Navy Medicine Initiative Receives Military Health System Innovation Award

Story Number: NNS141205-14Release Date: 12/5/2014 6:48:00 PM
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By Regena E. Kowitz, Naval Medical Center San Diego Public Affairs

SAN DIEGO (NNS) -- The Integrated Health Community Initiative (IHCI), a multiyear program to optimize population health and improve patient care while simultaneously reducing overall health care costs for Navy Medicine, received the 2014 Military Health System (MHS) Innovation Award Dec. 4.

The award was presented in recognition of the IHCI's success in moving targeted patients from health care to health and ensuring their long-term well being.

"Under the guidance of Rear Adm. Forrest Faison, the IHCI was launched in 2011 at Naval Medical Center San Diego (NMCSD) and Naval Hospital Camp Pendleton (NHCP) as a pilot program to improve our beneficiaries' health and reduce the rising costs of health care," said Cmdr. Sunny Ramchandani, medical director for the health care business directorate and the IHCI director in San Diego.

"This region was chosen due to the high concentration of MHS beneficiaries, as we have over 400,000 in the area," said Ramchandani. "As a pilot, we've designed the program to be scalable because we want other hospitals throughout Navy Medicine to be able to implement this program for the benefit of their patients as well as their bottom line."

Part of the IHCI's innovative strategy includes segmenting patient populations into primary, secondary, and tertiary prevention categories based on health conditions and then implementing appropriate measures to improve health outcomes. Patients in the tertiary prevention category, with complicated, chronic health conditions such as diabetes or heart disease, were the initial focus of the IHCI. On average, health care costs for these patients are 17 times higher than patients in the primary prevention population, who are generally healthy.

In collaboration with staff from NMCSD and NHCP's patient-centered Medical Home Ports, Navy Medicine's team-based and integrated approach to primary care, the IHCI has made a significant impact on tertiary prevention efforts and population health. The proactive monitoring and managing of the health of almost 400 patients with chronic conditions over the past two years has resulted in a 20 percent reduction in emergency department use and a 28 percent reduction in inpatient admissions among this population.

"In just two years, the IHCI reduced total health care costs for our targeted tertiary patients by 39 percent, an annual savings of $8.6 million," said Lt. Cmdr. Ryan Jarmer, IHCI implementation director at NMCSD. "We also initiated a business case analysis and found that our cumulative return on investment is approximately $5 million. This was based on a formula that determined costs avoided minus resources invested."

One of the innovations of the IHCI was harnessing the technology and data analytical capabilities currently available at military treatment facilities (MTFs) throughout Navy Medicine. A product developed by the IHCI is a patient "scorecard" that pulls patient information from different hospital databases into a single, easy-to-read document. The scorecard provides an overview of chronic conditions, emergency room use, hospital admissions, medical appointments with primary care and specialty providers, and the overall health care costs associated with a specific patient. That information is then used by the patient's primary care team to develop customized and targeted intervention measures to optimize the patient's health.

"One of the technology pieces that the IHCI also developed is a web portal to connect our providers and beneficiaries to a directory of free or low-cost health, wellness, and social services throughout the local community, on and off base," said Lt. Cmdr. Michael Mercado, IHCI implementation director at NHCP and family medicine physician. "We've made the portal simple and easy to use, and it's searchable by condition or geographic location, so whether you're a provider at Naval Hospital Camp Pendleton or you're a patient getting care at a clinic on Marine Corps Air Station Miramar, you can find the resource you need. Right now, the portal gets nearly 600 visits a month."

Based on its success in improving the health of beneficiaries and reducing health care costs in the San Diego region, the U.S. Navy Bureau of Medicine and Surgery (BUMED) plans to scale the IHCI throughout the Navy Enterprise, starting at four other Navy Medicine facilities on the East Coast in 2015.

According to Ramchandani, the IHCI at NMCSD and NHCP will begin implementing primary and secondary prevention measures.

"Now that we've been successful with our tertiary prevention, our next steps include preventing as many patients as possible from needing tertiary intervention," said Ramchandani. "We want to continue focusing on moving from health care to health by encouraging healthy behaviors and mitigating the impact of disease. We'll do this by seamlessly integrating appropriate health and wellness services into the health care system. It's really a win-win. Patients will not only be healthier and have a better quality of life, but the military health system will also benefit from the significant cost savings."

Founded in 2011, the Integrated Health Community (IHC) is a multi-year initiative focused on building a healthy population in San Diego County. The initiative seeks to empower patients to improve their health by integrating technology, innovation, and community health services to maintain positive health and well-being.

For more news from Naval Medical Center San Diego, visit

Hospital Corpsman 3rd Class Andrea Rogel administers a flu vaccine to Rear Adm. Bruce L. Gillingham.
141007-N-VY375-007 SAN DIEGO (Oct. 7, 2014) Hospital Corpsman 3rd Class Andrea Rogel, right, assigned to the preventive medicine department at Naval Medical Center San Diego, administers a flu vaccine to Rear Adm. Bruce L. Gillingham, commander of Naval Medical Center San Diego and Navy Medicine West. It is mandatory for all Department of Defense uniformed personnel, not medically or administratively exempt, to receive the seasonal flu vaccine. (U.S. Navy photo by Mass Communication Specialist 3rd Class Pyoung K. Yi)
October 8, 2014
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