Portsmouth, Va. (NNS) -- As military medicine moves toward integration among the branches of service and cost reduction becomes a primary goal, the Tidewater enhanced Multi-Service Market is continuing to prepare for providing health care in a joint environment, including most recently a visit from the leadership of the Office of Health Affairs July 17 - 18.
Dr. Karen S. Guice, principal deputy assistant Secretary of Defense for Health Affairs and others from OHA met at Naval Medical Center Portsmouth with leadership from NMCP, U.S. Air Force Hospital Langley and McDonald Army Health Center, as well as the deputy Surgeons General from the Army, Navy and Air Force or their representative.
The more than two dozen health care leaders, which also included leaders from Veterans Affairs and the Coast Guard, spent the two days discussing expectations, functions and challenges as the military treatment facilities in Hampton Roads prepare for changes to military medicine that take effect on Oct. 1.
"We are becoming a more integrated military health system, stronger and more relevant for the future," Guice said. "It's going to improve readiness, it's going to make sure our military health care providers have the clinical capabilities and capacity to take care of any kind of deployment environment they may face. It's all about maintaining readiness and doing so with the wealth of patient material that we have."
The changes she spoke of means that the TRICARE Management Activity and other military health offices will aggregate into the new Defense Health Agency. Starting Oct. 1, DHA will oversee about half of the common health services used by the military medical commands, such as TRICARE and pharmacy benefits, health information technology, medical logistics and facilities planning.
Locally, this new structure will mean the three services will operate their MTFs as one entity under the Tidewater eMSM.
"The multi-service market is basically a way of integrating medical health care among the services," said Cmdr. Susan Union, MSM director at NMCP. "Before, you had three separate services doing their own thing. The MSM concept has been around for nearly a decade, but the eMSM, the enhanced version, is still in its infancy."
The basic difference between MSM and eMSM is that under eMSM, the market manager has increased authority, including funding allocation, policy and better maximizing staff skill sets.
NMCP commander Rear Adm. Elaine C. Wagner will serve as the market manager for the Tidewater eMSM. Of the six eMSMs being created across the country, Wagner is the only Navy market manager.
"The market manager has the ability to move staff back and forth among the three services," Union explained. "She can take an Army medic and have him sent TAD to work at Portsmouth, and vice versa, send Navy corpsmen to the Army or Air Force MTFs. We have to look at ourselves as the Tidewater eMSM, not three individual entities when thinking about staffing and caring for patients. We have to think of ourselves as one market."
The goal of this new health care delivery structure is to recapture patients who are being sent to a civilian provider for care or who are going to an emergency room for non-emergencies, primarily by ensuring all appointment slots are being used and, in some cases, adding services.
"I think it's difficult for people to understand that TRICARE is an insurance just like any other health insurance, and we just can't let people go anywhere like we have been," Union said. "There is a cost associated with providing care, and when the patient isn't paying anything out of pocket, it can seem like free health care."
Union provided a few examples of how costs can rise beyond what's expected, including spending several million dollars for one child to receive care in a neonatal intensive care unit at a civilian hospital; someone with a stubbed toe or a cold coming to the ER; and more than 60 percent of prescriptions being filled at civilian pharmacies, much more than the 16 percent goal.
"We do great medical care, we have the ability and capacity, we just need to better utilize it," Union added. "We need to better educate our staff and beneficiaries about what we can do."
By doing this, they hope to reduce civilian purchased care costs by nearly $30 million annually. A change in the handling of consults for specialty care appointments will help move toward that goal.
"Currently, when a doctor puts in a consult for a patient, if they can't get seen within 30 days, they are referred out to the network," said Lt. Suzanne Tschauner, Healthcare Business Office staff at NMCP. "In the future, if that appointment is not available for that MTF, the other two services will look first to see if they have an appointment at their MTF before the patient is referred to the network. A lot of people want to be seen by military medicine, they just don't want to have to wait for more than 30 days for the appointment. So this will be a big advantage for both sides."
"I think we have tremendous opportunity," Guice concluded. "This is an almost one-in-a-lifetime opportunity to really change the way we do business. I'm quite excited about the challenge."
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