The document provides an overview of recent successes and hot topics within the U.S. Air Force Medical Service (AFMS). It discusses major transformational initiatives including the establishment of Emergency Medical Deployment Systems Health Response Teams. It also covers hot topics such as initiatives to increase resiliency and address suicide, traumatic brain injuries, and changes to military health structure and benefits. Accomplishments are highlighted relating to enhanced casualty care, implementation of patient-centered medical homes, and investments in education, training, and research.

1. Headquarters U.S. Air Force
Integrity - Service - Excellence
Air Force Association
AFMS Updates
Maj Gen Thomas W. Travis
Deputy Surgeon General
9 December 2011

2. Purpose and Overview
Purpose:
Provide overview of recent successes and discuss hot topics
Overview
Major Transformational Initiatives
Hot Topics
Human Weapon System
Structure
Benefits
Accomplishments
Discussion
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3. Air Force Medic Video
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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 Training
Center (METC)
USAFSAM Opens at WPAFB
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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
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7. Hot Topics: Structure and Benefits
Governance
Military Health System (MHS) in NCR
Entire MHS and Timelines
Awaiting SECDEF Decision and COA
AF & DoD Healthcare Efficiencies
TRICARE Fees/TRICARE Prime
No Cost to AD and Their Families
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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
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9. We’re Proud of Our Achievements!
- EMEDS HRT/Theater Med Info Prgm successfully exercised/ready
READY
- 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 partnerships
BETTER 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 recorded
BEST 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
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10. “TRUSTED CARE ANYWHERE”
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11. BACK UP SLIDES
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12. Focus and Alignment)
Through the AFMS Framework
Strategies
Overlapping
Mission 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
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13. In Pursuit of Lighter &
Leaner Medical Response
EMEDS 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 contingency
Pursuing Perfection in Medical Response Capability
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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 11
Combat 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 FORCE
from patient perspective MEDICAL HOME
Increased continuity
QUALITY PATIENT
Decreased ER visits MEASURES PATIENT
EXPERIENCE
Better health outcomes (HEDIS) EXPERIENE
Patient Satisfaction PATIENT
INFORMATION
Objectives: 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
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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 Investments
Travis 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
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17. Invest in Education, Training and
Research
Military Education and Training Center (METC)
Joint Medical Training
Open for Officer Medical Training Courses
USAFSAM Opening at WPAFB
CSTARS Course
Maintains Trauma Training
GME/DME and Nursing Education
Expanded Opportunities
Increased Healthcare Provider Numbers
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18. The Suicidal Mind
Suicide is a behavior, not a disease
How we think and communicate about it affects its rate
Usually characterized by desperation, hopelessness
Rage: anger and frustration - Impulse
Avoidance: legal/financial concerns, guilt
Mental illness: Depression, Bipolar Illness
Substance use often fuels the fire
Top risk factors
Relationship problems
Mental health history
Legal/ administrative problems
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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, AZ
Nurse Enlisted Commissioning Program (NECP)
USAF Dental Hygiene Program
Research
Partnerships are Vital Tools to Build & Sustain Medical Services
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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 16
Number
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
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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 empirical
evidence that a comprehensive, public health approach could, in fact, reduce suicide across
a population.” – Volpe Report
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22. Air Force Suicide
Prevention Overview
Suicide Rates (per 100,000/yr) AD Risk Factors/Stressors (%)
10 year Pre-Program 13.5 Relationship Problems 54.2
10 year Post-Program 9.9 History of Any Mental Health 45.8
CY10 Active Duty 16.4 Diagnosis
CY11 Active Duty (Rolling Rate) 13.4 Legal/Admin Problems 33.9
CY11 Q2-Q3 Active Duty 11.5
Seen by Mental Health in Past 18.6
CY11 Total Force (Rolling Rate) 14.1
Month
CY11 Q2-Q3 Total Force 12.9
By 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 12
Aircraft Maintenance (2A) 21.8
Financial Problems 10.2
Intelligence (1N) 0.0
Security Forces rate down > 30% from Feb ‘11 peak
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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
resources
AF accounted for 11% of TBI (deployed/non-deployed) cases
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24. Enhanced TBI Screening
Capabilities
All Warfighters medically evacuated from theater to Landstuhl
Regional Medical Center (LRMC) undergo TBI screening regardless
of injury for which they were evacuated
TBI screening on Post Deployment Health Assessment (PDHA), Post
Deployment Health Re-Assessment (PDHRA)
All clinical medics trained on current concussion management
guidelines in deployed setting
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25. Clinical Capabilities and
Measures of Success
Services:
Early and appropriate evaluation,
diagnosis, and treatment following a
potentially concussive event
Clinical algorithms standardize care
Capabilities:
Theater: 332 EMDG, Balad
Joint Base Elmendorf-Richardson
San Antonio Military Health System
Measures of Success:
Resolution/control of symptoms
Return to duty
Medical evaluation board statistics
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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 Processing
PTSD diagnosis under 0.5% or 1,300 Airmen; 4-5 times more
common in Airmen with combat exposure
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27. Air Force PTS Prevention
Airman Resiliency Training
Traumatic Stress Response Teams
Leader’s Guide
Deployment Transition Center
Telemental Health
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28. Improved AF Mental Health
Increased Mental Health providers FY12-FY16
Provider Type MH CLINIC BHOP SNC Peds Total/Increase
Psychiatrists: +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 Care
Airmen educated on mental health during Self Aid Buddy Care
Service member screened 5X face-to-face pre/post deployment
Building Mental Health Availability for the Total Force
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29. Beneficiaries Move Between Direct (MTF) and
Purchased Care (Downtown Network) Systems
Military Health System (MHS)
VHA
Benefits
Direct Care Purchased
(MTF) Care
Medicare
Employer
4.16 million Under 65 Sponsored
(Includes 950K 3.42 million Insurance
Guard/Reserve and Over 65
their 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
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30. Civilian Employers Share The Burden Of
Healthcare Costs With Employees At A Much
Greater Rate Than DoD
A 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 retirees
TRICARE 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
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31. A Number Interventions Have Been
Proposed ) Could Impact Readiness
Increase TRICARE beneficiary cost sharing to incentivize more prudent
utilization 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 and
logistics; a joint care model through a Unified Medical Command; or through a
federal health care system that includes VA
Establish correct balance between direct and purchased care system so that
own vs buy decisions are optimized and care is coordinated
Optimize the Graduate Medical Education training platforms so that they most
efficiently serve the readiness needs; own vs buy decisions.
Identify and mute variation in care delivery by establishing more standardized
and efficient care processes – process improvement
Estimates suggests a potential savings of up to 30%
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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
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33. Strategies Vary By Span Of Control
And Implementation Difficulty
Modify TRICARE StandardExtra Cost Sharing
Congress
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 )..
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