Officials: Military medicine must support readiness

8 Apr 2014 | Terri Moon Cronk

April 7, 2014 - U.S. national security and defense strategies must be supported by a strong, forward-leaning Military Health System, the Defense Department's top physician told Congress last week.

At an April 2 hearing of the House Appropriations Committee's defense subcommittee, Dr. Jonathan Woodson, assistant secretary of defense for health affairs, said DOD's request for fiscal year 2015 health program funding supports the department's health care goals and the Military Health System's "quadruple aim" of increased readiness, better health and better care at lower cost.

"We are committed to sustaining the medical readiness of our forces, the clinical skills of our medical forces and the world-class treatment and rehabilitation for those who fight battles today, yesterday and tomorrow," Woodson said.

The Military Health System performed well in 13 years of war, achieving historic outcomes in reducing the rate of disease and nonbattle injury in combat, and increasing the rate of war-wound survival, he noted. And while he's proud of those outcomes, he added, he and the service surgeons general have developed six lines of effort for the Military Health System to support Defense Secretary Chuck Hagel's priorities and meet the health care mission amid changing threats and limited resources.

Those lines of effort, Woodson said, would:

-- Modernize the Military Health System's management with an enterprise focus;

-- Define and resource the medical capabilities and manpower needed in the 21st century;

-- Invest in and expand strategic partnerships;

-- Assess the balance of the medical force structure;

-- Modernize the TRICARE health program; and

-- Define the Military Health System's global health engagement requirements.

Focusing on two efforts that directly relate to the fiscal 2015 health program budget request, Woodson addressed the newly stood-up Defense Health Agency and modernization of the TRICARE program.

"The Defense Health Agency, a combat support agency, is an important first step in modernizing our common business and clinical practices with accountability for performances both to the assistant secretary of defense for health affairs and the chairman of the Joint Chiefs of Staff," he said. "We have made substantial progress in achieving savings earlier than projected as we consolidated functions and we reduced redundancy."

By modernizing and simplifying TRICARE, incentives would exist to increase beneficiaries' wellness, decrease overuse and allow them to choose providers, he said. While the TRICARE proposal includes "modest increases" in beneficiaries' out-of-pocket costs, he said, the high quality of care would not be affected.

"The TRICARE benefit will remain one of the most comprehensive benefits in this country, and it will modernize the program for the first time in many years," Woodson said. "I believe this proposed budget meets the test."

The service surgeons general also testified at the hearing.

"The health and the readiness of our Army are inseparable, because health is a critical enablement to readiness," Lt. Gen. Patricia D. Horoho, Army surgeon general, told the House panel. "Today, we're beginning to see results in readiness, in health and cost savings. Through our service lines and standardization of processes across the medical command, we have synchronized our policy, program and resources, and we're starting to see some very strong results."

But this is a time of "hard conversations and very tough choices," she noted.

"For the first time, we are decreasing the size of our Army before the longest war in our nation's history has ended," Horoho said. "We are poised to transition to the interwar years, and we must work aggressively to sustain our combat-care skills, nurture an environment of dignity and respect, and maintain trust with the American people."

Adding that today is a time of challenge and opportunity, she said the nature of war always will create medical threats.

"Our job is to be ready whenever and wherever," the Army surgeon general said. "Anything less will cost lives, and this is not going to happen on my watch. We live in uncertain times. One thing is certain: a healthy, resilient and ready Army will be -- as it always has been -- the strength of our nation."

Similarly, Navy Vice Adm. (Dr.) Matthew L. Nathan, Navy surgeon general, said Navy medicine "is mission-ready in delivering world-class care anywhere, any time." By supporting the operational missions of the Navy and Marine Corps, Navy medicine must be an agile, expeditionary medical force that is "capable of meeting the demands of crisis response in global maritime security, he told committee members," Nathan said.

"These are transformational times in military medicine," he noted. "There is much work ahead as we navigate the important challenges ... to keep our sailors and Marines healthy, maximize the value for all our patients, and leverage our joint opportunities. I am encouraged with the progress we have made. I am not yet satisfied."

The Navy continues to look for ways to improve and remain on the forefront of delivering world-class health care anywhere and at any time, Nathan said.

Lt. Gen. (Dr.) Thomas W. Travis, Air Force surgeon general, told the panel that an eye on the future is essential. "With this war winding down, even with our fiscal challenges, we now have a clear responsibility to make sure our military medics are well-trained and well-prepared for whatever contingency the future brings, to include combat operations, stability operations, humanitarian assistance or disaster relief," he said.

To enhance Air Force core competency in air evacuation missions, medical providers must continue to have "robust opportunities to practice their skills," he added, "and [we must] continue to pursue critical research and modernization initiatives for the future."

As the way the nation fights wars evolves, the way medical support for operators is provided must also evolve, Travis said.

"Airmen who are manning systems such as distributed common ground stations, space and cyber operations or remotely piloted aircraft, and those who operate outside the wire, such as security forces, special ops and explosive ordnance disposal specialists, all face distinct challenges," he said. "The types of injuries or stressors, both visible and invisible, to members and their families are also changing."

Medical support must be provided in different ways than in the past to address "an expanding definition of operator," and military medicine must step up to its role as human performance practitioners, he added. "Not only will access in care be more customized for the mission, but so will prevention," he said.

Travis said he's never seen a time when it's been more evident how important military medicine is to the nation's operational capability.

"We've learned much, and our medics have performed magnificently," he told the panel. "Even in the face of budget challenges, we have to be as ready at the beginning of the next war as we are now with the end of the current war. I think our nation expects that."

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