The provision of healthcare services is a critical mission for the U.S. Department of Defense (DoD) and its military health system (MHS). It goes to the core of military readiness. From frontline combat support hospitals to its TRICARE program, the MHS provides care to its troops and their families on multiple fronts. “The [MHS], the entire system,” explains Rear Admiral Christine Hunter, M.D., deputy director, TRICARE Management Activity, “exists to provide health services in support of our nation’s military mission. We say ‘anytime, anywhere,’ and more recently, ‘whatever it takes, wherever it takes us.’”
With close to 9.5 million in beneficiaries and a budget in the tens of billions of dollars, Hunter manages a TRI CAREprogram that plays an important role in having an MHS that is fully integrated. The centerpiece of the MHS is the military hospitals and clinics “Complementing the direct care system,” notes Hunter, “is a family of contract-type products in which we use civilian medical resources to provide care, either where military care is not accessible, where we are not physically present, or where there are additional services that we would like to provide to enhance our benefit program.” TRICARE is the healthcare program serving active duty service members, National Guard and Reserve members, and retirees as well as their families, survivors, and certain former spouses worldwide.
Recently, TRICARE Management Activity selected contractors for its Third Generation (T-3) managed care support services contracts. “We divide the nation into three regions—north, south, and west. Contractors bid a package of healthcare and services that will complement our military direct care system in those areas and take care of patients who don’t live in close proximity to a military base or facility,” explains Hunter. These new contracts are set to focus on a more holistic pay for prevention approach, improved disease management, greater patient choice, improved information exchange, and financial incentives to mitigate fraud, waste, and abuse. “The goal,” says Hunter, “is to provide the best care and services, access whenever and wherever you need it, and with this new generation of contracts, to really focus on health and prevention.” With the increase in American life expectancy, our healthcare focus has turned from acute diseases to the managing of chronic illnesses. As a result, the focus on prevention and wellness has taken a central role. “We believe that the medical home model is one way to achieve what we call the ‘quadruple aim’ in healthcare,” says Hunter. She is referring to the Institute for Healthcare Improvements’ Triple Aim, which seeks to improve patient health, enhance the patient experience; and encourage responsible management of the cost. MHS adds readiness to the Triple Aim. “We say ‘readiness plus the Triple Aim gets to the quadruple aim.’ This quadruple aim can be effectively achieved under a medical home model, where a patient has access, continuity of care, a sustained clinical relationship, and coordinated care,” says Hunter. Patients are more engaged in their personal health and care, working with their clinicians to manage chronic conditions and enhance well-being.
The stress of military life can take its toll on the well‑being of service members and their families. Recently, the DoD introduced the TRICARE Assistance Program (TRIAP), which leverages evolving telecommunication technologies to bring behavioral healthcare closer to TRICARE beneficiaries. “Our beneficiaries and their families have been everywhere around the world, subject to the stressors of a brisk operational tempo and repeated deployments that take their toll on both the individual and the family. We’ve encouraged them to come forward if they need counseling, need someone to talk to, are suffering any consequences of what we’ve asked of them or what they’ve given to their country.” Hunter acknowledges that there is a stigma associated with asking for such help. “Many have been reluctant to do so. To walk through the door of a clinic labeled ‘mental health’ is sometimes seen as a sign of weakness.” TRIAP takes it to your home computer. “You can dial in on the web,” explains Hunter, “If you have a web cam, one of the commercial technologies like Skype, then you’re able to access a counselor 24‑7, 365.”
Rear Admiral Hunter faces many challenges in her new role. Improving beneficiaries’ health and satisfaction is front and center. “I’m a student of Admiral Mike Mullen. When he was chief of Naval Operations, he talked about listening, learning, and leading—in that order—and doing that every day as a leader. His words echo in my mind. I need to learn what these individuals need, what their families need, and what we can provide. My role is to integrate it. It is also to inspire those who report to me to learn more, do more, and be more creative with the tools we have.” Framing her leadership approach is a credo of optimism, opportunity, and innovation: “You’re faced with many challenges, but every challenge brings with it an opportunity to learn and combine the talents of the best of the best. We have the best of the best in the [MHS].”