have Been Proposed ) Could Impact ReadinessIncrease TRICARE beneficiary cost sharing to incentivize more prudentutilization of health care resources Single most significant lever, but under control of Congress What is recruitment impact?Create incentives for under 65 retirees to use employer based insurance Examine use of tax credits; how does this impact employment and recruitment?Medical Service Integration– share back office functions such as IT andlogistics; a joint care model through a Unified Medical Command; or through afederal health care system that includes VAEstablish correct balance between direct and purchased care system so thatown vs buy decisions are optimized and care is coordinatedOptimize the Graduate Medical Education training platforms so that they mostefficiently serve the readiness needs; own vs buy decisions.Identify and mute variation in care delivery by establishing more standardizedand efficient care processes – process improvement Estimates suggests a potential savings of up to 30% Integrity - Service - Excellence 31
  • 32. Strategies To Enhance Value And Bend The Cost Curve In Military Healthcare Can Be Grouped• Health Benefits and Eligibility Large potential impact, – Benefit design and cost sharing < selective co-pay but under Congressional control – Health Savings Account Transformational• Enhanced Medical Service Integration change, – Spectrum includes: Shared Services; Unified Medical but significant barriers Command; Federal Health Care System to implementation• Efficiencies Within the Direct Care System Opportunities to apply – Process improvement, medical home, care coordination, etc commercial sector best practices – Remove variation from service areas• Healthcare Network Integration And Opportunities for Management improved care • Includes better cost management and care coordination in coordination and Purchased care system management • And better integration of direct and purchased care system Integrity - Service - Excellence 32
  • 33. Strategies Vary By Span Of Control And Implementation Difficulty Modify TRICARE StandardExtra Cost SharingCongress Tax Credit for Health Benefits /Eligibility Employer Insurance Health Savings Accounts CMS Partnership/TFL Pharmacy Benefits/Copays Influence/Control Risk Based Approach Modify TRICARE Prime Cost Sharing To Managing Fraud Network Integration DoD Overhaul Cost Accounting Shared Services Unified Medical Command Direct/Purchased Care Balance New Care Models Performance Based Budgeting Efficiency Direct Care Service Strategic Sourcing Wellness Programs Modify GME Strategy Variation Analysis Least Hard Hardest Relative Difficulty Even I n t e Simple S e r v i c eAren’te So Easy ).. The g r i t y - Things - E x c l l e n c e 33

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