january 2008 critical decision making for medical executives: keys to improving healthcare delivery...

January 2008Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery

MHS Strategy Update : Quality is Job 1!

Presenter: Dr. Mike Dinneen, MD, PhDDirector, Office of Strategy Management

OASD(HA)[email protected]

2Critical Decision Making for Medical Executives: Keys to Improving Healthcare Delivery

Goals for our four hours together• Obtain your agreement that:

– There is a compelling need to change– The MHS is performance based organization but, it could

function much better– We need a practical, actionable, MHS Strategic Plan

understood and embraced by everyone

• Help you see the similarity between clinical diagnosis and treatment planning and MTF business planning so you can feel more comfortable in building your annual plans

• Have you recognize how you support the outcomes desired by the MHS through specific and measurable actions at your MTF and have you commit to spreading that knowledge within your work area


Managing in a Time of Crisis - Change Driven by External Forces

President’s Commission

PTSD

TBIDOD-VA

SharingGAO

Army Medical Action Plan (AMAP)

Unexpected Challenge—Coordinated Support for Wounded, Injured and Ill

• Re-examine the way we do business

• We are inundated with input from organizations that want to help

Independent Review Group


Dole Shalala Commission Recommendations

• Immediately Create Comprehensive Recovery Plans to Provide the Right Care and Support at the Right Time in the Right Place

• Completely Restructure the Disability and Compensation Systems

• Aggressively Prevent and Treat Post-traumatic Stress Disorder and Traumatic Brain Injury

• Significantly Strengthen Support for Families • Rapidly Transfer Patient Information Between

DoD and VA • Strongly Support Walter Reed By Recruiting

and Retaining First-Rate Professionals Through 2011


Bottom Line

We must master diagnosis and effective, compassionate care for TBI and PTSD


The Case for Change: The Rate of Increase in DoD Health Care Expenditures is Unsustainable – We need to

find a way to manage health care expenditures more effectively.

Military Personnel

Direct Care and Other

Purchased Care and Contracts

Pharmaceuticals

TFL PaymentsTRICARE For Life

0

10

20

30

40

50

60

70

80

1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013 2016 2019 2022

Actual Projection

Source: Congressional Budget Office (2004); OSD (2005)

(Billions of 2005 dollars) DoD 2005 Projection

• Health budget rising rapidly: $18B-2001, $36B-2005, $50B by 2010-2011 (est.)

• Due to new benefits (TRICARE For Life for over 65 population), very rich benefit with insufficient cost shares or indexes, Congressional expansions (TRICARE For Reserves), retirees under 65 opting for TRICARE vs. employer plans

• Aggressive effort to manage costs—New TRICARE private sector contracts ($45B over 5 years), pharmacy formulary, pharmacy federal prices, closure/merger of military hospitals, improved business practices.

• Required—Benefit structure adjustments, to include indexed premiums/co-pays for long term control of cost growth; Health Savings Accounts must also be pursued.


The Case For Change – Because we are not functioning as a health care system with

effective processes, we are failing to achieve quality outcomes

• Care costs are unevenly distributed– The top 1% of population spends 35% of health dollars– 50% of population spends only 3% of health dollars– Chronic disease states drive 70% of all health spending

• Care linkage deficiencies abound– Paper records don’t facilitate communication or identification of best

practices– Care silos abound

• Economic incentives significantly influence health care– RVU reimbursement scale drives unhealthy behavior– We do not reimburse for coordination of care or outcomes

• Systems thinking is almost never on the health care radar screen– Thinking is focused almost entirely on single care units– Comparative and concurrent data are not part of the American health

care culture• We have to be agile but our bureaucracy holds us back


Our Quality Focus: Managing and Preventing Chronic Diseases

• MHS Imperatives– PTSD– TBI

US Healthcare Imperatives– Congestive Heart Failure– Asthma– Diabetes– Coronary Artery Disease– Depression

• Then why are we spending so much effort on obesity, activity, alcohol use and tobacco use?


What do we need to do?• Support the Warfighters during the long war

and support the Military Strategy– Fit, healthy and protected force– Casualty care and humanitarian assistance

AND

• Create Healthy Individuals, Families, and Communities– Manage chronic diseases in a systematic manner– Prevent them from occurring in the first place


SWOT Analysis - MHS• Strengths

– Best team of medical professionals in the world

– Mission orientation and strong core values

– Battlefield care – Clinical data– Health education

• Weaknesses– Care discontinuity,

inefficient support processes

– Clinical and business information

– Customer relationship management

– Aging hospitals and clinics– Ambiguous governance

• Opportunities– National focus on

electronic health information

– Congressional support for wounded warrior care

– BRAC law as lever for change

– Pay for performance– New mission –

humanitarian assistance and stability operations

• Threats– Loss of confidence by

American people, Congress– Scrutiny by OSD, OMB,

Congress regarding financial performance

– Increasing competition for healthcare professionals


Key Tactical Imperatives• Quality Medical Care – achieving and documenting excellence• Wounded Warrior Care…more than just medical care on the

battlefield or at the bedside, but the comprehensive levels of coordination, communication and caring.

• Conducting Diplomacy Through Health…and how our military health system is an indispensable global asset that serves our national security interests and saves lives.

• Making AHLTA work for us, not the other way around.• Medical Recruitment and Retention…superb medical outcomes

result from years of preparation, training and execution; we need to sustain this medical quality through continued focus on quality people.

• Advancing Medical Research…for the people we serve, and for people around the globe.

• Communicating…freely, transparently with the people in the system, the people served by the system and the public.

• Improving our aging hospitals and clinics and building the healing environment of the future.

• Working together with more jointness and interoperability.


Components of the MHS Strategy• Mission - Approved

– Global Statement– Core business

• Vision – – Destination– Big Hairy Audacious Goal

• Values – Draft– The attitude, behavior and character of our organization

• Strategy– Our game plan– The high level goals and objectives that we will leverage to

make lasting positive change

• Measures of mission success – How we will know that we have succeeded

Military Health System Mission Statement -

Our team provides optimal health services in support of our nation’s military mission - anytime, anywhere.

Our team provides optimal health services in support of our nation’s military mission - anytime, anywhere.

Healthy Individuals, Families

AndCommunities

Education and

Training

Research and

Innovation

Our People, Our Values, Our Culture

Casualty Care&

HumanitarianAssistance

Fit, HealthyAnd

ProtectedForce

Information and

Technology

Customers: Wounded Warriors, the American public, the world stage and Congress

When: During and after operations

Where: Everywhere

Customers: Combatant Commanders

When: During entire career: before, during and after deployments

Where: Everywhere

Customers: All beneficiaries

When: Through our entire lifetime; from cradle to grave

Where: Everywhere


MHS Vision StatementOur nations healthcare and workplace of choice

….A team of health professionals ready to meet any

challenge…Conducting education, training, and research to

ensure…Premiere care for America’s heroes and their

families.


MHS Core Values and CultureSelfless & Courageous Service - We are honored to

serve those who serve, the warfighters and beneficiaries who trust us to always meet their needs, anytime, anywhere. Our high calling demands the courage to take risks, do what is right and go into harm’s way in unison with the warfighters.

Caring, Healing & Creating Health - We are healers who have a life-long obligation to the health and well-being of all those entrusted to our care. We are compassionate and committed to doing the right thing for our patients to eliminate disease and achieve health.

Developing Leaders - We lead with passion, respect, and loyalty because this is the best way to achieve our goals and meet our high expectations. We work jointly in close collaboration with line leadership to meet our operational and health support mission.


Creating Value for our Stakeholders: The American People, MHS staff, and those who rely on us for care

• A fit, healthy and protected force

• The full spectrum of casualty care to include evacuation, recovery, rehabilitation and coordinated care transition to VA and other services

• Humanitarian & civil assistance

• Healthy and resilient individuals, families and communities

• Restoration of health and effective care coordination across all elements of the Military Health System

• Premier health education and training

• Innovative health research


Fit, HealthyAndProtectedForce

Resource Perspective

Healthy Individuals, FamiliesAndCommunities

Casualty Care&HumanitarianAssistance

MHS Mission: Our team provides optimal health services in support of our nation’s military mission - anytime, anywhere.

Primary Execution Structure

Research and Development

Education and Training

(METC, GME, USUHS)

Shared Services(IM/IT, Contracting, Logistics, HRMgmt, Facilities, Fin Mgmt, etc)

Support Structures

Health Plan Management

(TMA/HPA, TROs, MCSCs)

Community HospitalsAnd Ambulatory Clinics

Major Multi-Service Market MTFs (NCA, SA, SD, Tidewater, Madigan, Tripler)

Operational Medicine

Tricare Network of Providers


MHS Tactical Objectives

1. Enhance warrior care – TBI/PTSD– Case Management– Disability Processing

2. Improve patient centered evidence based medicine

– Health Promotion - TOBESAHOL

– Disease Management– Focus on quality

1. Enhance warrior care – TBI/PTSD– Case Management– Disability Processing

2. Improve patient centered evidence based medicine

– Health Promotion - TOBESAHOL

– Disease Management– Focus on quality

3. Improve AHLTA usability– Speed, reliability– Implement clinical prompts to

support providers

4. Quality Incentives– Implement Continuous

Performance Improvement• Team STEPPS, LSS

– Business plan critical initiatives (Quality, safety, access, patient flow, IMR)

– P4P – Expand PBAM Concept5. Develop our people

– Military Education and Training Center curriculum integration

– Continuous Process Improvement Training

– Improve Recruiting and Retention

6. NCR and San Antonio Market Implementation

– Create healing environment– Improve governance

3. Improve AHLTA usability– Speed, reliability– Implement clinical prompts to

support providers

4. Quality Incentives– Implement Continuous

Performance Improvement• Team STEPPS, LSS

– Business plan critical initiatives (Quality, safety, access, patient flow, IMR)

– P4P – Expand PBAM Concept5. Develop our people

– Military Education and Training Center curriculum integration

– Continuous Process Improvement Training

– Improve Recruiting and Retention

6. NCR and San Antonio Market Implementation

– Create healing environment– Improve governance

Improving What WeDo Each Day

Building New Capabilities to Adapt to a Changing World


Performance Based Organization• A high performance organization is:

– Employer of choice – (staff)– Provider of choice – (customers)– Best value for investors (stakeholders)

• What is required to create a high performance organization:– A strategic plan that describes how value is created for each of the

three groups above– Business plans for each business unit that link with the strategic plan– Well understood objective measures of success and targets for

accountability– A workforce provided with incentives and tools to innovate (including

continuous process improvement)


• Now – we need to get the word out!• Communications must improve!

january 2008 critical decision making for medical executives: keys to improving healthcare delivery...

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