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Pandemic underscores MHS’ need for reform, McCaffery tells AMSUS

Image of Army soldier gets nose swab. Army Sgt. Toni-Moi Dewar, noncommissioned officer in charge of the Kenner Army Health Clinic’s Active Duty Clinic performs a COVID-19 swab of a soldier at Fort Lee in Virginia. (U.S. Army photo)

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The Department of Defense (DOD) is moving forward with its plans to integrate and optimize all Military Health System components after pausing to focus on national response to the COVID-19 pandemic, Assistant Secretary of Defense for Health Affairs Tom McCaffery announced Dec. 8 in remarks to the annual meeting of AMSUS, the Society of Federal Health Professionals.

“An important lesson learned as a result of the pandemic is that marshalling the Department’s vast medical assets to quickly respond to a requirement on the scale of a pandemic is challenging when those assets are separately managed by four distinct entities,” McCaffery told the military and federal medical professionals who attended the virtual meeting.

During his 2019 AMSUS speech he announced that he had asked MHS senior leadership to develop and codify a formal strategic framework to guide the integration and optimization of all MHS components. MHS senior leadership is composed of the Army, Navy, and Air Force surgeons general as well as the Joint Staff surgeon; the Defense Health Agency director; and the president of Uniformed Services University of the Health Sciences.

Before the COVID-19 pandemic, the MHS had embarked on reforms and initiatives to improve its medical support to the armed services.

Those reforms were intended to “develop a long-term strategic framework to help all MHS components to better coordinate and integrate their efforts and our shared mission of ensuring a ready medical force,” McCaffery said, but the pandemic forced a pause in several reform initiatives to ensure the MHS could properly focus on supporting the DOD and all government pandemic responses.

The MHS leadership team has resumed this effort to develop this long-term strategy, he noted. In November, the secretary “lifted the pause on activities supporting the transition of the management of all [Medical Treatment Facilities] MTFs from the services to the DHA and directed resumption of the department’s implementation plan to complete the transition by Sept. 30, 2021,” McCaffery said.

“The pandemic experience has underscored the need for a consolidated enterprise management of our health care system. Managing the department’s critical medical assets, under an enterprise framework, allows the health system to more effectively support the military departments’ man, train, and equip responsibilities that support a ready medical force,” he explained.

Having the private sector care under the TRICARE Health Plan and the DOD’s more than 700 military hospitals and clinics “under one joint agency will allow us to have standardized health care delivery policies and business practices across the entire military health system,” McCaffery said, “and that will go a long way to reducing undesirable variation for both providers and patients and improve our beneficiaries’ experience.”

The primary driver for this change is the National Defense Authorization Act of 2017. Congress mandated that a single agency will be responsible for the administration and management of all military hospitals and clinics to sustain and improve operational medical force readiness and the medical readiness of military members, improve beneficiaries' access to care and experience of care, improve health outcomes, and eliminate redundancies in medical costs and overhead across separate systems operated by the Army, Air Force and Navy.  DHA will be responsible for health care delivery and business operations across the Military Health System including budgets, information technology, health care administration and management, administrative policies and procedures, and military medical construction.

The impending COVID-19 vaccine distribution and administration effort is testament to the DHA’s increasing role in standardizing and coordinating military medical strategy and Direct CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care.

On Nov. 3, the Secretary of Defense established a DOD COVID-19 Vaccine Distribution Operational Planning Team following release of the Trump Administration’s plan.

“The Defense Health Agency was directed in partnership with the Joint Staff to develop a standardized and coordinated strategy for prioritizing, distributing, and administering a COVID-19 pandemic vaccine through a phased approach to all active duty service members, their dependents and to all of our 9.6 million beneficiaries,” McCaffery said.

Military Health System dollars and people are central to the success of the government’s Operation Warp Speed to produce and deliver 300 million doses of safe and effective COVID-19 vaccines to the U.S., McCaffery explained.

McCaffery stated that the initial COVID-19 military vaccination efforts will focus on those “critical to the response, providing direct care, and maintaining societal mission-essential functions, as well as those at highest risk for developing severe illness.”

In the U.S., four companies are in clinical trials with vaccines to combat COVID-19 (Pfizer, Moderna, AstraZeneca and Janssen), and there are six vaccine candidates across three platforms: nucleic acid (Pfizer, Moderna), viral vector (AstraZeneca, Janssen) and protein sub-unit (Novavax, Sanofi).

One or two vaccines – from Pfizer and Moderna – are expected to be approved by the Food and Drug Administration soon. Both companies have applied for emergency use authorizations.

“Throughout this pandemic, the department must ensure we can continue to maintain its military readiness and ensure our national security,” McCaffery said. “As such, in addition to conducting clinical/diagnostic testing, the department established a tiered testing framework, that prioritizes testing service members and personnel associated with vital national security missions, our engaged field forces, and forward deployed or redeploying forces.”

That support also has included civilian health care facilities, especially in the hardest hit areas of the pandemic last spring and into the fall surge.

“From the onset of COVID-19, the department has mobilized more than 7,000 doctors, nurses, and medical technicians – both active duty and reserve – to support many civilian health systems, including deployment of military health care professionals in direct support of hospitals and alternate care facilities,” McCaffery said. “This support has been critical to the hardest-hit communities and enabled their hospitals to sustain operations in the midst of unprecedented demand for their services. These communities were in desperate need of help and it was the military health system that provided it.”

On a different front, MHS moved quickly to direct its medical research and development capability to support the national effort to respond to COVID-19, he noted.

“We leveraged our prior investments that built an infectious disease research, development, and manufacturing infrastructure and our ongoing research on medical countermeasures to support the all-of-government effort to develop and manufacture vaccines and therapeutics to fight the virus,” McCaffery said.

One of the first approved therapeutics for COVID-19, remdesivir, was part of a DOD-sponsored research effort. Five MTFs are enrolling for the AstraZeneca vaccine clinical trial. The DOD also is supporting the development of Inovio’s vaccine.

Another major initiative that has been resumed during the COVID-19 pandemic is the deployment of the unified electronic health record (EHR) system called MHS GENESIS.

“Like our broader reforms, MHS GENESIS represents a concerted push toward standardization, integration and readiness,” McCaffery told AMSUS. There have been three waves of implementation that have launched MHS GENESIS at 19 military medical treatment facility commands since its rollout in 2017. Five additional waves will Go-Live in 2021.

The Department of Veterans Affairs is deploying the same EHR, “ensuring a seamless transition for service members during their career and into retirement,” he noted.

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