The Defense Department is on a mission to get the proper individuals into the proper navy hospital or clinic on the proper time—each medical employees and sufferers.

On Dec. 6, 2023, the deputy secretary of protection signed a memo directing the stabilization of the Military Health System. The memo requires that the MHS add capability to reattract sufferers and beneficiaries, enhance entry to care in navy hospitals and clinics, and enhance alternatives to maintain navy medical readiness for medical forces. 

The have to stabilize the MHS is evident. The realignment of medical personnel and the risky well being care financial system of the previous three years, created challenges within the  care of beneficiaries. Further, the flexibility to effectively generate and maintain prepared medical forces was additionally affected. 

“Coming out of COVID-19, there were capacity constraints across all health systems in both the United States and peer nations,” mentioned Dr. David J. Smith, the deputy assistant secretary of protection for well being readiness coverage and oversight, who’s main a job drive charged with implementing the memo’s directives. “Health-seeking behaviors changed as well as the demands on the war fighters and readiness … health systems worldwide could not keep up.”

Aligning with the lately launched MHS Strategic Plan for fiscal years 2024 via 2029, the memo primarily addresses the necessity for the MHS to proceed offering medically prepared forces and prepared medical forces whereas concurrently delivering high quality care to beneficiaries. Doing so successfully, “requires a stable, predictable workforce sufficiently staffed, trained, and routinely available to provide health care to our beneficiaries,” the memo states. 

“A big piece of this memo was about providing that stability: creating more stability for our staff so that they can provide more stability for our patients,” mentioned Smith. “This leads to better access to care and more clinical capabilities.”

Rarely have points within the MHS turn into so front-and-center. Recognizing the lasting impacts of the COVID-19 pandemic and reorganization, the undersecretary of protection for personnel and readiness started relying closely on the MHS government assessment board to supervise and implement main enchancment tasks. Moreover, the board started referring points to the senior most navy and civilian management within the DOD via the deputy secretary’s workforce council. 

“The board is chaired by the undersecretary of defense for personnel and readiness, with official representation from the Army, Navy, Air Force, joint staff and Marine Corps … all of the major components of the United States DOD,” Smith mentioned. “This is so essential to our senior management, as we’re actively discussing and updating this effort on the Deputy’s Workforce Council, essentially the most senior governance discussion board within the division masking personnel points. 

“This is a massive commitment of time from our senior-most leadership because we know that medical is critical to the war fight,” Smith mentioned. He added, in reference to the four-years-long reorganization of the MHS, “The [Defense] Department has undergone a tremendous transformation to deliver more effective and efficient health care. This is critical to the well-being of our patients and the well-being of our families.” 

The reorganization realigned all navy clinics and hospitals from the Army, Navy and Air Force to the Defense Health Agency. Doing so leverages economies of scale and standardizes take care of our warfighters and beneficiaries within the long-term, however the transition was huge. Smith mentioned the group has been characterised as the most important reorganization and transformation within the DOD for the reason that institution of the Air Force in 1947. Major transitions typically take time to stabilize and understand enhancements, particularly for organizations as giant and numerous because the MHS. 

Upcoming Steps to Stabilize the MHS 

The DOD will prioritize navy and civilian staffing and uniformed personnel administration at navy hospitals and clinics, incorporating the memo’s steerage into programming and planning actions. The focus is growing medical personnel delivering care at navy hospitals and clinics to optimize capability for beneficiaries and mission necessities. “The [Secretary’s] goal of taking care of our people is about investing in our workforce,” Smith mentioned, and that’s precisely what the Deputy Secretary’s memo does within the quick and long run. 

First and foremost, by June 30, 2024, the undersecretary of protection for personnel and readiness will full a complete assessment of all medical manpower and staffing. The assessment will inform how finest to extend capability to enhance entry to take care of service members, their households and all MHS beneficiaries whereas sustaining and enhancing readiness capabilities. 

The memo additionally directs the DOD to rethink insurance policies on the task of navy medical personnel to hospitals and clinics. In the quick time period, there might be a restricted redistribution of medical personnel to spice up capability at just a few key places to start no later than July 1, 2024, “to stabilize health care delivery and mitigate risk to operational forces and missions.”

“We’ll begin PCSing [permanent change of station] a number of health care professionals,” mentioned Smith. “From there, we’re going to a phased progression of assigning these providers to military hospitals and clinics.” Assigning navy medical forces primarily to navy hospitals and clinics will present extra predictability and continuity for sufferers and enhance capability for day-to-day well being care. 

“Another big change will be on civilian personnel staffing,” Smith mentioned. “We are going to implement authorities allowing us to recruit and retain our civilian employees better. This will include facilitating paying our civilian employees at rates commensurate with the [Department of Veterans Affairs] and the private sector.”

As Smith acknowledged, one important, key initiative is implementing the authorities underneath chapter 74 of Title 38 opens NIH.gov to enhance pay for civilian well being care personnel. The Department acknowledges the have to be a extra aggressive employer and pay civilian well being care personnel at charges equal to the Departments of Veterans Affairs and Health and Human Services.   

Boosting Staff to Bring Back Beneficiaries 

The DOD desires to reattract beneficiaries again to navy hospitals and clinics the place doable. Many have turned to the personal sector for well being care as fewer navy and civilian personnel have been accessible to ship care within the Defense Department’s hospitals and clinics. The DOD additionally acknowledges that burnout in well being care staff is a severe problem within the United States. Recruiting and making extra medical personnel accessible at navy hospitals and clinics reduces burnout, improves the office setting and enhances the expertise of take care of sufferers. 

“If we have more people in military hospitals and clinics, we won’t be burning out people as much. We also know that burnout is correlated with the experience of care for our beneficiaries,” Smith mentioned. “In doing so, we can reattract beneficiaries to MHS.”

Based on an financial mannequin that optimizes the longer term state of the MHS round warfighters and navy households, the memo directs, “reattracting at least 7 percent of available care from the private sector back to MTFs on average.” Reattracting 7% of sufferers from the personal care system is an bold but lifelike objective given the time it takes to shut gaps in medical personnel staffing. For sufferers, coming again to navy hospitals and clinics needs to be straightforward and restrict any out-of-pocket prices. 

“We want to bring beneficiaries back to the MHS  … and truly make the MHS the place you want to receive care,” Smith added. “We are going to rebuild that capacity first to earn trust from our beneficiaries.”

The Defense Department doesn’t plan to ask any sufferers to alter their well being plan or their physician. The objective is to make the MHS extra accessible to make getting care at navy hospitals or clinics the best, easiest selection. 

“We remain focused on readiness and health care for all our beneficiaries,” acknowledged Dr. Lester Martínez-López, the DOD assistant secretary for well being affairs, within the strategic plan. “The two are inseparable: When our people take care of people, we increase the readiness of the total force. I look forward to this work, knowing that it will lead to a stronger MHS capable of meeting the challenges we inevitably face.” His message to the MHS is that this, “I hear you. I know we have serious issues, and we have a plan to fix our situation. I am asking for your support during the time it will take to make the changes we need.”

Ultimately, the MHS exists to help the navy and the nation. Doing so is the very best calling, and the Deputy Secretary’s memorandum stabilizes and makes entire the MHS to supply higher entry to take care of the DOD’s 9.6 million beneficiaries within the United States and around the globe.