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VADM Raquel Bono: The end of a brilliant tenure, the beginning of a new chapter

Vice Admiral Raquel C. Bono Vice Admiral Raquel C. Bono

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Defense Health Agency

FALLS CHURCH, Va. – Three decades as a pioneer of change in military medicine prepared Navy Vice Adm. Raquel C. Bono to lead the Defense Health Agency.  But few knew just how much change was on the horizon as she became the DHA’s second director in the fall of 2015.

As she prepares to close a 36-year military career and her time at the DHA, Bono reflected on the DHA’s unique role in helping to transform the Military Health System, on the value of diverse voices within the military and medicine, and on balancing a demanding military career with family.

Bono became the DHA director just two years into its existence, and only a few months before Congress enacted historic changes to military medicine through the National Defense Authorization Act for Fiscal Year 2017. The legislation accelerated many reform trends that that the Department of Defense had already begun, and it handed DHA a series of major tasks, including significant changes to the TRICARE health plan and a consolidation of military hospitals and clinics – traditionally operated by the Army, Navy and Air Force – under the management of a single agency, the DHA.

“Just about every job I’ve had prior to this, every professional and life experience I’ve had prior to becoming DHA director, has somehow prepared me for this job and the particular place in history that the DHA has been in the last four years,” Bono said.

Bono will retire on Tuesday, after handing over the DHA directorship to Army Maj. Gen. Ronald Place, who will be promoted to three-star rank.

Strength in diversity

Bono is the first female Navy medical officer to achieve three-star rank, and as an Asian-American and a female surgeon, she has championed the value of diversity and inclusion – something she learned at an early age from her father, also a surgeon, whom she describes as “the first feminist I ever met.”

As a young girl, Bono would wait up at night for her father to return home from long days as a surgical resident. One night after he got home, she told him that she hoped to become a nurse so she could spend all day with him at the hospital.

“And he said, ‘Well, why don’t you want to be a doctor?’ And I very distinctly remember saying, ‘Well, I didn’t know girls could be doctors.’ And that’s when he told me I could be anything I wanted,” Bono said.

Bono has made it her mission to encourage women and minorities to pursue careers in the military and in medicine because diversity strengthens organizations. “We need to have a much more diverse and inclusive environment for health care and for the workplace and for the military,” she said. “I do believe that we have to have that critical mass of what (are) traditionally under-represented groups … so people can hear that voice and then consider that in the decisions they make.”

Bono also has encouraged those she leads to balance their careers and a family life. Her husband, Art Dwight, a former Marine and later an Army infantry officer, has been a partner in her success, from raising their three daughters to issues as small as learning to spit-polish her shoes. “He’s the one that keeps things real for me,” Bono said. “He’s the one that brings me down to Earth.”

Driving change

Bono has not shied away from using the term “disruption” – one more commonly used at Silicon Valley tech companies – to describe the changes occurring in military medicine, changes DHA and Bono have helped drive.

Disruption “is an accurate description of what I believe needs to happen in health care, and certainly military health care,” she said. “We are at a point where incremental changes will not transform us in the way we need. And the best way of getting to those changes is by being willing to disrupt what is the conventional framework.”

One of the biggest changes for the 9.5 million beneficiaries of the MHS has been a series of reforms to TRICARE. Under Bono’s leadership, the DHA awarded $57 billion contracts to two managed care contractors to operate regional health care networks in the eastern and western United States. When Congress mandated the establishment of TRICARE SelectStarting on January 1, 2018, TRICARE Select replaces TRICARE Standard and Extra. TRICARE Select is a self-managed, preferred provider network plan. TRICARE Select is a fee-for-service option in the United States that allows you to get care from any TRICARE-authorized provider.  Enrollment is required to participate. TRICARE Select after those contracts were awarded, DHA worked with the contractors to implement the contract kickoff and the implementation of Select in the same year.

“I’m excited that we’ve been able to do the things we’ve been able to do with TRICARE,” she said, including the shift of retiree dental plan beneficiaries to FEDVIP, the dental and vision plans Federal employees enjoy.

But Bono’s biggest legacy is likely to have set the stage for DHA’s management of hundreds of military hospitals and clinics around the world. On Oct. 1, just weeks after Bono’s retirement, DHA will assume responsibility for all U.S. military medical facilities.

Bono said consolidating hospital and clinic operations, along with other shared services DHA provides to the entire Military Health System, such as pharmacy, information technology and logistics, are vital if beneficiaries are to continue enjoying a comprehensive health benefit.

“Medical inflation is probably not going to drop. And likewise, I don’t see anybody saying we should change the benefit to offer less services,” she said. “We have to instill the discipline in ourselves to be able to find the savings so that we can take those savings and put them into the benefit for our patients.”

As she prepares to exit, Bono said she has high expectations for the DHA’s future, a future in which the agency drives to the best solution for patients, without regard to divisions along service lines or lines between civilian and military capabilities. She envisions a future DHA having “a collective conversation where there’s a variety of uniforms ... and that the conversations that are happening are (about) what is the best way to ‘fill in the blank,’” she said.

“I would love to be able to see also at that table our partners in the managed care support contractors, our dental partners, our pharmacy partners, and that we’re having a very broad conversation about what is the best way to make sure that our patients get the care that they need and they deserve.”

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