Dr. Brian Lein, assistant director of health care administration for the Defense Health Agency, led a panel of military health experts to discuss how the Military Health System supports and promotes health and readiness to over 9.5 million beneficiaries during the Association of the United States Army 2023 Annual Meeting in Washington, D.C. on October 10.

The panel, titled “Support of the Military Health System,” included U.S. Army Lt. Gen. Telita Crosland, the director of the Defense Health Agency, and U.S. Army Brig. Gen. Mary V. Krueger, the special assistant to the Director of the Army Staff and chief of the U.S. Army Medical Corps. The panel also included Jessica Slaughter, health care systems specialist with the Exceptional Family Member Program, Office of the U.S. Army’s Deputy Chief of Staff.

Krueger recently served as the commanding general for the Army’s Medical Readiness Command East.

Crosland was the deputy U.S. Army surgeon general before becoming DHA director in January 2023.

Below is the discussion between panel members on the Exceptional Family Member Program, MHS education and training opportunities, how the DHA works, staffing needs, and what the DHA can do to bring in more retired military to the hospitals and clinics. Some questions were submitted in advance and others were taken from the audience. (Note: Questions and answers have been edited for clarity and length.)

Lein: Why is the Exceptional Family Member Program in the U.S. Army so important?

Slaughter: The EFMP allows that closer look … to where a service member and family are being sent. Why is this so important? We want to make sure that the family’s needs can be met where they are moving to. And, so we can also offer family support access. Without this support, we may lose the [service member] if we can’t take care of the family.

Lein: The DHA manages the Click to closeDirect CareDirect care refers to military hospitals and clinics, also known as “military treatment facilities” and “MTFs.”direct care system (all military hospital and clinics) and the Click to closeprivate sector careNetwork and non-network TRICARE-authorized civilian health care professionals, pharmacies, and suppliers.private sector care system (TRICARE network). We have other options such as the TRICARE dental plan and a TRICARE pharmacy plan. How are we going to integrate those seemingly disparate systems?

Crosland: As an agency, when we look at how to make things better, we don't just look at how we can make things better in the direct care system, we must make sure that we look across the totality of the system. That means we must put processes, procedures, and resources in place to help navigate that space to help us (DHA) be able to see when you're out in the (TRICARE private care) network.

Lein: You had to work with military hospitals and clinics, the DHA, and the senior commanders at installations about how you manage health care delivery, and readiness requirements for everybody that's in uniform today. How did you manage that in your role as commanding general of the medical readiness command?

Krueger: We're all in the MHS. It really does come down to that partnership. The measure of my success is that there are [service members] that are ready to go out the door because we've addressed their medical needs, whether it's in the direct care system or with partners in the private sector care system. It also means that for the medical professionals, who will support us as the Army, whether they're here stateside working in MHS facilities, or whether they're going down range, they have all the skills, they've got all the training, and they are ready to go.

Lein: You talked a little about the responsibility of the military hospital commander is a lot more than just the military hospital or clinic. Can you talk a little bit about how you enable and standardize the responsibilities across the myriad of platforms?

Krueger: Our senior mission commanders are key in helping us understand what they need from Army medicine. The nice thing about our commanders also being the directors of the military hospitals and clinics is, not only do they get the command signal from the senior mission commander, but they also have the resources that they're able to answer that with, whether that's locally or even in a broader sense.

Lein: What do you say to those who are struggling to get adequate care at some of these small and more remote installations?

Crosland: Full transparency—there’s a finite amount of capacity in any health care system. We were defining for everyone what having access means. It meant you must have a face-to-face appointment, but we can do some of that virtually. Second, we'll start to bring in some active duty … within the DHA, and to some of our more remote relocations so that we can hire more at some of the larger locations where it’ll be easier to hire. We also want to have some traveling clinicians. We're also looking at leveraging all the capacity we have in the use of technology. We can also use the services to support each other. That’s the advantage of being an agency—we may have some Air Force teammates visiting an Army installation to provide a capacity that is needed for the installation, and the reverse is true as well.

Slaughter: This is why identification in the EFMP is so important. We cannot send a family … to a location where their needs cannot be met. We understand the importance of making sure that families can be taken care of at the location where they are going and where they are currently serving. We need to work closely with those who are making these decisions … when those assignments are made and when the [service members] are being considered for an assignment, that we look closely at the access to care, and making sure that their needs are being met.

Lein: What are we doing in the DHA about trying to attract more of the TRICARE For Life and the older populations back into our military treatment hospitals and clinics?

Crosland: We're accountable for all 9.5 million beneficiaries. And most of that population is retirees and their family members. I care deeply about that promise to deliver care anytime, anywhere, always. That applies to them, as well. And we've had incentives in the direct system. We've got to be quicker. If you're in the network, you're experiencing what most Americans experience -- shortages of health care workers. We're going to identify some of those barriers that keep them from getting the care they expect.

Lein: General Krueger and General Crosland are successful graduates of our military’s graduate medical education system. Can you both talk a little bit about the power of that graduate education?

Krueger: Today's graduate medical education, continuing medical education, across the board really ensures that we have medical professionals that are ready to take care of our force. It ensures that we do have physicians, nurses, medics, who are able to meet the need. It’s important because we do have areas where it's challenging to practice, and where it will be hard to hire people. So sometimes we must generate our own.

Crosland: There's a symbiotic relationship when you must train and run a health care system that has a certain amount of capability and capacity that all of us benefit from … because we also need those for our military mission.

Lein: Talk about the staffing at our military hospitals and clinics with our active duty military and the challenges of civilian hires. Are we going to allow remote working at our facilities and are we going to be hiring more staff?

Krueger: Having active duty working at military hospitals and clinics is critical to our active duty medical personnel, both gaining and maintaining their medical skills and expertise. For our medical personnel to maintain their currency, they must work in our facilities. They must see patients; they also have their profession of being soldiers.

Crosland: There's a shortage of nurses, 250,000 nationwide and it is projected to grow. And there'll be a shortage of physicians. We need to find a way to hire more civilians. We’re also going to have to look at how we deliver care. We're going to have to look at the model of care. There can’t be a dependency on a resource that we're short on; there are other ways and better ways. It's not a quick, easy fix. It's going to take us some time to get the right balance of resources.