Defense Health Agency: Good First Year, Challenges Ahead

by U.S. Medicine

January 5, 2015

By, USAF, director, Defense Health Agency

We just completed a remarkable first year in the Defense Health Agency. 

Lt. Gen. Douglas Robb

Lt. Gen. Douglas Robb

In December, you will all be receiving our first Annual Report on what we have accomplished, and where we are headed in 2015. But let me give you a preview of what I consider the principal takeaways from our first year.

Unity of Effort is critical. Our successes in year one  are directly attributable to your ability to bring people together on behalf of our broader purpose in military medicine. We put a new system of decision-making for the Military Health System (MHS) in place. And it ensured engagement at every level – the Office of the Secretary of Defense, the service secretaries, the Joint Chiefs, the service Surgeons General and all of their staffs. To some, the MHSER, the SMMAC, the MDAG, the MOG, BOG, and MPOG are an alphabet soup of bureaucracy. But not to me, and hopefully not to you. These committees are the machinery that allows us to tee up, vet and make sound decisions on the future of this vital system of care. Together.    

The business of building consensus is not easy – but the payoffs are enormous. And, so for the many initiatives that we introduced this year, we succeeded when the hard work of building trust, ensuring transparency and skillful execution were sustained.

And the inverse is also true, when unity of effort was lacking, when the processes became slow or bogged down – sometimes on substantive policy issues, sometimes on minutiae, and sometimes on simple misunderstanding – we fell short of our goals. But, if we had nothing but successes this year, I think it would be a sign that we were not challenging ourselves enough. Perseverance matters. We will pick it up in 2015.  

Success is not only measured in dollars saved.  I am as pleased as anyone that we saved $250 million in 2014, which was $250 million more than we projected! This was supposed to be a building year, creating the infrastructure and hiring staff. But through aggressive action by leaders at all levels, we also provided the department and the taxpayer with a return on investment. Yet, equally important to saving dollars is the long-term work of creating common clinical and business processes.

Let me give you one example of an area where no money has yet been saved, but tremendous progress has been made: creating a common cost accounting structure for the MHS. This has been “behind the scenes” work by an often unheralded team of budget and financial management experts. They are positioning the MHS for the long-game.

In the coming years, we will look back at the work of 2014 – across all of our domains – and we will recognize this was the beginning of a process that genuinely allows us to compare performance in a meaningful way across the system of care. Not just counting dollars and cents, but utilization, outcomes, quality, safety and access to care. Not every success has a price tag on it, but they are all valued. 

2014 was a down payment on a bigger promise.  It has been a transformational year. At the same time that we stood up the DHA, which required a tremendous amount of energy and intellect in its own right, we have also played an indispensable role in the Secretary of Defense’s “Review of the Military Health System” and in implementing the action plan that followed it. We have an important role to play – in creating, maintaining and communicating a Performance Management System as well as a broad mandate for ensuring greater transparency to the public.

Now, add in the deployment of thousands of service members to West Africa in support of the larger federal response to the Ebola outbreak, along with the deployment of service members to Iraq to confront the threats from ISIS, and you have a sense of why having a “Medically Ready Force…Ready Medical Force” is more than a mere slogan; it is a perpetual promise in our combat support agency role.

In such a world, our customers – the services and the combatant commanders – need a system that ensures their medical logistics needs are met. They need medical facilities that are designed, built and sustained for 21st century medicine.  They need a pharmacy system that can deliver vaccines, therapeutics and other medicines that prevent disease when possible, and treat disease when needed, which is often immediately. They need a health system in which private sector providers complement our direct care system and reach every corner of the globe where our service members and families live and work. They expect the care that we provide in Afghanistan, Iraq, Liberia, South Korea or the South Pacific to be captured, shared and available worldwide to our medical teams through a functioning Electronic Health Record. They need a global public health system that monitors the environment and disease threats anywhere in the word. They demand a medical research and development system that never stops the search for better ways of addressing the myriad  threats and disease and injuries we face in this unique line of business. They need us to educate and train thousands of new recruits and experienced professionals. They need a procurement system that can respond in a timely manner with high quality products and services. And they need us to properly budget, oversee and account for all of these things. And they need leading, joint institutions for health care delivery – and they are right here in the National Capital Region.

And they need the DHA. 

And we have a deep moral and personal obligation to ensure that their needs are met.

I know that many of you were double- and triple-tasked to manage the avalanche of requests for policy reviews, data calls, and briefings. But it all had a purpose. In Dr. Woodson’s words, we are building a better, stronger, more relevant MHS. I can see the concepts that were just words a year ago beginning to take root. This has been an extraordinary year of progress. And, yet, our work has just begun. So, let’s keep our sleeves rolled-up and let’s keep our unity of effort focus … we’re burning daylight as we speak!


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