, Welcome to the Air Force Medical Service (AFMS)
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Integrated and Synergistic: The Joint, Coalition, & Interagency TeamThe Air Force is a part of a much bigger team doing the nation’s businessWe Organize, Train and Equip our Airmen to support joint, interagency and coalition partnersIn doing so, we must maintain interoperability as well as become an interdependent forceAll these organizations are our allies in this war on terror…we must seek to partner with them at every opportunity Jointness: Jointness refers to the mutual support and doctrinal understanding that must exist within all military services. Jointness is a state of mind as well as a statement of fact. It predisposes those who share its goals to emphasize the unique capabilities of the Nation's military services in planning and operations that are by design, from beginning to end, synergistic, cooperative, and interdependent. We are an integral part of a Joint team; jointness is really about synergy of the parts” Joint Connotes activities, operations, organizations, etc., in which elements of two or more Military Departments participate. To improve, we must build partnerships and interoperability to advance cradle to grave health deliveryThe best form of C2: collaboration and coordination As an AFMS we can expect to participate in more joint operations The AFMS has proven to be a vital partner within the USAF and with Joint Forces. Our vision confirms…and our record of performance demonstrates…we can and will provide quality healthcare and health service support anywhere in the world at anytime to support all of our military family, be they active duty, retired, or a family member. Let’s talk about our vision of the future and highlights of current operations.
Unified Combatant Commands (UCC): HQsRegional Responsibilities:United States Africa Command (USAFRICOM): Kelley Barracks, Stuttgart-Mohringen, GEUnited States Central Command (USCENTCOM): MacDill AFB, Tampa, FLUnited States European Command (USEUCOM): Patch Barracks, Stuttgart-Vaihingen, GEUnited States Pacific Command (USPACOM): Camp H. M. Smith, Honolulu, HIUnited States Northern Command (USNORTHCOM): Peterson AFB, Colorado Springs, COUnited States Southern Command (USSOUTHCOM): Doral(Miami), FLFunctional Responsibilities:United States Joint Forces Command (USJFCOM): Norfolk, VAUnited States Special Operations Command (USSOCOM): MacDill AFB, Tampa, FLUnited States Strategic Command (USSTRATCOM): Offutt AFB, Omaha, NEUnited States Transportation Command (USTRANSCOM): Scott AFB, ILOur mission is to provide seamless health services support to AF and Combatant Commanders, leveraging our joint capabilities to provide “Trusted Care Anywhere!”
AF Medical Service operates a total of 75 medical facilities throughout the world. We have 63 military treatment facilities (MTFs) in 34 states (including AK, HI) , the District of Columbia, and the US Territory of Guam.
Although our Command and Control system is through the Line (from the Wing Commander to the MAJCOM/CC to CSAF) , our budget dollars and MILCON funding comes from OASD(HA) Health Affairs. Our FY11 operating budget was $6.3B dollars allocated across the 6 areas.
Our integrated and overlapping mission areas of Fit Force, Casualty Care, and Resilient Families capture the three unique and dynamic environments in which the AFMS operates. Our homestation care to our beneficiaries underpins our readiness, builds resilient families and supports our Combatant Commanders by keeping our warfighters healthy and ready to deploy. In the deployed setting, AF medics provide both routine care and life-saving casualty care for our Joint and coalition forces. Additionally, AF medics also operate across the full spectrum of operations to include disaster response, humanitarian assistance, and partnership building with other nations. As a result, AF medics must be highly skilled and adaptable to operate in any environment under any condition. The relationship between Strategy, Common Practice and Cultureis the foundation of our framework for the future. Our Strategy ensures that we are properly aligned to achieve our vision. Our Common Practice reduces variability, improves organizational efficiency, and ensures we deliver the best care across the enterprise. Ultimately, through our Strategy and Common Practice, we create the environment and build the Culture that will enable us to sustain our high performing patient-centered organization and continue to deliver “Trusted Care Anywhere”. The three strategies to achieve our vision include:Transform deployable CapabilityBuild Patient-Centered CareInvest in Education, Training, and Research StrategyMust have plan for the present, near future and distant futureMust analyze risk, operational requirements, and future threats/demandsMust leverage personnel, resources, and partnerships for mission accomplishmentMust integrate Strategy, Culture, and Common Practice to create a sustainable organization Common PracticeReducing variability so that our customers get the same great service/outcome every time…no matter where they receive their careApplying EBM/lessons learned to deliver the best care CulturePatient Centered CareOur People are our most important resource and enable mission successContinuous improvement/learning organization Live each day…with the simple goal of making a difference some else’s life…a passion to simply leave your office, your next patient, the world better than you found it
Our People are the Key to Success: The AFMS exists to support the Combat Commanders both at home and abroad by deploying clinically current medics and keeping AF personnel mission ready for global operationsThe key to mission success is “Our People”…with all the technology in the world…nothing can replace the dedicated professional men and women who take care of our countries most precious resource. Additionally, through effective knowledge transfer, we are applying state-of-the-art procedures developed stateside to our global operations…with life-saving results. Similarly, our deployed care operations provide valuable lessons learned which in turn positively impact home station health care delivery. Through this cycle…our innovations can be sustained.
As of 15 Nov 2011 // Since 10 Oct 2001: > 92K patients moved AFCENT Reports 92% Survival Rate Aug 10 – Jul 11Tactical Critical Care Evacuation Team, or “TCCET” is a mission specific medical personnel and equipment package to execute inter-facility movement of post op, ICU-level casualties between forward surgical teams (FST) and theater hospitals via rotary-wing or tactical fixed wing aircraftTCCET: Fast-tracked concept development, equipment build, operational and safe-to-fly testing, and training of 2 teams (primary and alternate) in less than 9 months-- TCCET designed to fill the critical care gap with personnel OT&E to provide the critical care support necessary to maintain the continuum of care en route-- First team deployed (3 pax) June 2011 for 179 days, in place co-located with rotary-wing transportation assets at multiple OEF locations; ALREADY FLYING MISSIONS; As of 15 Nov 11 80 patients movedInterfly agreement with Canada, United Kingdom, Australia, and New Zealand. Our interoperability was the foundation of a unique operation involving two critical care teams…one CCATT from the US and one CCAST from the UK working side-by-side in the back of a HC-130P. INTERFLY AGREEMENT (Only for C-17s at this time...ASIC is looking to expand to other air frames like C-130/Chinook)Partners provide more options to bring our heroes home with “Interfly” on US/UK C-17s Expands capability of critical care patient movement; Increases capability to respond to worst case eventOvercame equipment approval challenges; CCATT Equipment has UK OEC clearance /waiver to fly US equipment on UK C-17sCCAST Equipment: Feb ‘10 approval for flight on US C-17s; Teams to share ideas common practices & exploit interoperability opportunities
It started in PACAF with the deployment of our newly Humanitarian Assistance Rapid Response Team to respond to the earthquake in Indonesia in Oct 2009. The HARRT was a tremendous success providing medical care to those affected by the7.6-magnitude earthquake: Total Patients:1945, Acute care: 1224, Minor surgery: 36, PrevMed encounter: 32, Prescription filled: 3519Earthquake (Haiti) Jan – Feb: Additional lessons learned…Earthquake (Chile) Feb – Mar: After these three HA missions in less than 6 months…we challenged ourselves…and asked “Can we do better?” How about Care upon arrival…1st patient in less than 1 hour, 1st surgery in less than 4 hours. EMEDS WAY AHEAD: Force Development Evaluation (FDE) Feb 2011, Travis AFB - ACC (SG), Travis (MDG/CRG), HAF/SG3, pilot units, AFMESA, C-NAFs, NHRC, & Combat Camera participation – COMPLETEFA-HUM 11 (SOUTHCOM) Apr 2011, Trinidad & Tobago – ACC (SG), Travis (MDG/PA), McGuire CRG, & AFMESA participation – COMPLETE FY11/12 – build nine (9) additional EMEDS HRTs Personnel and equipment packages FY14 – strategic/POM review of all EMEDS platformsFurther notes:-EMEDS HRT (Healthcare Response Team) is a medical only package. MDG+CRG teams at Travis; built on PACAF CRG HARRT and Operational AARs and successfully exercised in Apr 11. BOS support remains an A4/A7 responsibility. ACC/SGX and HAF/SGX are engaging with A4/A7 to develop a BOS capability scaled to support EMEDS-HRT, although we do not know what the pkg will look like, from HARRT, operational lessons learned, plus exercise, it is projected the BOS + HRT will be logistically supported for movement on two C-17s. Transition from Alaska Shelters to UtilisAK Shelter Compatible; Decreased Build Time Joint Program Testing w/ Collective Protection Developing “Portable” Functional Supply System (ER/OR/ICU/Peds/GYN/etc)Improved Storage/ShippingSecure/Weather Proof Versus Triwalls/RopakStandardized Packing Portable Drawer Modules
The AFMS has always conducted BP missions and is committed to further synchronize its effort to support ACS’ highly mobile, rapid, flexible, robust and integrated mission.Building Partnerships (BP) became a USAF core function in 2008; BP is now a Joint Capability Area (JCA) (one of 9 JCAs); SecAF & CSAF signed the AF Global Partnership Strategy (AFGPS) in Dec 2008. AFGPS establishes ends, ways and means to support CCDR objectives. Medical is listed under SSTR mean. For example, to Generate Goodwill or Gain Access, we conduct MEDCAP/DENCAP. To Build Trust, we conduct Subject Matter Expert Exchanges (SMEE). We establish Influence---conduct Train-the-trainer courses/share medical operating procedures and doctrine. Develop Capable Partner—Aerospace Medicine exchanges. Directly Intervene—HA/DR (HARRT)Global Health Engagement is one of the means the Air Force uses to partner with other nations to achieve health security cooperation, building partnerships and partner capacity objectives through health related activities and exchanges. Global health engagement activities allow for the AF Medical Service and Partner Nation (PN) armed forces, or foreign civilian authorities or agencies to build trust and confidence, share information, coordinate mutual activities, and maintain influence and achieve interoperability with PN. The Air Force uses the full spectrum of health capabilities and disciplines in both Mil-Mil and Mil-Civ engagement activities to build partner capacity, support security cooperation, and meet humanitarian objectives. Health engagement activities may include training, mentoring, planning, consultation, direct healthcare, and exercises in conjunction with national and international partners. Specific Health Engagement may include: Mil-Mil and Mil-Civ consultation and training in public health and preventive medicine, disaster/outbreak response, combat casualty care, aeromedical evacuation, expeditionary medical support, exercises, disease surveillance, medical and dental civic action programs, force health protection, veterinary medicine, health system, and medical logistics, facilities, and equipment repair. For FY09, our air components conducted over 40 missions treating over 100,000 patients. In addition, they conducted 3,500 optometry and 4,000 dental exams, and performed approximately 5,000 dental extractions. We also saw over 11,000 pediatric patients. Furthermore, our medics trained over 1,200+ host nation or partner nation medics. The Defense Institute for Medical Operations conducted 21 mobile courses, which resulted in the training of 850 foreign medics. Air Components are globally engaged: Medical Civic Action Programs; US Military Medical Training; Coalition Engagements; Theater Security Cooperation; Medical Readiness Training and Exercise
The Military Health System’s Quadruple Aim highlights the 4 priorities of our healthcare system….In the fall of 2009, MHS leaders recognized that our plan is consistent with the concept of the Triple Aim proposed by the Institute for Healthcare Improvement (IHI) in October of 2007. The Triple Aim was intended to describe the kind of results that could be achieved when all of the elements of a true health care system worked together to serve the needs of a population. The MHS is a system dedicated to the health of the military family, and it seemed reasonable to adopt the Triple Aim with the addition of one key element – readiness. Readiness reflects our core mission and reason for being; it is first among our aims.ReadinessEnsuring that the total military force is medically ready to deploy and that themedical force is ready to deliver health care anytime, anywhere in support of the full range of military operations,including humanitarian missionsPopulation HealthImproving the health of a population by encouraging healthy behaviors and reducing the likelihood of illness throughfocused prevention and the development of increased resilienceExperience of CareProviding a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always ofthe highest qualityResponsibly Managing the Total Health Care CostsCreating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total costof care over time, not just the cost of an individual health care activity
Data date range: FY11 Denominator: FY11 (excludes weekends & holidays) (AFMOA/SGHC)Outpatient Encounters FY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1 = ‘B’ Appt Status Cd <> ‘6’ (No Tcons)Source: SADR, M2Surgery ProceduresCY107 Currency MTFsSourced from Dr. Mark Boston / Dr. JenningsBabies DeliveredFY11Treatment DMIS Service F&G (MTF & ERSAs)Source of Admission = ‘L’ (Live Birth within MTF)Source: SIDR, M2Inpatient AdmissionsFY11Treatment DMIS Service F&G (MTF & ERSAs)Source: SIDR, M2Prescriptions FilledFY11Treatment DMIS Service F&G (MTF & ERSAs)Source: PDTS, M2Lab ProceduresFY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Lab, M2Rad ProceduresFY11Treatment DMIS Service F&G (MTF & ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Rad, M2Dental (AFMOA/SGD)
Institute for Health Care Improvement developed Triple Aim to focus improvement of care delivered in all areasMHS has adapted to develop QUADRUPLE AIM, with key component of readiness addedEnabling a medically ready force, a ready medical force, and resiliency of all MHS personnel.Improving quality and health outcomes for a defined population. Advocating and incentivizing healthy behaviors. Managing the cost of providing care for the population. Eliminate waste and reduce unwarranted variation; reward outcomes, not outputs. All metrics should sonehow point back to the Quadruple Aim
- The measures chosen are central to the concept of PCMH and already in use. They are all currently being tracked via a PCMH push report through the SG EGL website.* While Team satisfaction is measured, the MHPI “Satisfaction” measurement only includes Patient Satisfaction.
As of Dec 2011
MHPI uses standard PCMH Push Report measures. Data is already available and scores are the average of the three monthly scores for each measures. HEDIS is the exception where we use the last month of the period as the snapshot for HEDIS Composite score. MHPI Scores are heavily averaged and weighted and are used as a means to award incentive funds.
MTFs A and B are actual PCMH sites and the data is real.
Elmendorf – Increased AccessOutpatient Visits +40%, Surgery +40%Eglin – Increased Surgical CapabilitySpecialty Surgery GrowthAdding Medical SpecialtiesLangley – Addition/Expansion $114M in Projects On-GoingNellis – Newest Medical CenterFamily Medicine ResidencySurgery Residency PlannedTravis – Surgical Recapture118% increase in Neurosurgery New Cardiac/Vascular Services
GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include: Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU & VA programs 84 Advanced Education General Dentistry-1 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)11 sites; 166 trained in FY08; Increasing to 241 in FY09Sites Include: Cincinnati, OH & Scottsdale Healthcare, AZ Nurse Enlisted Commissioning Program (NECP)50 per year Nursing School of their Choice ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB USAF Dental Hygiene Program10 Scholarships/year
In many of our larger facilities, we have launched our Surgical Optimization Initiative, conducting process improvement evaluations with the goals of improving OR efficiency and throughput, enhancing surgical teamwork, and eliminating waste and redundancy.
Leveraging Technology via Applied Clinical Epidemiology (ACE) - Deliver Best Evidence-Based Medicine To The Hands That Need It! Transform Health through Personalized MedicineReduce generalization risk when applying best evidence Shorten timeline of evidence discovery to evidence in clinicPopulation-based screening guidelines must not preclude targeting prevention to those that carry the preponderance of risk.Target our resources most effectively—prevent rather than treat—give the right patient, the right treatment, at the right time CarePoint: Data Transparency & Simplified ReportsWeb-based application which leverages the MHS Population Health PortalIt provides near real-time data to expedite evidence-based preventionEnables targeted prevention directly to the provider and patient. “Transforming Data into Actionable Information”Personal Health Record and Secure Messaging Improves ContinuityPersonalizing care with patient-provider communication optionsWeb-based Microsoft HealthVaultPilot test at Elmendorf AFBPatients selected by presence of select medical conditionsPatients control their own health and wellness record Benefits:Improved communication & relations; provider can coach the patientEmpowers patient to achieve ownership for outcomes and health Reduces ‘phone tag’, frustration, and unnecessary visitsImproves utilization of clinic health team to focus on patient care
Over the past decade, the military medical community has seen a dramatic growth in the volume of data collected within our system. This data represents a treasure trove of information that can be translated into knowledge and used for decision support. As we move forward with improving provider decision support systems like CarePoint, we must not forget about our patients. By Integrating WiFi and remote sensing devices or mobile applications with medication alerts or patient information, we can transform data into wisdom and ultimately change.
Our Joint Theater Trauma Registry is a great example of how we have used technology to build a database which has provided critical insights into how we manage our casualties. These lessons learned have been translated into clinical practice guidelines and are now being used across the DoD and have been shared with our civilian counterparts. Advances in remote monitoring and improvements with patient provider communication systems hold great potential for improving disease management thus supporting both better care and better health.
GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include: Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU & VA programs Advanced Education General Dentistry- 91 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)188 trained in FY11Sites Include: Cincinnati (OH); Lackland AFB;Scottsdale Healthcare (AZ); and Miami (FL) * Nurse Enlisted Commissioning Program (NECP)45 Graduates in FY11*Nursing School of their Choice ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB
6 week long European Air Group Advanced Aerospace Medicine Course; in fact, this was the first time a USAF flight surgeon was able to attend this course, and did so by utilizing a British "training slot" in the course, which they graciously gave to us. Numerous international physicians, nurses, aerospace physiologists, and enlisted technicians coming to USAFSAM for training in our all of our courses, which certainlygreatly increases "...interoperability, integration, interdependence", hence: synergy. And there is also the USAFSAM Defense Institute of Medical Operations (DIMO) that travels to many countries around the world, providing training for a variety of operational medical subjects, again building interoperability, integration, interdependence, hence: synergy.ALL of these are "good news" stories, including the graduation this week of the Advanced Aerospace Medicine for International Medical Officers (AAMIMO) Course which is celebrating its 50th anniversary, being the 50th course of its kind, the 1st class graduating in 1960. More than 110 countries have participated in this course, and of its graduates, 37 have gone on to become the Surgeon General equivalent of their nation's military, as well as countless others who have gone on to serve in very senior ranking positions within their nation's military health service.
Modernization: Mission: Provide policy, guidance, resources, and oversight to integrate technology and deliver enhanced solutions to the AFMS, our warfighters, and the beneficiary community Six Modernization Thrust Areas(MTAs) are identified and codified in FY12-17 MPPG, based on the capabilities needed to support AFMS strategies. MTAs provide a key organizational mechanism to seek balance, continuity, and integration of the modernization portfolioEnroute Care: Continuum of care during transport of patients from point of injury to point of definitive care Expeditionary Medicine: Improving care during contingency ops; medical countermeasures against combat/operational stressorsForce Health Protection: Prevention of recognition injury/illness & the early or detection of emerging threats Health Informatics: Enriched IT service quality and effectiveness at MTFs Health Performance: Enhancing performance of Airmen in challenging environments Operational Medicine: Definitive patient care/treatment in-garrison
Shaping the Future of Military HealthcareDefinition of an "imperative": a philosophical concept that implies an obligation. For example, we have an obligation to deliver patient centered healthcare under a medical home construct or strategy via FHI as a key means. An imperative is and how we will support our priorities and shape our approach to our mission.Specifically, to assure success today and tomorrow, we are focused on the following theme:Patient-Centered Care: Patients want someone who cares with reliable and universally accessible information that allows active participation in their health care.Technology Integration: Our AFMS must continually monitor all (not just medical) technologies; understand how they will influence our AFMS mission, and rapidly integrate them.Synergy-Integration – Joint, Coalition, and Interagency: We must build partnerships and interoperability to advance cradle to grave health delivery. Precision Healthcare: We must minimize the cycle time from implementation of evidence-based medicine to common practice, and create incentives for prevention. Organizational Agility – Light, Lean, and Life Saving Capabilities: An organization that is able to respond, adapt, and influence changing environments quickly through agile processes as seen by changing approaches to acquisitions, facilities, technology; changing approaches to programming process, policy, and law. Process to adapt to changes, influence, changes, funding processes within the fiscal year, to respond between POM cycles.
Introduction to the Air Force Medical Service (AFMS)
Engagement Guidance Theme: Introduction to the Air Force Medical Service (AFMS 101) Purpose: Provide an approved and standardized slide deck to communicate the AFMS organization, infrastructure, strategies, and mission capabilities Design: Organized around the AF/SG’s key strategies, which highlights our three primary strategies to accomplish our integrated mission areas by addressing strategy, common practice, and culture Format: Unclassified Envisioned Uses: Serve as a template for executive officers, staff officers, commanders and chiefs to use when sharing the AFMS message with key audiences Intent is for slides to be tailored/customized to the particular audience or venue. While some slides convey duplicate/similar information, this is intentional to provide multiple options to create your unique briefing Intended audience include: Internal and external customers Stakeholders and employees Integrity - Service - Excellence 1
Headquarters U.S. Air Force Integrity - Service - Excellence Introduction to the Air Force Medical Service (AFMS) Rank First Lastname Position CAG-v6 (3 Jan 2012)
Air Force Medical Service MISSION: Seamless Health Service Support to USAF and Combatant Commanders UPdateTotal Force Personnel Deployed (MOC) 32,487 Active Duty >92K patients moved out of 6,818 Civilians CENTCOM since 10 Oct 01 3,750 Contractors 1,362 medics deployed to 30 15,469 AF Reserve/Guard countries in 49 locations Update FY11 Homestation (AFMOA/SGHC) Budget/Infrastructure ~2.5M eligible beneficiaries (AF) $6.3B (all programs) ~6.5M visits/40K admissions/yr 75 Medical Facilities Investing in our Future 63 CONUS Education & Training 12 OCONUS Research & Development Air Force Medicine…Delivering “Trusted Care Anywhere!” Integrity - Service - Excellence 3
We’re All In AF Mission The mission of the United States Air Force is to fly, fight and win…in air, space and cyberspaceAFMS Mission AFMS VisionSeamless Health Service World-Class Healthcare Support to USAF and for Our BeneficiariesCombatant Commanders Anywhere, Anytime Through Global Vigilance, Reach, and Power! Integrity - Service - Excellence
Alignment of Priorities Air Force AFMS Continue to Strengthen the Deliver Best Medical Reliability Nuclear Enterprise for the Nuclear MissionPartner with Joint and Coalition Enhance Full Spectrum Medical Team to Win Today’s Fight Capabilities to Support Winning Today’s Fight Develop and Care for Airmen Implement Patient-Centered Care and their Families to Sustain Healthy and Resilient Airmen & Families Modernize our Air, Space, & Advance Medical Capabilities Cyber Inventories, through Research & Organizations & Training Infrastructure Recapitalization Recapture Acquisition Build Interoperability & Medical Excellence Acquisition Expertise Integrity - Service - Excellence 5
Joint, Coalition, & Interagency Team Provide Opportunity for Innovation Mis-InformationJOINT Cooperation COALITION Inter- INTER- AGENCY Operability Collaboration SYNERGY Integrity - Service - Excellence
Operational Command Structure Command & Control Manpower Secretary of the Air Force Chief of Staff of the Air Force Major Command NAF Commanders Wing Commanders Medical Treatment Facilities AIR FORCE MAJOR COMMANDS (MAJCOMs)Command & Control With Seamless Total Force Integration Across MAJCOMs Integrity - Service - Excellence 7
Scope Of Operations Mc Cho Fair rd chil Mal Min Lakenheath Ramstein AFB d mstr om ot Grand AFB Forks AFB RAF Croughton Landstuhl AFB Mountain AFB Ellswor Hansco m AFB Mildenhall Pirmesens Kadena Beale Home AFB th AFB Yokota AFB Travis AFB Hill FE McGuire Spangdahlem Misawa AFB Buckley Warren Offu AFB tt Wright AFB Dover AFB Andrews LajesVanden USAF AFB Nellis AFB Peterson Academ McConn AFB White man Scot Patterson AFB Bolling AFB AFB Langley Asbgabat berg y AFB t Edwards ell AFB AFB AFB Seymour AFB Los AFB Angeles Luke Kirtlan d AFB Canno Vance AFBTinker Littl AFB Pope Shaw AFB Johnson AFB Pristina Manas Altu AFB AFB AFB Davis- Monthan Hollo n AFB s Sheppa Dyes AFB rd AFB e Rock mbu Barksdale Colu Ro bin AFB Charlest on AFB Incirlik Bagram AFB man s Goodfell AFB s Maxwel Eielso AFB AFB ow AFB AFB E s Moody Keesler AFB gll AFB AFAFB Kandahar n AFB Elmen Hicka Laugh Randol AFB in Tyndall Hurlburt B AFB Patrick Aviano Kabul Osan dorf AFB m AFB lin Lacklan AFB dph AFB AFB Field AFB A F AFB AFB MacDill Kuwait Kunsan B Qatar Khost Eskan Village Andersen Honduras Djibouti Curacaco Monrovia Jolo Baghdad Mosul Manta City Bogota Balad Camp Victory Kirkuk Basrah-Magal Tallil/Ali Al Ramadi Al Taji 42,000 AFMS Personnel 63 Facilities in 34 States, DC, And Guam 12 Medical Treatment Facilities In 7 Countries1,362 AF Medics Deployed In 30 Countries In 49 Different Locations Integrity - Service - Excellence
Medical Treatment Facilities (MTFs) 63 MTFs in 34 states, the District of Columbia, and Guam McChord AFB Fairchild AFB Malmstrom Minot AFB AFB Grand Forks AFB Mountain Home AFB Hanscom AFB Ellsworth AFB Beale AFB FE Warren AFB McGuire AFBTravis AFB Hill AFB Offutt AFB Dover AFB Buckley AFB Wright Patterson AFB Andrews AFB USAF Academy Bolling AFB Whiteman AFB Nellis AFB Peterson AFB Scott AFBVandenberg AFB McConnell AFB Langley AFB Edwards AFB Seymour Johnson AFB Kirtland AFB Vance AFB Los Angeles AFB Pope AFB Luke AFB Tinker AFB Cannon AFB Little Rock AFB Shaw AFB Altus AFB Davis-Monthan AFB Sheppard AFB Columbus AFB Charleston AFB Holloman AFB Dyess AFB Robins AFB Barksdale AFB Maxwell AFB Goodfellow AFB Eglin AFB Moody AFBEielson AFB Keesler AFB Tyndall AFB Laughlin AFB Hurlburt Patrick AFBElmendorf AFB Hickam AFB Randolph AFB Field AFB Lackland AFB MacDill AFB Integrity - Service - Excellence
Forward Operating Locations & Overseas Military Treatment Facilities Ramstein Lakenheath Landstuhl RAF Croughton Pirmesens Mildenhall Spangdahlem Asbgabat Kadena Lajes Yokota Pristina Manas Misawa Aviano Incirlik Bagram Kandahar Osan Kuwait Kabul Kunsan Qatar Khost Honduras Eskan Village Andersen Curacaco Djibouti Monrovia Jolo Manta City Bogota Baghdad Mosul Peru Balad Camp Victory Kirkuk Basrah-Magal Tallil/Ali Al Ramadi Al TajiAFMS Operates 12 Military Treatment Facilities In 7 Countries (blue)1,362 AF Medics Deployed In 30 Countries in 49 Different Locations >92K Patients Moved From CENTCOM Since 10 Oct 2001 Integrity - Service - Excellence
FY11 BudgetDollars & MilCon AFMS FY11 Budget Execution ($ Billion)* DHP Office of the Secretary of Defense (OSD) Operations & Operations & Maintenance, MILCON, $0. OASD(HA) $3.056 Management 165 Health Affairs $2.554B Air Force AFMOA Surgeon General Provides direct reach- War Reserve (AF/SG) back capability for Materiel, $0.0 clinical processes, resource execution, and Military 67 Major Command administrative Personnel, $ Procurement, management supporting Surgeons medical activities 3.002 $0.056 (MAJCOM/SG) PAD 07.13, Jan 2008 RDT&E, $0.0 40 Medical Treatment Facility Aligned with Local Mission(s) * End of Year Execution as of 30 Sep 2011 Integrity - Service - Excellence 12
Air Force Medical Service FY12 Personnel Authorizations Active Guard Reserve Facility Commanders 77 89 46 Medical Corps (MC) 3,776 507 547 Dental Corps (DC) 960 89 170 Nurse Corps (NC) 3,447 870 1,583 Medical Service Corps (MSC) 1,040 426 425 Biomedical Sciences Corps (BSC) 2,411 422 404 Officers (subtotal) 11,711 2,314 3,129 Enlisted Corps (subtotal) 19,714 3,673 6,959 Civilian – Defense Health Program (DHP) 6,818 - - Contractors 3,750 - - Line Officers - DHP Funded 279 - - Line Enlisted - DHP Funded 1,885 - - TOTAL 42,457 6,229 9,007*As of 1 Dec 11 Integrity - Service - Excellence
Personnel by Component & Corps Manpower Active Duty Personnel Guard Reserve Line- 11% 16% Nurse DHP Medical Corps, 3,447, 1% Corps, 3,776, 11% 11%Contract 6% Biomedical Sciences Enlisted Corps, 2,411, Officers Corps 8% 19% 19,714Civilian- 64% DHP Medical 12% Service Enlisted Corps, 1040, 35% Dental 3% Corps 960 Defense Health Program (DHP) 3% Integrity - Service - Excellence 14
Office of the Surgeon General Leadership Team Lt Gen Green Maj Gen Travis CMSgt Cole MAJCOM SG Staff Surgeon General Deputy Surgeon Chief Medical General Enlisted Force (SG1) (SG3) (SG8) Strategic (AFMSA)* (AFMOA)**Medical Force Health Care Medical Plans, AF Medical AF MedicalDevelopment Operations Programs & Budget Support Agency Operations AgencyMaj Gen Col Brig Gen Brig Gen Brig GenSiniscalchi Collier Miller Carroll Ediger*AFMSA includes Acquisitions, IM/IT, & Modernization Divisions **AFMOA is the operational execution arm working w/MTFs Integrity - Service - Excellence 15
Our Framework For The Success… 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
Our People are the Key to Success …at Home and Deployed HOME AF Medics Sustain GLOBAL STATION OPERATIONS Full Spectrum Operations Readiness is Job # 1 We exist to deploy clinically current medics and keep AF personnel deployable for global operationsDelivering Home Station Healthcare Underpins Readiness Peacetime care sustains clinical skills and continuity to do Job #1 Integrity - Service - Excellence 17
TRANSFORM DEPLOYABLE CAPABILITIES Integrity - Service - Excellence 18
Aeromedical Evacuation: The Lifeline Home Scott Ramstein Andrews EUCOM Travis Wilford Hall Kadena CENTCOM PACOM Hickam C-17 Empty Air Ambulance Airborne ICUTransport Aircraft Cargo Hold Configuration Capability Continuing or increasing levels of care…from point of injury to resuscitation to definitive care! Integrity - Service - Excellence 19
Aeromedical Evacuation: Total Force Effort! Critical component of AF Global Mobility Joint, interoperable, and interdependent ANG: 10 AE Squadrons Modular A/E units / CCATT Modular MASFs and CASFs Aircraft independent Percentage Engaged in AD: 4 AE Squadrons Todays Fight AFRC: 18 AE Squadrons Over 92K Wounded Warriors Transported Home To The Best Care! Integrity - Service - Excellence 20
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 Expeditionary IOperations eEvolvingxtoe Save eLives Globally ntegrity - S rvice - E c llenc
In Pursuit of Lighter & Leaner Medical Response Humanitarian Assistance Health Response Team (HRT) Rapid Response Team (HARRT) Airlift Deployment Requirements:EarthquakesIndonesia < 24 HRS + C-17’s Rapid Response Medical Capabilities: Emergency, Resuscitative, & Surgical CareEarthquakes Chile T+0 hrs Operational Results: Immediate Care < 20 min EREarthquakes < 2 hrs Haiti OR & ICU < 3 hrs T+3 hrsPursuing Perfection in Medical Response Capability Integrity - Service - Excellence
Building Partnerships and Partnership CapacityAFRCANG PACOMAFRICOM SOUTHCOMCENTCOM EUCOM Integrity - Service - Excellence 23
BUILD PATIENT-CENTERED CARE Integrity - Service - Excellence 24
National Health Reform and Military Health System Quadruple AimREADY (Readiness): Enabling a medicallyready force and a ready medical force;transform deployed capabilitiesBETTER CARE (Experience of Care): patientcentered care; providing patients with carethey want, when they want it, and where it ismost convenient; safe careBETTER HEALTH (Population Health): Improvingquality and health outcomes for a definedpopulation; preventive and precision careBEST VALUE (Per Capita Cost): managing the cost ofproviding care; direct and indirect costs or savings;value in terms of service, quality, safety; capitalizingon technology integration or the right reasons AFMS Imperatives Align With Quadruple Aim Integrity - Service - Excellence
Delivering World Class Care: A “Day” in the Life of the AFMSMaintaining Currency Through Homestation Care 17,808 Outpatient Visits 109 Inpatient Admissions 50 Surgery Procedures 41,408 Prescriptions Filled 21 Babies Delivered 20,477 Lab Procedures 6,365 Dental Encounters 5,374 Rad Procedures Delivering the Benefit and Providing Compassionate Care Integrity - Service - Excellence 26
Medical Home Performance Index (MHPI) Objective: recognize and reward strong performance and significant improvement in AF Medical Home Focus outcomes: Satisfied patients High continuity of care Consistent application of appropriate preventive measures Coordinated, effective management of diseaseAF Surgeon General’s target: “Reward Outcomes” Integrity - Service - Excellence 27
MHPI BLUF IAW AF/SG Direction, MHPI is designed to use financial and non- financial incentives linked to Patient-centered performance improvements Financial incentives are focused on Improving Patient Satisfaction Increasing Continuity Improving HEDIS Decreasing ED/UCC Utilization Non-Financial incentives will recognize superior performance and innovative care practices and encourage teamwork Supports Medical Home Panel Mission and PCMH imperatives to transform Primary Care capabilities through the provision of patient-centered, effective and appropriate medical care Integrity - Service - Excellence 28
AFMS Strategies – Medical Home Family Health Clinics Implemented – 69 DATE MAJCOM MTF Purpose Enrolled FH Population – 661,461 29 Nov AETC Altus PCMH SC Visit Pediatric Clinics Implemented – 35 30 Nov AFMC Tinker PCMH SC Visit Seymour Enrolled Population – 112,461 6 Dec ACC Johnson PCMH SC Visit 6 Dec AETC Vance PCMH visit #2 Total Population Enrolled –773,887 PCMH GO Visit 6 Dec USAFE Lackenheath 82% of AFMS Enrollment 8 Dec AMC MacDill PCMH SC Visit 94% FH Enrollment 7 Dec USAFE RAF Croughton PCMH GO Visit 48% Pediatric Enrollment 8 Dec USAFE RAF Upwood PCMH GO Visit 12 Dec USAFE Ramstein PCMH GO Visit 13 Dec USAFE Spangdahlem PCMH GO Visit 14 Dec USAFE Geilenkirchen PCMH GO Visit 15 Dec AFGSC Whiteman PCMH SC Visit Effective 1 Dec111/5/2012 Integrity - Service - Excellence 30 Data from DSS enrollment numbers Sep 11
Incentive Distribution Timeline Example: Incentive to be distributed quarterly based on previous quarter’s performance (3 month lag) Q4 Q1 Q2 Q3 Payout Payout Payout Payout Q1 Data Compiled Q2 Data Compiled Q3 Data Compiled Q4 Data Compiled Q1 Q2 Q3 Q4 Q1 Fiscal Year 1 Fiscal Year 2 Integrity - Service - Excellence 31
MeasuresMeasure Weight Goal Definitions Roll-up (Average ) of SDA questions 1,3,4,5, and 6.Satisfaction Measure: Patients answering either a 4 or 5 on a 5-point 10% 95% w/visit Likert scale / Total responses. Average of FHT “Team” continuity from patientContinuity perspective. Number of empanelled patient visits with 40% 90% team / total number of empanelled patient PC visits (Team) (excludes T-Con and non-count visits) Average of the HEDIS composite from FHI Push Report (Diabetes LDL Screening, Diabetes LDL Control, HEDIS Diabetes HbA1C Screening, Diabetes HbA1C Control, 30% 4 Asthma Meds, Colorectal Screening, Cervical Cancer Average Screening, Breast Cancer Screening) (max 5 points) (BGA* pts only) ED visits with Emergency E&M and BIA MEPRS for DC or Place of Service = 23 for network. UC visit without ED/UC Emergency E&M and BHI MEPRS for DC or Place of 20% <3/100/mo Service = 20 for network. rate/100 Integrity - Service - Excellence 32
Maximum Possible Quarterly Earnings Measure Weight MTF A MTF B Improvement Sustainment Improvement SustainmentPotential Quarterly 100% Payout $9,400 $19,100 $47,200 $95,800Satisfaction w/visit 10% $940 $1,910 $4,720 $9,580 40% $3,760 $7,640 $18,880 $38,320Continuity (Team) 30% $2,820 $5,730 $14,160 $28,740 HEDIS Average ED/UC rate/100 20% $1,840 $3,820 $9,440 $19,160 Integrity - Service - Excellence 33
Innovation & Insight to Recapture Care Delivering Patient-Centered Care To Our Beneficiaries Creating Currency Opportunities To Support Travis AFB, CA Langley AFB, VA Readiness Allowing Medics To Practice Full Scope Of Care Tackling Per Capita Cost Through Targeted Nellis AFB, NV Elmendorf AFB, AK Investments Eglin AFB, FL Keesler AFB, MS WPAFB, OH Specialty Hospitals Focused on Currency and Recapture Integrity - Service - Excellence 34
Establishing Partnerships to Enhance Capabilities Physician/Dentist Education (GME/DME) Stand alone programs Masters with civilian universities Integrated/affiliated with Federal partners Nurse Education (Transition Program) New sites include: Cincinnati, OH & Scottsdale, AZNurse Enlisted Commissioning Program (NECP) USAF Dental Hygiene Program Research Partnerships are Vital Tools to Build & Sustain Medical Services Integrity - Service - Excellence 35
Operating Room Throughput and Modernization Road Map Tomorrow Metrics Standardized Parameters Of Throughput Now UniformStandard Scheduling Software & Method Defined 9 Platforms Evaluated Today Improved Throughput = Improved Currency Seizing The Future Today Through Modernization Integrity - Service - Excellence 36
E-Health Initiatives MEDICAL AND MODELING AND SIMULATIONIntegrity - Service - Excellence 37
eHIP Background eHealth Initiatives Project (eHIP) 10 initiatives in various stages of maturity using electronic media Three overarching goals: Activate patients to achieve their health needs and goals Optimize PCMH operations Recapture specialty care eHIP Co-Champions: AF/SG and AFMOA/CC Integrity - Service - Excellence 38
Leveraging Medical Informatics DATA INFORMATION KNOWLEDGE WISDOM CHANGE Better CareTMDS Clinical Through Practice Evidence Based GuidelinesDEERS Practice CarePoint Medication Better HealthPDTS Health Alerts Enhanced Patient Services Registries Data Safety$ / M2 Warehouse User Home Best Value (HSDW) Interfaces Sensors Healthy BehaviorDMHRS i Better Care Expedited EHR Test Results Improved Patient Experience Decision Support is No Longer Just for Our Providers Integrity - Service - Excellence
Transforming Data Into Knowledge Ready Better Health Better Care Patients receiving Diabetic patient massive infusions of > educated on 10 pints experienced “remote mortality of 33% monitoring” glucometer Clinical Study Readings Practice registry MTF calls automaticallyGuideline to identify patient to sent todeveloped trends discuss healthcare management team Conclude infusing whole blood Uncontrolled sugar reduced mortality levels Identified to less than 20%Using Informatics to Accelerate Change in Practice Patterns & Behavior Integrity - Service - Excellence 40
INVEST IN EDUCATION,TRAINING AND RESEARCH Integrity - Service - Excellence 41
Building Our Capabilities Goals Increase Capacity and Department Currency of Staffs of Defense Build “Win-Win” Partnerships in Training, Research and Development Trained Recapture Care CIVILIAN Current ACADEMIAHOSPITALS Deployable Effects Improves Quality of Care More Patient Choices Retains Providers VETERANS AFFAIRS Reduces Cost Saves Lives Coordinated Care to Deliver Expertise and Value Integrity - Service - Excellence 42
Enduring Academic Partnerships Physician/Dentist Education (GME/DME) Stand alone and integrated programs Masters with civilian universities Integrated/affiliated with Federal partners Advanced Education General Dentistry- 91 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program) 188 trained students in FY11 New sites include: Ohio and Arizona Nurse Enlisted Commissioning Program (NECP) 45 per year with school of their choice Research USAF Dental Hygiene Program 10 scholarships per year Diabetes Trident Technical College (SC) Telepathology St. Petersburg College (FL) TeleradiologyEducation & Research – Absolutely Critical to Building & Sustaining the AFMS! Integrity - Service - Excellence 43
A do le s A ce n er os t M 60% 65% 70% 75% 80% 85% 90% 95% 100% pa e A ce dic l le i rg Me ne y d Im i c m i ne un A o lo A ne g ne sth y st es he ia si a C a CC AF RATE C rdi yt ol op og NATL RATE at y D h ia De ol o gn rm g y E ost ato m ic lo er R ge a gy nc dio y lo g E Me y nd d o ic F cri i ne am n o i ly lo G M gy as e tr di G oi n cin en te e er st a in H l S al em u In e rg e fe O ry ct n io co us lo In g 100% pass rate te Di s y rn ea al s M e 18 specialties with N ed eo ic na i ne t N olo ep g hr y o N Ne l og uc u y le ro ar lo M gy ed ic in O O e ph b th G al yn m Board Pass Rates: AF vs. National Average O ol rth ogIntegrity - Service - Excellence O o y to pe la ry dic ng s Combined Aeromedical-Family Medicine initiative ol P og at y ho P log ed y ia P tric sy s P ch ul m ia tr o y R na he ry Restoration of GME programs at Keesler AFB after Katrina um C at C ol og U y ro lo gy BRAC integration & maturation of civilian-military partnerships (GME) Success Graduate Medical Education Expansion of GME sites- Nellis, UC-Davis, Portsmouth, Ft Belvoir 44
Health Professions Scholarship Program (HPSP) and Financial Assistance Program (FAP) Fill Rates AF Census by Year100% 1,666 1,59980% 1,29860% HPSP/FAP40%20% 0% 2006 2007 2008 2009 2010 2011 Following the increased resourcing of student-based accession sources across the FYDP, the AFMS is approaching 100% in HPSP and FAP annual census. Integrity - Service - Excellence
Civilian Trauma Collaboration BALTIMORE CINCINNATI ST LOUIS UC- Davis Sustaining Trauma Center for Sustainment of Trauma And And Resuscitation Readiness Skills Skills-Program (C-STARS) (STARS-P) Trauma & Surgical Skills (Baltimore) Travis/UC Davis MC Advanced CCATT (Cincinnati) W-P/Miami Valley Trauma Skills (St. Louis) Luke/Scottsdale HC & Maricopa County Nellis/Univ. MCKeeping Medics Ready Through Civilian Partnerships & Programs Integrity - Service - Excellence 46
711 HPW & USAFSAM Wright-Patterson AFB, OH Research Modeling & Simulation of UAS Operators Stress & Fatigue Survey of RPA Community JSF/F-35 Life Support System Testing & Development Education & Training Attended 6-wk European Air Gp Adv Aerospace Med Course Defense Institute of Medical Operations (DIMO) To date, 7000 foreign medics trained from 124 countries Adv Aerospace Medicine for International Med Officers (AAMIMO) 110 countries have participated…37 students became SG equivalents Exchange Officer ProgramsFostering Interoperability, Integration, & Ultimately…SYNERGY! Integrity - Service - Excellence 47
ModernizationEnroute Expeditionary Force Health Health Human Operational Care Medicine Protection Informatics Performance Medicine Supports Full Spectrum of Medical Care Mission Product Lines Provide policy, guidance, Medical Requirements resources, and oversight to Strategic Medical Acquisitions Medical Innovations integrate technology and Clinical Research Projects deliver enhanced solutions to Medical Technology Developmentthe AFMS, our warfighters, and Medical Technology Testing the beneficiary community Medical IM/IT Services, Operations Delivering The Future Today…One Project At A Time! Integrity - Service - Excellence 48
Shaping the Future of Military Healthcare Synergy- Patient-Centered Joint & Coalition Care Organizational Precision Agility Healthcare Technology IntegrationWorking Together, Achieving Success Through A Common Vision Integrity - Service - Excellence
Mission Ready Medics Serving Proudly Doctrinally Aligned Healthy, Fit Force Resilient Families Operationally Focused MedicsJoint, Interoperable, Interdependent…Mission Effective! Results The Trust of Our All Volunteer Force The Trust of Our Nation to Care for Its Sons & Daughters Integrity - Service - Excellence
TRUSTED CARE ANYWHERE” Integrity - Service - Excellence 51