As we close out this year and look ahead to the next one, I have been reflecting on the topics and issues we have covered in the past 12 months. Several themes emerged that are seen across the health care system, including in the Military Health System (MHS). The MHS is facing many of the same challenges as the commercial market, such as rising costs, pressure to meet consumer demand, and making the transition from volume to value. Though there are many similarities, the primary difference between the MHS and other large integrated delivery systems is its mission of readiness—ensuring both a “ready” medical workforce and a “ready” force that can be deployed anywhere at any time across the world.
Readiness and the Quadruple Aim
The Triple Aim has been a major driving force behind many health care system initiatives. For the MHS, the Quadruple Aim is its strategic vision and core values. The concept of Readiness sits at the center of the MHS mission, surrounded by three other Aims, as the MHS balances this set of strategic initiatives to maximize value for all of its customers.
The Quadruple Aim:
- Readiness: Ensure that the entire military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere
- Population health: Keep people healthy and reduce the frequency of the visits to hospitals and clinics
- Experience of care: Provide a care experience that is safe, timely, effective, efficient, equitable, and patient- and family-centered
- Per capita cost: Create value by focusing on quality, eliminating waste, reducing unwarranted variation
Whether it is providing humanitarian assistance in an underdeveloped country, aero evacuating a wounded warrior in an austere environment, or providing lifesaving combat casualty care, the MHS can be a model for other health care organizations. This summer, the National Academies of Sciences, Engineering, and Medicine published a report suggesting the US could significantly improve trauma care if we integrated insights from military care into civilian hospitals.1 While the battlefields have only grown more dangerous for our soldiers, the MHS has reduced fatality rates for wounded soldiers from nearly 25 percent in Vietnam to less than 10 percent in Afghanistan and Iraq. It has also succeeded in cutting death rates from injury by half from 2005 to 2013.2
But, the MHS is more than just a trauma care system for treating soldiers in combat. The MHS is under pressure to accomplish many critical missions in addition to providing health care to service members in dangerous settings in the battlefield. These include supporting the deployment of a medically ready force and providing services to almost 10 million beneficiaries who are not on the battlefield, such as non-active duty, military family members, and retirees.
The challenges MHS is facing are multi-faceted: It operates in a highly matrixed organization with multiple lines of authority that is undergoing a changing organizational structure; it must integrate new regulatory stipulations and increased security requirements, all while facing budgetary pressures; and it must manage electronic health record (EHR) modernization efforts, which include the acquisition and deployment of the new EHR by 2017.
As one of the largest health care systems in the US, with total spending of more than $50 billion per year, the MHS shares many features with civilian health care systems.3 It is continually adapting and evolving to changing demographics, new policies and standards for access and quality, advances in science and medicine, complex payment and cost considerations, a changing health IT landscape, and the continual challenge of meeting patient expectations.
Looking ahead: Future of MHS
The MHS is a complex global, comprehensive, integrated system of both commercial providers and health plans as well as over 60 inpatient Military Treatment Facilities. It is tasked with care delivery and public health services, medical education and training, and advancing medical research. I see MHS evolving and adapting to prepare for the future in the following areas:
- Moving from a system of health care to health: The MHS is focusing on prevention by implementing innovative population health initiatives and leveraging public health partnerships to create healthy communities.
- Shifting from volume to value-based care: All activity military duty providers and administrators are focused on shifting budgeting and reimbursement from productivity to outcomes based on quality and cost thresholds and implementing innovative payment models.
- Establishing a culture of safety: The MHS patient safety mission centers around promoting a culture of safety to end preventable patient harm by engaging, educating, and equipping care teams to put evidence-based practices in place across the organization.
- Investing in medical education and training: The MHS system manages a comprehensive medical research and development program that works closely with academia and private research organizations to provide diverse medical education and training programs. The next generation of physicians and clinicians, whether they serve in the MHS or not, must learn how to operate in a team-based, integrated, interoperable system and provide holistic, patient-centered care with a focus on prevention and an increased emphasis on shared decision-making with patients.
- Advancing medical research: The MHS is continually finding innovative ways to protect, support, and advance the health and welfare of the community it serves. In the coming year, the MHS will likely continue its focus on leveraging data analytics, robotics, and Artificial Intelligence to improve outreach, diagnosis, and treatment as well as to advance clinical research and training.4
The National Academies of Sciences’ report focused on the benefits the civilian sector could reap if the system adopted leading practices from the MHS on reducing trauma deaths after injury. But, joint efforts to share leading practices in other areas, including care delivery, public health, training, and advancing research, could also reap benefits for both systems.
As we prepare for President-elect Trump and a new administration to transition to the White House, we know the only constant in health care is change. In the coming year, the MHS, like the rest of the stakeholders in the system, will move forward in advancing its understanding of population health, new opportunities in clinical innovation, and future generations of physicians and clinicians to train. I look forward to tracking progress, sharing lessons learned, and challenges overcome to finally achieve the Quadruple Aim.
1 The National Academies Press, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury,” 2016
2 The National Academies Press, “A National Trauma Care System: Integrating Military and Civilian Trauma Systems to Achieve Zero Preventable Deaths After Injury,” 2016
3 Department of Defense, “Overview of the Department of Defense’s Military Health System,” 2014
4 Military Health System, Innovation