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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 1 of 15
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COL Anthony S. Cooper, CDFM, FACHE, DFMCP3MAJ Deepak J. Mathew, CDFM, DFMCP2
31 March 2016
Financing Army Medicine: Driving the System for Health
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 2 of 15
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Purpose and Outline
Outline:
1. Army Medicine
2. Our Environment
3. Integrated Resource and Incentive System
4. Impact of Budget Methodologies
5. Final Thoughts
Purpose: To describe the journey of the U.S. Army Medical Command’s paradigm shifts in its resourcing model and the impact to our system for health.
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 3 of 15
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Army Medicine
Military Medicine Mission Areas -- Priorities
Combat Casualty Care: Medical personnel, services, and doctrine that save Service members’ and DoD Civilians’ lives and maintain their health in all operational environments.
Readiness and Health of the Force: Medical personnel and services that maintain, restore, and improve the deployability, resiliency, and performance of Service members.
Ready & Deployable Medical Force: Military personnel who are professionally developed and resilient, and with their units, are responsive in providing the highest level of healthcare in all operational environments.
Health of Families and Retirees: Medical personnel and services that optimize the health and resiliency of Families and Retirees.
Health of Families & Retirees
Readiness of the Force
Readiness of the Medical
Force
Casualty Care
• An interdependent and overlapping mission set
• An effective integrated system ofcomprehensive care
• Providing many services not found in privatesector healthcare
• Driven by service, not profit
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 4 of 15
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United States Army Medical Command
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 5 of 15
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PersonnelAMEDD Total OTSG/MEDCOM
Total AC 53,879 27,178Civilian (All Medical) 50,849 42,219Contractors ~7,784 ~5,554Compo 2/3 43,650 1,391Total 156,162 76,342
BeneficiariesActive Duty (AD) 546KFamily Members (AD) 856KDependant Survivor 229KEligible NG/RC 128KFamily Members of NG/RC 202KRetired 775KFamily Members Retired 909KInactive G/R 89KFamily Member IGR 140KOther 29KTotal 3.90M
FY14 SRC08 EAB TOE Units
Active / Reserve
Combat Spt Hosp (CSH) 10 / 16
FWD Surg Tm (FST) 16 / 22
Other Active Units 90 / 0
Other Army NG Units 0 / 52
Other Army AR Units 0 / 134
AC / NG / AR Deployable
Units
116 / 52 / 172
(340 Total)
ResourcingFY15 Funded: $11.7B(all appropriations)*MEDCOM Appr Funds Only (No LN/NAF), OTSG CS-W00LAA, and All Army CP53
Army TDA FacilitiesMedical Centers 8Community Hospitals 15Health Centers 10Primary Care Clinics 110Occupational Health Clinics 29Dental Clinics 137Veterinary Facilities 77Research & Development Laboratories 24Laboratory Support Activities 5Over 1000 individual administrative and healthcare buildings totaling over 24 million square feet
AMEDD at a Glance
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 6 of 15
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Average Day in Direct Care - MEDCOM
Babies
42 BirthsFY15 (Oct14-May15)
Laboratory33,792 Lab Services
FY15 (Oct14-May15)
Radiology7,339 Rad Services
FY15 (Oct14-May15)
Outpatient Care 30,851 Clinic Visits
FY15 (Oct14-May15)
Vaccines5,140 Immunizations
FY15 (Oct14-May15)
RX
30,749 Prescriptions FY15 (Oct14-May15)
Inpatient Care706 Beds Occupied
234 Patients DischargedFY15 (Oct14-May15)
Personnel Deploying100s of Soldiers and CiviliansIncludes all global engagements: Kuwait, Afghanistan, Africa, Germany, Pacific, others.
Dental 13,816 Services
FY15 (Oct14-May15)
Veterinary Services (FY14)1,583 Veterinary Outpatient Visits$38.7 Million of Food Inspected
328 Food Safety Visits
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 7 of 15
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What is our Environment
TSG Guidance
AM2020CPAssessment
National StrategicGuidance
MEDCOM TNG
SecArmyPriorities
Key LeaderEngagement
Congressional Calendar
CSAPriorities
- Smaller Army, Personnel Reductions, Fiscal Uncertainty- MHS, though losing flexibility, is still well resourced – Labor a
constraint- Military Compensation & Retirement Modernization
Commission (2015)- Stakeholders want change; Willing to be innovative & even
radical
IRISSpecial
ProgramsHiring Cap
TDA/PSM
UBO
DMHRSiMEPRs
SOOService Lines
Performance Plan
Core
• IRIS• Special Programs• Hiring CAP• TDA/PSM• DMHRSi• Service Lines• UBO• MEPRS• SOO• Where is my Core!
What! Why!
POM DHA President’s Budget eMSMs
Per Capita Cost
Congressional Action
Operating Company
Model
Small Hospital Study
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 8 of 15
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MTF Business Plan
Strategy:Objectives, Initiatives,
Measures
Performance
ReadinessAccessQualityPatient SafetySatisfactionEnrollmentEfficiencyData Quality….Productivity
MTF Execution
MTF Budget
Performance
Management FrameworkPerformance Planning Lifecycle
FARMs
CampsRADaR
Campaign Assessment
Campaign Synchronization
IRIS
RADaR
Service Lines
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 9 of 15
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Historical Resourcing Method
• Medical Care Composite Unit
(MCCU) (up to 1990)
• Gateway to Care (1991-1993)
• The Years Adrift (1994-2001)
• The Early War Years (2002-
2004)
• DoD Perspective Payment
System (PPS) (2004-2012)
– Performance Based Budgets
(PBB) (2004-2006)
– Performance Based Adjustment
Model (PBAM) (2006-2013)
• Integrated Resourcing and
Incentive System (IRIS) (Oct
2013-present)
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 10 of 15
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Integrated Resourcing and Incentive System
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 11 of 15
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Execution Tracking Dashboards
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 12 of 15
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Why we use IRIS
Enhance Experience of Care• APLSS considerably increased thought the enterprise.
• TRISS improved within enterprise.
Increase Readiness Cost Capture • Capture and show scattered Readiness data within work centers
• Established Framework to have dimensional look of efforts towards Readiness
Improve Population Health• Improved IPSRs by 267 additional per month.
• Average HEDIS compliance improved by 7 throughout MEDCOM
Reduce Per Capita Cost• Standardized unit price set stage for defining unit of allocation.
• Accounting accuracies are improved considerably.• Controlled PMPM drastic negative shift of PMPM
+ 24%
+ 1%
+ 7
+ 6%
MILPAY
PMPM
APLSS + 7%
TRISS
+ 18%Continuity
HEDIS + 267
IPSRs
Data based on2010 to 2015
PBAM/IRIS trends
PMPM is comparing FY14Q2 to FY15Q2 with No Retail RX
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 13 of 15
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Impact of Performance-based Budgeting
TROSS: Satisfaction with Healthcare
HEDIS Performance over time
HEDIS Performance Over Time
PMPM by Service
23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 14 of 15
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Final Points
• Massive organizational paradigm and culture shifts toperformance based budgeting.
• Paying for performance works.
• Education/Knowledge of our staff.
• Cultivâtes an entrepreneurial culture that enhance a positivepatient expérience.
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23-Mar-16Name/Office Symbol/(703) XXX-XXX (DSN XXX) / email addressCOL Anthony S. Cooper/ e-mail :[email protected] / 210-295-3812 31 March 2016Slide 15 of 15
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Guidance