CMSA Today - Issue 1, 2014 - (Page 24)

Military Health System (MHS) Health Care Reform in the Military Are we part of the conversation? By MELANIE A. PRINCE, Col., USAF, NC, RN, MSN, CNE, CCM W ith all of the back and forth in the 24-hour news cycle about the Affordable Care Act (ACA) the political battles (no pun intended), the debates and opinions, comedic fodder, and radio chatter - I decided to jump into the fray knowing that my military status allowed me to "watch from the sidelines." Or does it? After all, military health care is just as concerned about quality care and cost reduction as the public. We want satisfied patients who are delighted to seek care in military treatment facilities (MTFs). Perhaps military health care is not on the sidelines after all. When the fog and friction surrounding the ACA is dispersed, several questions about military health care are worth pondering: As military health care leaders, do we have processes and programs in place to achieve the goals of health care reform? How would a provider who is a novice in health care reform law assure patients that their military care meets the intent of health care reform? How do we compare against reform tenets? Where are the impact areas for case managers? The health care reform law, or ACA, requires basic health care coverage. Also called minimum essential coverage, health insurance plans that meet the ACA health care coverage criteria do not require beneficiaries to make any changes. TRICARE, the military's health care plan, meets minimum essential coverage, including: TRICARE Prime; Prime Remote; Prime Overseas; Standard and Extra; Standard Overseas; TRICARE for Life; Reserve Select and Retired Reserve if purchased; TRICARE Young Adult; and U.S. Family Health Plan (the official website of the Defense Health Agency is www.tricare.mil). Therefore, as a plan, we are GTG (Good-to-Go in military lingo). However, how do we rack and stack against specific aspects of health care reform? This commentary represents results of a cursory review of publicly available information on Military Health System (MHS) programs that are compatible with health care reform and the ACA. These results can provide the reference support for military health care leaders to assure patients, beneficiaries, and other stakeholders that, while "exempt" from ACA participation, the MHS delivers health care that is compatible - and in some cases - has been in practice for many years prior to today's health care reform. In fact, I posit that the MHS has been very successful in mirroring health care reform objectives because of the unique organizational structure and culture of continuous improvement. Reforms, and indeed transformation, are constants in the MHS as leaders respond to operational and peacetime environmental changes in support of the Department of Defense. A key advantage is the MHS organizational structure. Dr. Jonathan Woodson, assistant secretary of Defense for Health Affairs, described the MHS structure as unique in two ways: 1) it owns almost every element of its system, from clinical facilities, Case managers are the drivers and problem-solvers who ensure patients receive the optimal benefits from programs established under health care reform. 24 CMSA TODAY Issue 1 * 2014 * DIGITAL to educational platforms, to insurance plans, to research and development; 2) the system is integrated from top to bottom - strategically to tactically (Woodson, 2013). The MHS is a comprehensive medical network and an integrated health care payor, provider, and employer of its beneficiaries serving a broad patient population in the largest global health system in the world (Dorrance, Ramchandani, Neil, Fisher, 2013). This organizational structure provides an inherent advantage in the MHS's ability to: implement system-wide changes and innovative programs quickly; use standardized metrics and evaluate enterprisewide impacts; and promote large scale transformation to reform clinical and business processes (Dorrance, Ramchandani, Neil, Fisher, 2013). Health care reform strives to help providers and patients achieve better health and better care at a lower cost (McClellan, et al, 2010). Other health care reform tenets are depicted in the Institute for Healthcare Improvement's (IHI) Triple Aim objectives, which include improving patient experience of care and the health of populations, as well as reducing the cost of health care (McCarthy and Klein, 2010). McCarthy and Klein emphasized the need to balance health care reform objectives, because increasing or decreasing one will have a negative impact on the other. They also suggested that balancing better health, better care, and lower cost objectives are challenging for health systems to implement when competing forces influence resources, clinical focuses, various payor sources, and organizational traditions (McCarthy and Klein, 2010). What is exciting about the MHS is that its unique organizational structure - comprised of beneficiaries, employers, payors, educators, and owners - can balance, implement and transform the major tenets of health care http://www.tricare.mil

Table of Contents for the Digital Edition of CMSA Today - Issue 1, 2014

President’s Letter
CMSA Corporate Partners
Association News
The Opportunity to Lead Change
An Integrated Approach
Health Care Reform in the Military
Innovation as Necessity
Opioid Abuse Crisis
Index of Advertisers

CMSA Today - Issue 1, 2014

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