1. May 2, 2013
ILN Briefing
Innovation in the Military Health System
Rachel C. Foster, FACHE
MHS, Chief Innovation Officer &
Director, Financial Performance & Planning
Health Budgets and Financial Policy

2. - 2 -
U
Introduction
Rachel C Foster, FACHE
Ms.
Foster
is
the
Director
for
Financial
Performance
and
Planning
in
the
Department
of
Defense,
Health
Affairs
office
of
Health
Budgets
and
Financial
Policy
(HB&FP).
In
this
posiCon,
she
directly
supports
the
Deputy
Assistant
Secretary
of
Defense
for
HB&FP.
AddiConally,
Ms.
Foster
was
recently
appointed
the
first
ever
Military
Health
System
Chief
InnovaCon
Officer
(CINO),
directly
reporCng
to
the
Assistant
Secretary
of
Defense,
Health
Affairs.
As
the
CINO,
Ms.
Foster
spearheads
the
acCviCes
of
the
MHS
InnovaCon
Strategy
and
team.
Her
main
responsibiliCes
include
creaCng
a
sustaining
culture
of
innovaCon
across
the
Enterprise
and
supporCng
innovaCons
in
the
areas
of
recapture
of
specialty
and
inpaCent
care,
obesity
and
tobacco
use
reducCon,
and
knowledge
sharing.
Her
appointment
as
the
CINO
subsumed
and
is
the
natural
progression
for
the
InnovaCon
Investment
Process
(IIP)
–
an
iniCaCve
geared
toward
idenCfying
cost
savings
for
the
Military
Health
System
(MHS),
of
which
Ms.
Foster
was
the
program
manager.
Some
key
iniCaCves
undertaken
by
the
IIP
include
the
CONUS-­‐wide
Nurse
Advice
Line
for
all
TRICARE
beneficiaries
and
the
purchase
of
a
single
anesthesia
reporCng
and
monitoring
device
for
worldwide
installaCon
across
the
MHS.
From
April
2009
through
January
2011,
Ms
Foster
was
the
AcCng
Deputy
Assistant
Secretary
of
Defense
for
HB&FP.
In
this
posiCon,
her
responsibiliCes
included
chairing
the
Chief
Financial
Officer
IntegraCon
Council;
overseeing
the
Planning,
Programming,
BudgeCng
and
ExecuCon
Process;
and
aligning
financial
processes
with
the
Military
Health
System
Strategic
Plan.
During
that
Cme,
she
led
the
2010
Quadrennial
Defense
Review
(QDR)
Medical
Working
Group.
Prior
to
this
2010
effort,
Ms.
Foster
chaired
the
2006
QDR
Medical
TransformaCon
IntegraCon
Working
Group,
which
developed
business
transformaCon
iniCaCves
for
the
MHS
and
the
Medical
Readiness
Review
Resources
Subgroup.
Ms.
Foster
is
board
cerCfied
in
Healthcare
Management
and
is
a
Fellow
of
the
American
College
of
Healthcare
ExecuCves.
She
holds
a
Bachelor
of
Arts
in
Economics
from
the
University
of
Texas,
AusCn;
a
Master
of
Public
Policy
and
AdministraCon
degree
from
Columbia
University
in
New
York;
and
a
Post
Master’s
degree
in
Health
Services
AdministraCon
from
the
George
Washington
University
in
Washington,
DC.
Ms.
Foster
has
served
on
the
Board
of
Trustees
for
the
Metropolitan
Area
PrevenCon
of
Blindness
Society
since
2002.
In
June
2011,
Ms.
Foster
accepted
an
Ex-­‐Officio
membership
on
the
Health
Services
Division
NaConal
Governing
Board,
Federal
Bureau
of
Prisons.

3. § Ability
to
have
broad,
interacCve
discussions
and
collaboraCons
§ Ability
to
access
seed
money
and
data
§ Belief
that
senior
leaders
value
innovaCon
§ Freedom
to
think
outside
policy
constraints
§ Knowledge
of
the
enterprise’s
strategy
and
prioriCes
§ Rewards
for
risk-­‐taking
and
failure
Cri$cal
Success
Factors
These
include
elements
of
the
innova2on
culture
enablers
(See
Culture
of
Innova2on
Slide).
§ Accountability
for
explicit
Cmelines
with
clear
decision
points
§ MoCvated
owner/implementer
§ Process
for
rapid
decision-­‐
making
§ Provision
of
seed
money
and/or
waivers,
as
appropriate
§ Support
from
senior
leadership
§ Commitment
of
senior
leadership
to
full
implementaCon
§ Full
engagement
by
owner/
implementer
§ Funding
and
resourcing
for
full-­‐scale
implementaCon
§ Tools
to
monitor
success
of
innovaCon
and
share
knowledge
2012
Innova$on
Focus
Areas
Innova&on
Value
Chain
(Innova&on
Process)
Create
Ideas
(Internally
&
Externally)
Refine
&
Develop
Idea
Take
ownership
Drac
Proof
of
Concept
Genera$on
Conversion
Diffusion
Screen
InnovaCve
Ideas
Award
Seed
Funding
/
Approve
Waivers
Test
InnovaCve
Idea
(e.g.
pilots)
Evaluate
Results
&
Make
Go/No-­‐
Go
Decision
Engage
ExecuCve
Sponsor
Develop
ImplementaCon
Plan
(including
milestones)
Launch
ImplementaCon
Monitor
ImplementaCon
Share
Knowledge
&
Lessons
Learned
2012
MHS
Innova$on
Focus
Areas
By
Phase
Tobacco
&
Obesity
Re-­‐Capture
of
Specialty
Care
Pa$ent
Safety
PCMH
Innova$on
Effort:
Tri-­‐Service
Workflow
Mul$ple
Diseases
(6)
Metabolic
Diseases
Lower
Back
Pain
3
In
2011,
the
ASD/HA
made
it
a
priority
to
encourage
and
ins2tu2onalize
a
culture
of
innova2on
across
the
Military
Health
System

4. MHS
Innova$on
Environment
Iden2fying
innova2ons
and
expanding
them
across
the
enterprise
proved
challenging
,
as
it
would
for
any
complex
organiza2on.
Establishing
the
innova2on
infrastructure
allows
for
innova2ons
to
move
up
through
the
organiza2on
in
line
with
strategic
goals
and
objec2ves

5. MHS
Innova$on
Strategy:
Enterprise
View
of
Innova$on
Genera$on
Conversion
Diffusion
Conversion
Genera$on
Diffusion
Genera$on
Conversion
Diffusion
MHS
Local
Strategically
Supported
Innova&on
The
overall
strategy
of
the
MHS
and
priori2es
of
the
ASD(HA)
will
determine
which
innova2ons
are
targeted
for
support
at
the
enterprise
level.
Innova2ons
that
align
with
the
strategic
focus
areas
will
be
solicited
at
all
levels
of
the
organiza2on,
allowing
innova2ons
to
“skip”
levels
for
rapid
dissemina2on
throughout
the
enterprise.
Strategically
supported
innova2ons
will
be
scalable,
tri-­‐Service
and
posi2vely
impact
the
Quadruple
Aim.
External
Partnerships
Services
5

6. - 6 -
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Innovation Deep Dives - Rapid Idea Generation and Approval
Deep Dives bring together a diverse group of participants and innovators to collaborate in developing truly innovative solutions for strategic challenges facing the MHS
M H S I N N O V A T I O N D E E P D I V E S
6 Months After Deep DiveDeep Dive Event – Day 2Deep Dive Event – Day 1Prior to Deep Dive Deep Dive Event – Day 3
Select a diverse group of
participants
·∙
SMEs
·∙
MTF Leaders
·∙
External
Representatives
Participants submit initial
innovations/ideas
Kick-off calls introduce the
Deep Dive format and focus
area
B u il d in g
M o men t u m
Id ea
S o l ic it a t io n
K n o w l ed g e
E x c h a n g e
Participant
Review
Executive
Cell
Review
Senior
MHS
Leadership
Review
War Room provides subject matter
expertise and data to help refine initiatives
Participants develop selected ideas for
review by Executive Cell (comprised of
representatives of the Surgeon Generals)
Executive Cell provides feedback, identify/
address potential threats & weaknesses,
and provides recommendations to finalize
briefing to Senior MHS Leadership
Implementation leads and pilot sites are
determined
Impr o v ed
S y s t em
P er f o r ma n c e
F a il in g
F a s t
D ef in e
S c o pe
o f
P r o bl em
S t a t emen t
Id ea
S el ec t io n
R a pid
D ec is io n
M a k in g
D ef in in g
S u c c es s
D ev el o p
P il o t
P r o po s a l s
D iv er s e
R epr es en t a t io n
A ppr o v e
P il o t
P r o g r a ms
C o l l a bo r a t io n
Impl emen t
P il o t
P r o g r a ms
L es s o n s
L ea r n ed
F u n d in g
Facilitators introduce the problem and focus
area
Participants define metrics of success
Participants brainstorm and discuss an
initial list of ideas
Initiative list is narrowed through participant
analysis and discussion
Executive Cell pre-briefs the Assistant
Secretary of Defense and the Surgeon
Generals
Participants present proposed solutions via
decision brief to Senior MHS Leaders
Senior MHS Leaders approve promising
innovations that are aligned with the
Quadruple Aim
Innovations are assigned a
mentor
Execute pilot programs over
the next six to twelve months
Provide periodic reports on
success of implementation
Stop pilot programs that are
unsuccessful and document
lessons learned
Prepare business case for full
implementation at the end of
pilot period
Inputs
Inputs
InputsOutcomes
Outcomes
Outcomes
L ea d in g
E d g e
S o l u t io n s
Id ea
R ef in emen t
R ef in in g
D is r u pt iv e
&
T r a n s f o r ma t iv e
In n o v a t io n s

7. - 7 -
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MHS Innovation Value Chain Accomplishments and Goals
Given MHS Innovation’s success in generating hundreds of new ideas in 2012, and selecting 15 pilot
initiatives and 3 challenge winners, our near-term focus will be on converting innovations
Recapture of Specialty Care Obesity Management Tobacco Cessation & Prevention
Genera$on
Idea
Crea&on
Group
+
Challenge
Diffusion
As
needed
Proposed Focus for 2013
Innovation Value Chain
Innovation Topic Areas
§ MHS Innovation will focus on piloting 15
approved initiatives and 3 challenge
winners by:
‒ Launching the Pilot Toolkit to
support pilot owners and address
bottlenecks currently slowing the
process
‒ Partnering with Innovation
Council and Service Innovation
Cells to help trouble shoot barriers
faced by innovators
‒ Re-doubling efforts to find strong
mentors and team members to
support initiative owners
§ However, MHS Innovation will continue to
foster new ideas by:
‒ Leverage LinkedIn community for
idea generation
‒ Facilitating next MHS Innovation
Challenge during summer of 2013
‒ Holding another Deep Dive in
approximately 6-9 months
We propose that for future Deep Dives and Challenges that MHS Innovation continues to focus on the
2012 key innovation topics.
Conversion
Pilot
15
approved
ini&a&ves
and
3
challenge
winners

8. - 8 -
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Looking ahead to 2013
MHS Innovation is re-balancing its efforts from identifying new ideas to developing a long-term
sustainable infrastructure that will support a culture of innovation.
Focus
System Performance
Continue to strengthen
governance and improve
visibility into local innovations
Activities
Knowledge Sharing
Facilitate moving from
information to wisdom
Human Capital Activation
Encourage, reward, and
recognize innovators
‒ Create Innovation Contract to spur conversion/piloting
‒ Strengthen governance through monthly Innovation Council
Meetings and partnership with Service Innovation Cells
‒ Realign MHS Support Initiatives (MHSSI) process to provide
Innovation Council visibility into local recapture innovations and
streamline the approval process
‒ Run Knowledge Sharing pilots and create Knowledge Sharing
whitepaper with lessons for the broader strategy
‒ Continue to improve and enhance knowledge sharing via creation of
LinkedIn sub-groups to connect innovators
‒ Continue to develop external partnerships through ILN
‒ Continue to monitor effectiveness of Clinical Enterprise Intelligence aka
Health Services Data Warehouse
‒ Evaluate opportunities to include innovation in the performance
management process
‒ Develop a Leadership Innovation Recognition Strategy to
recognize innovators, and support calculated risk taking
Data
Knowledge
Information
Wisdom

9. Appenix

10. The
Innova$on
Framework
is
a
tool
for
classifying
innovaCon
efforts
throughout
the
Military
Health
System.
The
goal
is
a
balanced
porfolio
of
innovaCons
across
the
MHS
that
is
aligned
with
the
Quadruple
Aim
and
spans
a
range
of
different
types
of
innovaCon.
Quadruple
Aim
Readiness:
Ensuring
that
the
total
military
force
is
medically
ready
to
deploy
and
to
deliver
health
care
anyCme,
anywhere
in
support
of
the
full
range
of
military
operaCons,
including
humanitarian
missions.
Experience
of
Care:
Providing
a
care
experience
that
is
paCent
and
family
centered,
compassionate,
convenient,
equitable,
safe
and
of
the
highest
quality.
Popula$on
Health:
Reducing
the
generators
of
ill
health
by
encouraging
healthy
behaviors
and
decreasing
the
likelihood
of
illness
through
focused
prevenCon
and
the
development
of
increased
resilience.
Per
Capita
Cost:
CreaCng
value
by
focusing
on
quality,
eliminaCng
waste
and
reducing
unwarranted
variaCon;
considering
the
total
cost
of
care
over
Cme,
not
just
the
cost
of
an
individual
health
care
acCvity.
Types
of
Innova$on
Process
Improvement:
Improving
the
efficiency
and/
or
effecCveness
of
processes
through
incremental,
localized
changes.
Leading
Prac$ce:
AdopCng
proven
soluCons
from
within
and
outside
of
MHS
that
update
and/or
expand
exisCng
work
streams
or
services.
Transforma$ve
Innova$on:
New
or
fundamentally
redesigned
work
streams
or
services
that
deliver
expanded
value
proposiCons.
Disrup$ve
Innova$on:
Ground-­‐breaking
changes
that
disrupt
current
behavior,
render
exisCng
approaches
and
delivery
mechanisms
obsolete
and
that
change
the
value
proposiCon.
Innova$on
Framework
10