Late Breaking News
DoD and VA Help to Build Reserve Component Medical Readiness
- Categorized in: November 2009
Traditionally during a foreign conflict, the National Guard and Army Reserve operate domestically, while active duty service members are almost solely responsible for deploying to theatre. However, at the onset of the 1990-1991 Gulf War, this practice changed. The Reserve component was called up to comprise roughly 17% of the total deployed force. Although this shift in the makeup of deployed forces eased the strain on active duty service members, it also highlighted an issue within the DoD’s medical strategy. Until that point, no medical policy existed to prepare the Reserve component for the austere conditions of theatre.
In 1997, a DoD research effort known as the “746 Study” was published. It cited diminishing trends in institutional capacity and Reserve readiness training, and an increasing frequency of Reserve deployments and commitments. Those trends verified the need for a medical and dental support strategy that would specifically support the Reserve component. As a result, the Office of the Chief, Army Reserve, developed the Federal Strategic Health Alliance (FEDS_HEAL) concept in concert with the Department of Health and Human Services, Federal Occupational Health (FOH) agency. Shortly thereafter, a pilot program began with the 81st Regional Readiness Command, and in September 2001, a contract was issued by FOH to Logistics Health Incorporated, officially beginning the FEDS_HEAL program.
The outset of Operation Enduring Freedom in 2001 coincided with that of the FEDS_HEAL program. At that time, more than 25% of the DoD’s Reserve components that were called to active duty were not medically ready to deploy. FEDS_HEAL would soon prove effective in reducing those numbers as the three service branches of the military began outsourcing Reserve component medical and dental examinations to an alliance of VA, FOH, and private sector network providers and clinics. These medical and dental services were contracted and paid for in order to ensure the readiness of Reserve forces and provide them with the opportunity to be examined and treated locally.
In subsequent years, DoD has become more reliant on the FEDS_HEAL network, and new health services such as dental restorative treatment, vision care, airborne and specialty exams, immunizations, diagnostic audio exams, and Post Deployment Health Reassessments (PDHRA). By July of 2005, the FEDS_HEAL program provided 48 distinct categories of medical services, and continued to provide hundreds of thousands of treatments and examinations to Reserve component members in a multi-organizational approach to health care. Due to the rising number of deploying Reserve forces—as of February 2009, roughly 691,000 Reserve service members were called up to Iraq or Afghanistan – these services proved crucial in maintaining a healthy and protected force.
By 2006, FEDS_HEAL was receiving $70 million annually, and was capable of supporting all of DoD’s Individual Medical Readiness needs. However, HHS and DoD both agreed that the contract should transfer to DoD management. Thus, DoD brought the program under its own control and instituted a $41 million bridge contract to ensure uninterrupted medical and dental support for Reserve components, while a new, competitively bid contract was being developed. Finally, in September of 2007, the Reserve medical and dental support network left the umbrella of the FOH and came under full DoD control, with a new contract and a new name: the Reserve Health Readiness Program (RHRP).
At the onset of DoD’s management of the program, research showed that in addition to Reservists who were not medically ready to deploy, 32% of the Reserve component had an unknown medical readiness status. In order to meet the growing medical, dental, and behavioral needs of the Reserve population, RHRP has annually provided hundreds of thousands of Reserve troops with the medical examinations and treatments they need in a joint effort with the VA, DoD, and a nationwide network of more than 36,000 private providers. Most medical and dental services are provided either in-clinic, at the offices of the civilian provider, or at a military unit’s location. The PDHRA is the only service that can be completely conducted via call centers. It is also the only service that actively involves the VA, which provides referrals and disability benefits advice, as well as informs, enrolls, and assists service members in making their appointments after they return home from a deployment.
DoD’s Reserve component, which numbered roughly 1.1 million at the end of 2008, is an integral part of America’s fighting force. The biggest problem facing this population is the number of service members who have an unknown medical status. Since RHRP began, that number has dropped from 32% in 2006 to roughly 25%. After 2 years, RHRP continues to be successful in providing a comprehensive set of services that will help to improve the medical status of the Reserve forces.
The collaborative efforts of the VA, DoD, and private providers have contributed to the development of a program that increases the baseline health for these service members, creating a more healthy force. During the 2008 fiscal year, RHRP provided more than 765,000 services to roughly 350,000 service members, but there is still more to be done. With DoD, VA, and the private sector working side by side, we hope to establish an optimal baseline of health for our armed forces and maintain a military that is always fit to fight!
This article was contributed by Michael E. Kilpatrick, M.D., Director of Strategic Communications for the Military Health System in the Office of the Assistant Secretary of Defense for Health Affairs.