Post on 02-Jan-2016
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transcript
Addressing the Shortage of Contract Specialists:
Too Little, Too Late for Success?
Andrew C. Obermeyer, Fellow, CPCMPresented at the Cape Canaveral Chapter
Winter Education ConferenceMarch 3, 2011
http://www.tricare.mil/tma/ams/default.aspx
• What is TRICARE– A health care plan using military health care as the
main delivery system – Augmented by a civilian network of providers and
facilities – Serving our uniformed services, activated National
Guard and Reserve, retired military, and their families worldwide
TMA Overview
http://www.tricare.mil/tma/ams/default.aspx
TMA Overview, Cont.
Mission:
• To provide optimal health services in support of our nation’s military mission — anytime, anywhere
Vision:
• The provider of premier care for our warriors and their families
• An integrated team ready to go in harm’s way to meet our nation’s challenges at home or abroad
• A leader in health education, training, research, and technology
• A bridge to peace through humanitarian support
• A nationally recognized leader in prevention and health promotion
http://www.tricare.mil/tma/ams/default.aspx
TMA Overview, Cont.
• 9.6 million beneficiaries – 3.7 million TRICARE Prime enrollees
Direct care system
– 1.6 million TRICARE Prime enrollees Contractor networks
– Remainder • TRICARE Standard/Extra• TRICARE for Life• TRICARE Reserve Select
• Military Treatment Facilities (MTFs)– 59 Hospitals & Medical Centers– 364 Health Clinics
• Over 380,000 network providers
• Over 60,000 retail pharmacies
http://www.tricare.mil/tma/ams/default.aspx
TMA Overview, Cont.
• 2.5 million prescriptions– 923,000 direct care– 1.39 million retail pharmacies– 202,000 home delivery
• 179,300 behavioral health outpatient services
– 46,100 direct care– 133,200 purchased care
• 21,800 inpatient admissions– 5,000 direct care– 16,800 purchased care
• 1.6 million outpatient visits – 737,000 direct care – 876,400 purchased care
• 2,300 births – 1,000 direct care– 1,300 purchased care
• 3.5 million claims processed
• 12.6 million electronic health record messages Behavioral Health
Outpatient VisitsPer Year
“A week in the life of TRICARE”
http://www.tricare.mil/tma/ams/default.aspx
The Goal - Quadruple Aim
• Readiness• Pre- and Post-deployment• Family Health • Behavioral Health • Professional Competency/Currency
• Quality OutcomesHealthy service members, families, and retirees
• A Positive Patient ExperiencePatient and Family centered Care, Access, Satisfaction
• CostResponsibly Managed
Readiness
http://www.tricare.mil/tma/ams/default.aspx
Understanding Cost Drivers
Defense Health Program
Private Sector Care In-House Care
Health Care Support
In-House Care Private Sector Care Health Care Support
Data Source: Defense Health Program FY10 Appropriation. Excludes all costs associated with the Medicare Eligible Retiree Health Care Fund
– e.g., $3.8B TRICARE Senior Pharmacy
$14.6B 54%
$5.8B 21%
$6.9B 25%
FY10 Defense Health Program Budget (Operations and Maintenance)
• Private Sector Care contracts breakdown:– Domestic Health Care/Claims $10.8B– Overseas
$0.3B– Pharmacy
$2.0B– Dental
$0.1B– Other (including Quality and $1.4B
Fraud, waste & abuse)
• Cost Drivers– New users– Utilization– Expanded benefit– Medical inflation– Special populations– Pharmacy
AM&S Organization
Contract Operations Division -Aurora
Acting Chief Functional OfficerMr. Michael Fischetti
Contract Operations Division – Falls Church
Acquisition ManagementOffice A Branch
Acquisition ManagementOffice B Branch
Office of Small Business Programs
Chief of Staff
Acquisition Career Management
Acquisition Information Systems Manager
Property Manager
Acquisition Policy and Compliance Division/Competition Advocate
Contract Policy and Pricing Branch
Information SystemsBranch
HQ SupportBranch
Acquisition Oversight and Management/Deputy CAE
Staff in Aurora, CO
Acquisition EfficienciesManager
Workload Statistics• Health Care Services Contracts
– 1535 contractual actions (FY10)– $10.9 billion (FY10)– Major contractors
• Healthnet, Inc.• Humana, Inc.• AEA International Holding• Triwest Healthcare Alliance• Express Scripts, Inc.• Wisconsin Physician Services• Meridian Resource• Delta Dental
Workload Statistics• IT and Non-Health Care Services Contracts
– 1,655 contractual actions (FY10)– $2.3 billion (FY10)– Major contractors
• SAIC• Deloitte, LLP• Planned Systems International• Axiom Resource Management• Irving Burton Associates• Veritas Capital• Northrop Grumman
A decade to remember…
• 9/11
• Wars in Afghanistan and Iraq
• Department of Homeland Security
• Hurricane Katrina
• Financial Meltdown of 2008
• American Recovery and Reinvestment Act
• Southern Border crisis
September 11, 2001
• 26,608 Federal Contract Specialist – DoD 18,565– Civilian Agencies 8,043
• 1991 – 31,436 Federal Contract Specialist– 22, 722 at DoD– 8,664 at Civilian Agencies
• Appropriate or not? It’s what we had
DoD Staffing and Workload
• 2001 DoD Workload– 115,679 actions > $100,000– Total obligations of $144.6B– Minimal post 9/11 impact in last 20 days of FY
• 2009 DoD Workload– 211,345 actions > $100,000– Total obligations of $359.9B
• Specialist increase – 1221 to 19,786
Civilian Agencies Staffing and Workload
• EOY 2008 staffing at 9,921– An increase of 1,878 or 23%
• 56% Increase in spending– From $80B to $138B– FY2000 to FY2008
• Program Impacts– Homeland Security– TSA (originally a poorly managed contract issue??)– Hurricane Katrina
Are There Problems?
“As we approach the end of the first decade after the turn of the century, concerns about defense acquisition outcomes – cost escalation, reports of improper payments to contractors, appeals filed over source-selection outcomes, schedule delays – pervade the popular press as well as DoD audits and internal reports.”
-- “Shining a Spotlight on the Defense Acquisition Workforce – Again,” 2009 RAND National Defense Research Institute Occasional Paper
Insufficient Staffing?
“This lack of capacity requires the workforce to make trade-offs during the acquisition life cycle that may reduce the chance of successful outcomes”
-- Lesley Field, Deputy Administrator, OFPP
Three factors
• As growth in workload outstrips growth in staffing, quality should be expected to fall
• As stress levels increase, retirement eligible workers are more inclined to retire
• Training newly hired workers places additional strains on the existing workforce
-- Don’t believe me? -- 2,600 new hires in FY2006 resulted in net gain of 350
Money Talks
• GS5/7 starting salaries – $31,315 to $38,790
• Median salary for new 2010 Bachelor of Business Administration graduates – $45,000
-- Do we really want the bottom half of the graduating class?
How much is enough?
• 2001 in DoD– 18,565 CSs, 115,679 actions greater than
$100k– 334 available staff hours per action
• 2008 in DoD– 19,786 CSs, 211.345 actions greater than
$100k– 195 available staff hours per action
--Anyone really believe we’ve achieved a sustained seven percent annual productivity improvement?
The Retirement Drain
• 2008 – 1,283 GS7 Contract Specialist• If the total number were promoted and replaced
each year for the next eight years, it would only generate 10,264 new CSs
• That number is 5,000 short of the number of CSs eligibles for retirement in 2018
-- “Adding, say, 10,000 each with one year’s experience is different than adding 500 people with 20 years’ experience” Norm Augustine
Solutions
• Gansler Commission• Five percent increase at civilian agencies• Secretary Gates April 6, 2009 announced plans
to add 9,000 acquisition billets, and insource 11,000
• All are “acquisition workforce” and all are pre-election, pre-”Tea Party” commitments
-- “Do more without more” Ashton Carter, April, 2011
What can you do?
• Press leadership on commitments to hiring and developing interns
• Talk up the career field
• Talk to high schools and colleges
• Engage in your own productivity growth– Participate in NCMA
“We do the nation’s business, everyday!”