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Engagement Guidance

   Theme: Introduction to the Air Force Medical Service (AFMS 101)
   Purpose: Provide an approved and standardized slide deck to communicate
    the AFMS organization, infrastructure, strategies, and mission capabilities
   Design: Organized around the AF/SG’s key strategies, which highlights our
    three primary strategies to accomplish our integrated mission areas by
    addressing strategy, common practice, and culture
   Format:
      Unclassified
   Envisioned Uses:
      Serve as a template for executive officers, staff officers, commanders and
        chiefs to use when sharing the AFMS message with key audiences
      Intent is for slides to be tailored/customized to the particular audience or
        venue. While some slides convey duplicate/similar information, this is
        intentional to provide multiple options to create your unique briefing
      Intended audience include:
           Internal and external customers
           Stakeholders and employees

                    Integrity - Service - Excellence                                  1
Headquarters U.S. Air Force
 Integrity - Service - Excellence


        Introduction to the
 Air Force Medical Service
                   (AFMS)
                          Rank First Lastname
                                      Position




                                     CAG-v6 (3 Jan 2012)
Air Force Medical Service
            MISSION: Seamless Health Service Support to
                     USAF and Combatant Commanders
   UPdateTotal Force Personnel      Deployed (MOC)
      32,487 Active Duty               >92K patients moved out of
      6,818 Civilians                   CENTCOM since 10 Oct 01
      3,750 Contractors                1,362 medics deployed to 30
      15,469 AF Reserve/Guard           countries in 49 locations

   Update FY11                      Homestation (AFMOA/SGHC)
    Budget/Infrastructure               ~2.5M eligible beneficiaries (AF)
      $6.3B (all programs)             ~6.5M visits/40K admissions/yr
      75 Medical Facilities         Investing in our Future
         63 CONUS                      Education & Training
         12 OCONUS                     Research & Development

       Air Force Medicine…Delivering “Trusted Care Anywhere!”
                 Integrity - Service - Excellence                            3
We’re All In
                                AF Mission
                               The mission of the
                           United States Air Force is
                          to fly, fight and win…in air,
                            space and cyberspace

AFMS Mission                                              AFMS Vision
Seamless Health Service                                   World-Class Healthcare
 Support to USAF and                                       for Our Beneficiaries
Combatant Commanders                                        Anywhere, Anytime




       Through Global Vigilance, Reach, and Power!
                  Integrity - Service - Excellence
Alignment of Priorities
         Air Force                               AFMS
  Continue to Strengthen the          Deliver Best Medical Reliability
       Nuclear Enterprise                  for the Nuclear Mission

Partner with Joint and Coalition     Enhance Full Spectrum Medical
    Team to Win Today’s Fight            Capabilities to Support
                                          Winning Today’s Fight

 Develop and Care for Airmen         Implement Patient-Centered Care
       and their Families                  to Sustain Healthy and
                                         Resilient Airmen & Families

 Modernize our Air, Space, &          Advance Medical Capabilities
      Cyber Inventories,                    through Research &
   Organizations & Training            Infrastructure Recapitalization

    Recapture Acquisition            Build Interoperability & Medical
          Excellence                        Acquisition Expertise

                 Integrity - Service - Excellence                        5
Joint, Coalition, & Interagency Team
    Provide Opportunity for Innovation
                            Mis-Information




JOINT              Cooperation
                                                          COALITION




                                                 Inter-
                                  INTER-
                                 AGENCY       Operability
   Collaboration




                                                             SYNERGY
          Integrity - Service - Excellence
Operational
                        Command Structure
                                                      Command
                                                      & Control
                                                      Manpower
                                                      Secretary of
                                                      the Air Force

                                                     Chief of Staff of
                                                      the Air Force

                                                     Major Command
                                              NAF
                                                      Commanders


                                                    Wing Commanders




                                                         Medical
                                                    Treatment Facilities
         AIR FORCE MAJOR COMMANDS (MAJCOMs)

Command & Control With Seamless Total Force
      Integration Across MAJCOMs
         Integrity - Service - Excellence                                  7
Unified
                            Command Structure
FUNCTIONAL                       REGIONAL
COMMANDS                         COMMANDS




             Supporting Our Combatant Commanders
              Integrity - Service - Excellence
Scope Of Operations
          Mc
          Cho Fair
          rd chil            Mal                Min
                                                                                                                    Lakenheath         Ramstein
          AFB d              mstr
                             om
                                                ot      Grand
                                                AFB Forks AFB                                                       RAF Croughton      Landstuhl
               AFB
                  Mountain
                             AFB
                                               Ellswor
                                                                                                           Hansco
                                                                                                           m AFB        Mildenhall     Pirmesens                         Kadena
    Beale
                  Home AFB
                                               th AFB                                                                                                                    Yokota
    AFB
    Travis AFB          Hill
                                      FE                                                              McGuire
                                                                                                                                Spangdahlem                              Misawa
                        AFB Buckley
                                      Warren Offu
                                      AFB        tt
                                                                                   Wright
                                                                                                      AFB
                                                                                                      Dover
                                                                                                      AFB
                                                                                                   Andrews            Lajes
Vanden
                          USAF
                             AFB
                Nellis AFB Peterson
                          Academ          McConn
                                                 AFB           White
                                                               man
                                                                       Scot
                                                                                   Patterson
                                                                                   AFB
                                                                                                   Bolling
                                                                                                   AFB
                                                                                                   AFB
                                                                                                    Langley
                                                                                                                                                       Asbgabat
 berg                     y AFB                                        t
        Edwards                           ell AFB              AFB                                  AFB
                                                                                                  Seymour
 AFB Los
        AFB
         Angeles     Luke
                                  Kirtlan
                                  d AFB Canno
                                                     Vance
                                                     AFBTinker
                                                                 Littl
                                                                       AFB                     Pope
                                                                                            Shaw
                                                                                               AFB
                                                                                                  Johnson AFB                               Pristina           Manas
                                                    Altu AFB
         AFB         AFB
                      Davis-
                      Monthan Hollo
                                        n AFB       s Sheppa
                                                  Dyes AFB
                                                      rd
                                                    AFB
                                                                 e
                                                                 Rock mbu
                                                               Barksdale
                                                                         Colu
                                                                                      Ro
                                                                                      bin
                                                                                            AFB
                                                                                             Charlest
                                                                                             on AFB
                                                                                                                                                Incirlik         Bagram
                      AFB        man              s
                                                 Goodfell        AFB s            Maxwel
   Eielso                        AFB              AFB
                                                 ow AFB
                                                               AFB              E     s Moody
                                                               Keesler AFB gll AFB AFAFB                                                                         Kandahar
   n AFB
   Elmen
                          Hicka
                                               Laugh
                                                       Randol
                                                               AFB              in
                                                                                   Tyndall
                                                                            Hurlburt B
                                                                                   AFB        Patrick                         Aviano                             Kabul
                                                                                                                                                                          Osan
   dorf
   AFB
                          m AFB
                                               lin Lacklan
                                               AFB dph AFB
                                                       AFB
                                                                            Field
                                                                            AFB
                                                                                A
                                                                                F          AFB
                                                                                              AFB
                                                                                           MacDill                                                     Kuwait             Kunsan
                                                                                B                                                                        Qatar   Khost
                                                                                                                                                     Eskan Village          Andersen
                                   Honduras                                                                                                            Djibouti
                                         Curacaco                                                                    Monrovia                                                Jolo
                                                                                                                                     Baghdad Mosul
                                          Manta City Bogota
                                                                                                                                     Balad      Camp Victory
                                                                                                                                     Kirkuk     Basrah-Magal
                                                                                                                                     Tallil/Ali Al Ramadi
                                                                                                                                     Al Taji

                      42,000 AFMS Personnel
             63 Facilities in 34 States, DC, And Guam
          12 Medical Treatment Facilities In 7 Countries
1,362 AF Medics Deployed In 30 Countries In 49 Different Locations
                                                                           Integrity - Service - Excellence
Medical Treatment Facilities
                                                                                                                                (MTFs)
                                           63 MTFs in 34 states, the District of Columbia, and Guam
        McChord
        AFB Fairchild
                AFB              Malmstrom            Minot AFB
                                 AFB                              Grand Forks AFB


                      Mountain Home AFB                                                                                                     Hanscom AFB
                                                     Ellsworth AFB
 Beale AFB
                                            FE Warren AFB                                                                             McGuire AFB
Travis AFB                 Hill AFB
                                                                      Offutt AFB                                                     Dover AFB
                                              Buckley AFB                                                    Wright Patterson
                                                                                                             AFB                  Andrews AFB
                                             USAF Academy                                                                       Bolling AFB
                                                                             Whiteman AFB
               Nellis AFB                      Peterson AFB                         Scott AFB
Vandenberg AFB                                                     McConnell AFB                                                    Langley AFB
    Edwards AFB                                                                                                                Seymour Johnson AFB
                                      Kirtland AFB             Vance AFB
     Los Angeles AFB                                                                                                        Pope AFB
                      Luke AFB                                      Tinker AFB
                                              Cannon AFB                           Little Rock AFB                      Shaw AFB
                                                              Altus AFB
                         Davis-Monthan AFB                   Sheppard AFB                  Columbus AFB               Charleston AFB
                                     Holloman AFB       Dyess AFB                                             Robins AFB
                                                                                 Barksdale AFB        Maxwell AFB
                                                      Goodfellow AFB
                                                                                                     Eglin AFB Moody AFB
Eielson AFB                                                               Keesler AFB
                                                                                                              Tyndall AFB
                                                     Laughlin AFB                                Hurlburt                   Patrick AFB
Elmendorf AFB                 Hickam AFB                      Randolph AFB                       Field AFB
                                                             Lackland AFB                                             MacDill AFB




                                 Integrity - Service - Excellence
Forward Operating Locations &
                Overseas Military Treatment Facilities
                                                Ramstein
                          Lakenheath            Landstuhl
                      RAF Croughton            Pirmesens
                          Mildenhall         Spangdahlem
                                                                Asbgabat                     Kadena
                    Lajes                                                                    Yokota
                                                     Pristina           Manas                Misawa
                     Aviano                              Incirlik         Bagram
                                                                          Kandahar   Osan
                                                               Kuwait     Kabul      Kunsan
                                                                  Qatar   Khost
     Honduras                                                 Eskan Village                 Andersen
         Curacaco                                                Djibouti
                               Monrovia                                              Jolo
      Manta City Bogota
                                       Baghdad Mosul
            Peru                       Balad      Camp Victory
                                       Kirkuk     Basrah-Magal
                                       Tallil/Ali Al Ramadi
                                       Al Taji

AFMS Operates 12 Military Treatment Facilities In 7 Countries (blue)
1,362 AF Medics Deployed In 30 Countries in 49 Different Locations
      >92K Patients Moved From CENTCOM Since 10 Oct 2001
                      Integrity - Service - Excellence
FY11 Budget
Dollars & MilCon                                AFMS FY11 Budget Execution ($ Billion)*
      DHP

 Office of the Secretary
       of Defense
          (OSD)
                                                                      Operations &
                                                                 Operations &
                                                                    Maintenance,              MILCON, $0.
      OASD(HA)                                                         $3.056
                                                                 Management                       165
     Health Affairs
                                                                   $2.554B
      Air Force                      AFMOA
   Surgeon General         Provides direct reach-                                            War Reserve
       (AF/SG)             back capability for                                               Materiel, $0.0
                           clinical processes,
                           resource execution, and       Military                                 67
    Major Command
                           administrative              Personnel, $                       Procurement,
                           management supporting
       Surgeons            medical activities
                                                          3.002                               $0.056
     (MAJCOM/SG)             PAD 07.13, Jan 2008

                                                                                           RDT&E, $0.0
                                                                                               40

  Medical Treatment Facility
 Aligned with Local Mission(s)
                                                              * End of Year Execution as of 30 Sep 2011

                             Integrity - Service - Excellence                                             12
Air Force Medical Service
                               FY12 Personnel Authorizations
                                             Active     Guard   Reserve
   Facility Commanders                             77        89        46
   Medical Corps (MC)                           3,776       507       547
   Dental Corps (DC)                              960        89       170
   Nurse Corps (NC)                             3,447       870     1,583
   Medical Service Corps (MSC)                  1,040       426       425
   Biomedical Sciences Corps (BSC)              2,411       422       404
   Officers (subtotal)                         11,711     2,314     3,129
   Enlisted Corps (subtotal)                   19,714     3,673     6,959
   Civilian – Defense Health Program (DHP)      6,818         -         -
   Contractors                                  3,750         -         -
   Line Officers - DHP Funded                     279         -         -
   Line Enlisted - DHP Funded                   1,885         -         -
   TOTAL                                       42,457     6,229     9,007

*As of 1 Dec 11      Integrity - Service - Excellence
Personnel by
                                            Component & Corps
                Manpower                      Active Duty Personnel
                        Guard       Reserve
        Line-            11%         16%                     Nurse
        DHP                                                               Medical
                                                          Corps, 3,447,
         1%                                                             Corps, 3,776,
                                                              11%
                                                                            11%
Contract
  6%                                                                     Biomedical
                                                                          Sciences
                                               Enlisted                 Corps, 2,411,
                                 Officers       Corps                        8%
                                  19%           19,714
Civilian-
                                                 64%
  DHP                                                                     Medical
  12%                                                                     Service
                      Enlisted                                          Corps, 1040,
                       35%                                       Dental     3%
                                                                 Corps
                                                                  960
            Defense Health Program (DHP)                          3%




                        Integrity - Service - Excellence                                14
Office of the Surgeon General
                                                     Leadership Team
                                                        Lt Gen Green
                      Maj Gen Travis                                              CMSgt Cole

                                                                                                             MAJCOM
                                                                                                             SG Staff

                                                    Surgeon General
                      Deputy Surgeon                                            Chief Medical
                         General                                                Enlisted Force


    (SG1)                   (SG3)               (SG8) Strategic              (AFMSA)*                   (AFMOA)**
Medical Force           Health Care             Medical Plans,             AF Medical                  AF Medical
Development             Operations            Programs & Budget          Support Agency             Operations Agency




Maj Gen                    Col                      Brig Gen                 Brig Gen                    Brig Gen
Siniscalchi                Collier                  Miller                   Carroll                     Ediger
*AFMSA includes Acquisitions, IM/IT, & Modernization Divisions    **AFMOA is the operational execution arm working w/MTFs

                                  Integrity - Service - Excellence                                                          15
Our Framework For The Success…

                                    Strategies
 Overlapping
Mission Areas           Transform Deployable Capability
                     Rapid Response to Any Worldwide Contingency

     Fit
    Force                  Build Patient-Centered Care
                       Continuity & Prevention to Optimize Health


                    Invest in Education, Training & Research
                            Sustain Our Future Capabilities




    Strategy  Common Practice  Culture



            Integrity - Service - Excellence
Our People are the Key to Success
                              …at Home and Deployed




        HOME           AF Medics Sustain                    GLOBAL
       STATION                                             OPERATIONS
                   Full Spectrum Operations




                      Readiness is Job # 1
          We exist to deploy clinically current medics and
        keep AF personnel deployable for global operations
Delivering Home Station Healthcare Underpins Readiness
  Peacetime care sustains clinical skills and continuity to do Job #1
                 Integrity - Service - Excellence                       17
TRANSFORM DEPLOYABLE
     CAPABILITIES




   Integrity - Service - Excellence   18
Aeromedical Evacuation:
                                           The Lifeline Home



                                        Scott

                                                              Ramstein
                                                  Andrews
                                                              EUCOM
                          Travis
                                   Wilford Hall
 Kadena                                                                    CENTCOM
 PACOM          Hickam




     C-17                   Empty                    Air Ambulance       Airborne ICU
Transport Aircraft        Cargo Hold                 Configuration        Capability

      Continuing or increasing levels of care…
from point of injury to resuscitation to definitive care!
                     Integrity - Service - Excellence                                   19
Aeromedical Evacuation:
                                                  Total Force Effort!
 Critical component of AF Global Mobility
 Joint, interoperable, and interdependent          ANG:   10 AE Squadrons
    Modular A/E units / CCATT
    Modular MASFs and CASFs
    Aircraft independent        Percentage
                                   Engaged in
      AD:   4 AE Squadrons        Today's Fight

                                                    AFRC: 18 AE Squadrons




 Over 92K Wounded Warriors Transported Home To The Best Care!
                     Integrity - Service - Excellence                        20
Continuous Advances in
                                                               Casualty Care
                         WWII
                         30%                Learning From Coalition Partners, We
                                             Leveraged Trauma Registry Data To
                                                  Build Innovative Solutions
                                              > 80 Patients Moved as of Nov 11
Combat Mortality Rate




                         Korea
                          25%           Tactical Critical Care Evacuation Team (TCCET)



                        Vietnam
                          24%
                                               INTERFLY AGREEMENT
                                       Applying Lessons Learned From the C-17
                                             *AeroSpace Interoperability Council
                        Persian
                         Gulf
                         24%            Creating a “patient staging” continuum
                                    Modular Aeromedical Staging Capability (MASC)
                        OIF/OEF             New CASF Activated at SAMMC
                         <10%
                                            Re-engineering Global Patient Staging



                        Expeditionary IOperations eEvolvingxtoe Save eLives Globally
                                       ntegrity - S rvice - E c llenc
In Pursuit of Lighter &
                           Leaner Medical Response
   Humanitarian Assistance                         Health Response Team (HRT)
 Rapid Response Team (HARRT)
                                            Airlift Deployment Requirements:
Earthquakes
Indonesia                                      < 24 HRS +
                                                                      C-17’s

                                               Rapid Response Medical Capabilities:
                                              Emergency, Resuscitative, & Surgical Care
Earthquakes
    Chile                                T+0 hrs                  Operational
                                                                   Results:
                                                                Immediate Care
                                                                   < 20 min
                                                                      ER
Earthquakes                                                         < 2 hrs
     Haiti                                                         OR & ICU
                                                                    < 3 hrs
                               T+3 hrs



Pursuing Perfection in Medical Response Capability
                 Integrity - Service - Excellence
Building Partnerships and
                  Partnership Capacity




AFRC
ANG                                          PACOM
AFRICOM                                      SOUTHCOM
CENTCOM                                      EUCOM
          Integrity - Service - Excellence              23
BUILD PATIENT-CENTERED
         CARE




    Integrity - Service - Excellence   24
National Health Reform and Military
            Health System Quadruple Aim
READY (Readiness): Enabling a medically
ready force and a ready medical force;
transform deployed capabilities

BETTER CARE (Experience of Care): patient
centered care; providing patients with care
they want, when they want it, and where it is
most convenient; safe care

BETTER HEALTH (Population Health): Improving
quality and health outcomes for a defined
population; preventive and precision care

BEST VALUE (Per Capita Cost): managing the cost of
providing care; direct and indirect costs or savings;
value in terms of service, quality, safety; capitalizing
on technology integration or the right reasons


  AFMS Imperatives Align With Quadruple Aim
               Integrity - Service - Excellence
Delivering World Class Care:
                             A “Day” in the Life of the AFMS
Maintaining Currency Through Homestation Care
    17,808 Outpatient Visits         109 Inpatient Admissions
    50 Surgery Procedures            41,408 Prescriptions Filled
       21 Babies Delivered           20,477 Lab Procedures
    6,365 Dental Encounters          5,374 Rad Procedures




 Delivering the Benefit and Providing Compassionate Care
                 Integrity - Service - Excellence                26
Medical Home Performance
                              Index (MHPI)
   Objective: recognize and
    reward strong performance
    and significant improvement
    in AF Medical Home
   Focus outcomes:
      Satisfied patients
      High continuity of care
      Consistent application of
       appropriate preventive
       measures
      Coordinated, effective
       management of disease


AF Surgeon General’s target: “Reward Outcomes”
                Integrity - Service - Excellence   27
MHPI BLUF
   IAW AF/SG Direction, MHPI is designed to use financial and non-
    financial incentives linked to Patient-centered performance
    improvements
   Financial incentives are focused on
      Improving Patient Satisfaction
      Increasing Continuity
      Improving HEDIS
      Decreasing ED/UCC Utilization

   Non-Financial incentives will recognize superior performance
    and innovative care practices and encourage teamwork
   Supports Medical Home Panel Mission and PCMH imperatives to
    transform Primary Care capabilities through the provision of
    patient-centered, effective and appropriate medical care

                   Integrity - Service - Excellence                   28
MHPI 3Q FY2011



          Satisfaction      FHT Continuity
           FHI Avg            FHI Avg
             93%                85%
          Goal 95%            Goal 90%
          ED/UC Rate            HEDIS
           FHI Avg            FHI Avg
        5.4/100 enrollees        3.4
           Goal <3             Goal 4

Creating Incentives To Achieve Our Goals!
       Integrity - Service - Excellence       29
AFMS Strategies – Medical Home
    Family Health Clinics Implemented – 69
                                              DATE      MAJCOM   MTF              Purpose
       Enrolled FH Population – 661,461
                                               29 Nov    AETC        Altus             PCMH SC Visit

    Pediatric Clinics Implemented – 35        30 Nov    AFMC        Tinker            PCMH SC Visit
                                                                    Seymour
       Enrolled Population – 112,461          6 Dec     ACC
                                                                    Johnson
                                                                                       PCMH SC Visit

                                               6 Dec     AETC        Vance              PCMH visit #2
    Total Population Enrolled –773,887                                                PCMH GO Visit
                                               6 Dec    USAFE     Lackenheath
       82% of AFMS Enrollment                 8 Dec     AMC        MacDill            PCMH SC Visit

           94% FH Enrollment                  7 Dec    USAFE
                                                                 RAF Croughton
                                                                                       PCMH GO Visit

              48% Pediatric Enrollment        8 Dec     USAFE    RAF Upwood           PCMH GO Visit


                                               12 Dec    USAFE      Ramstein           PCMH GO Visit


                                               13 Dec    USAFE    Spangdahlem          PCMH GO Visit


                                               14 Dec    USAFE    Geilenkirchen        PCMH GO Visit


                                               15 Dec    AFGSC     Whiteman            PCMH SC Visit




                                                                    Effective 1 Dec11
1/5/2012                 Integrity - Service - Excellence                                                30
                                                                    Data from DSS enrollment numbers Sep 11
Incentive Distribution
                                           Timeline
   Example: Incentive to be distributed quarterly based on previous
    quarter’s performance (3 month lag)


             Q4                      Q1                       Q2                      Q3
           Payout                  Payout                   Payout                  Payout




                Q1 Data Compiled         Q2 Data Compiled        Q3 Data Compiled        Q4 Data Compiled


      Q1              Q2                         Q3                    Q4                        Q1

                                      Fiscal Year 1                                          Fiscal Year 2




                            Integrity - Service - Excellence                                                 31
Measures
Measure        Weight     Goal                          Definitions
                                    Roll-up (Average ) of SDA questions 1,3,4,5, and 6.
Satisfaction                        Measure: Patients answering either a 4 or 5 on a 5-point
                10%        95%
  w/visit                           Likert scale / Total responses.
                                    Average of FHT “Team” continuity from patient
Continuity                          perspective. Number of empanelled patient visits with
                40%        90%      team / total number of empanelled patient PC visits
 (Team)
                                    (excludes T-Con and non-count visits)

                                    Average of the HEDIS composite from FHI Push Report
                                    (Diabetes LDL Screening, Diabetes LDL Control,
 HEDIS                              Diabetes HbA1C Screening, Diabetes HbA1C Control,
                30%         4       Asthma Meds, Colorectal Screening, Cervical Cancer
 Average
                                    Screening, Breast Cancer Screening) (max 5 points)
                                    (BGA* pts only)

                                    ED visits with Emergency E&M and BIA MEPRS for DC
                                    or Place of Service = 23 for network. UC visit without
  ED/UC                             Emergency E&M and BHI MEPRS for DC or Place of
                20%     <3/100/mo   Service = 20 for network.
 rate/100



                      Integrity - Service - Excellence                                         32
Maximum Possible
                              Quarterly Earnings
   Measure               Weight              MTF A                         MTF B
                                   Improvement   Sustainment   Improvement    Sustainment
Potential Quarterly
                           100%
     Payout                          $9,400       $19,100        $47,200       $95,800


Satisfaction w/visit       10%        $940         $1,910        $4,720         $9,580



                           40%       $3,760        $7,640        $18,880       $38,320
Continuity (Team)


                           30%       $2,820        $5,730        $14,160       $28,740
 HEDIS Average




 ED/UC rate/100            20%       $1,840        $3,820        $9,440        $19,160




                       Integrity - Service - Excellence                                     33
Innovation & Insight to
                                 Recapture Care
    Delivering Patient-Centered Care To Our
                 Beneficiaries
 Creating Currency Opportunities To Support   Travis AFB, CA     Langley AFB, VA
                   Readiness
  Allowing Medics To Practice Full Scope Of
                      Care
  Tackling Per Capita Cost Through Targeted    Nellis AFB, NV   Elmendorf AFB, AK
                  Investments


                                                Eglin AFB, FL     Keesler AFB, MS




                                                          WPAFB, OH


   Specialty Hospitals Focused on Currency and Recapture
                 Integrity - Service - Excellence                              34
Establishing Partnerships to
                                                Enhance Capabilities
    Physician/Dentist Education (GME/DME)
   Stand alone programs
   Masters with civilian universities
   Integrated/affiliated with Federal partners
     Nurse Education (Transition Program)
   New sites include: Cincinnati, OH & Scottsdale, AZ
Nurse Enlisted Commissioning Program (NECP)

        USAF Dental Hygiene Program
                   Research




    Partnerships are Vital Tools to Build & Sustain Medical Services
                             Integrity - Service - Excellence           35
Operating Room Throughput and
                                        Modernization Road Map



   Tomorrow
            Metrics Standardized
    Parameters Of Throughput Now Uniform
Standard Scheduling Software & Method Defined


                                9 Platforms Evaluated




 Today


           Improved Throughput = Improved Currency
        Seizing The Future Today Through Modernization
                      Integrity - Service - Excellence           36
E-Health Initiatives




      MEDICAL AND MODELING AND
      SIMULATION




Integrity - Service - Excellence           37
eHIP Background

   eHealth Initiatives Project
    (eHIP)
      10 initiatives in various
       stages of maturity using
       electronic media
   Three overarching goals:
      Activate patients to
       achieve their health needs
       and goals
      Optimize PCMH operations
      Recapture specialty care

   eHIP Co-Champions:
      AF/SG and AFMOA/CC


                   Integrity - Service - Excellence    38
Leveraging Medical Informatics
 DATA        INFORMATION            KNOWLEDGE           WISDOM         CHANGE



                                                                   Better Care
TMDS                                        Clinical
                                                                     Through
                                            Practice
                                                                 Evidence Based
                                           Guidelines
DEERS                                                                Practice

                       CarePoint           Medication              Better Health
PDTS       Health
                                             Alerts              Enhanced Patient
          Services     Registries
            Data                                                      Safety
$ / M2   Warehouse
                          User               Home                  Best Value
          (HSDW)
                       Interfaces           Sensors              Healthy Behavior
DMHRS
  i                                                                Better Care
                                           Expedited
 EHR                                      Test Results           Improved Patient
                                                                   Experience


  Decision Support is No Longer Just for Our Providers
                     Integrity - Service - Excellence
Transforming Data Into
                                                Knowledge
                 Ready                         Better Health           Better Care

        Patients receiving                               Diabetic patient
       massive infusions of >                             educated on
       10 pints experienced                                  “remote
         mortality of 33%                                  monitoring”
                                                           glucometer
 Clinical                         Study
                                                                         Readings
 Practice                        registry      MTF calls
                                                                        automatically
Guideline                       to identify    patient to
                                                                           sent to
developed                         trends        discuss
                                                                         healthcare
                                              management
                                                                            team
            Conclude infusing
               whole blood
                                                       Uncontrolled sugar
            reduced mortality
                                                        levels Identified
            to less than 20%

Using Informatics to Accelerate Change in Practice Patterns & Behavior
                      Integrity - Service - Excellence                               40
INVEST IN EDUCATION,
TRAINING AND RESEARCH




    Integrity - Service - Excellence   41
Building Our Capabilities
                                                   Goals
                                         Increase Capacity and
            Department                    Currency of Staffs
                of
             Defense                     Build “Win-Win”
                                          Partnerships in Training,
                                          Research and Development
              Trained                    Recapture Care
 CIVILIAN     Current
                           ACADEMIA
HOSPITALS    Deployable                           Effects
                                         Improves Quality of Care
                                         More Patient Choices
                                         Retains Providers
             VETERANS
              AFFAIRS
                                         Reduces Cost
                                         Saves Lives

  Coordinated Care to Deliver Expertise and Value
              Integrity - Service - Excellence                        42
Enduring
                      Academic Partnerships
       Physician/Dentist Education (GME/DME)
          Stand alone and integrated programs
          Masters with civilian universities
          Integrated/affiliated with Federal partners
          Advanced Education General Dentistry- 91 slots/yr
          Dental Specialty certificate/Masters program opportunities

       Nurse Education (Transition Program)
        188 trained students in FY11
        New sites include: Ohio and Arizona

       Nurse Enlisted Commissioning Program (NECP)
        45 per year with school of their choice



       Research                                USAF Dental Hygiene Program
                                                10 scholarships per year
        Diabetes
                                                Trident Technical College (SC)
        Telepathology
                                                St. Petersburg College (FL)
        Teleradiology



Education & Research – Absolutely Critical to
     Building & Sustaining the AFMS!
           Integrity - Service - Excellence                                       43
A
                                    do
                                          le
                                             s
                                   A ce
                                                  n




                                                                                                                                                                                               
                                                                                                                                                                                                                 
                                                                                                                                                                                                                                  
                                                                                                                                                                                                                                                    
                                    er
                                         os t M




                                                                          60%
                                                                                             65%
                                                                                                        70%
                                                                                                              75%
                                                                                                                    80%
                                                                                                                          85%
                                                                                                                                90%
                                                                                                                                      95%
                                                                                                                                            100%
                                             pa e
                                    A ce dic
                                       l le                       i
                                            rg Me ne
                                               y           d
                                                  Im i c
                                                       m i ne
                                                          un
                                                  A o lo
                                            A
                                                      ne            g
                                               ne sth y
                                                   st          es
                                                       he ia
                                                          si
                                                              a
                                                    C
                                                       a CC




                                                                                              AF RATE
                                              C rdi
                                                 yt ol
                                                    op og




                                                                                NAT'L RATE
                                                        at y
                                   D                       h
                                     ia De ol o
                                         gn rm g
                                                                     y
                                   E ost ato
                                    m ic                        lo
                                         er R
                                            ge a gy
                                                 nc dio
                                                     y           lo
                                                                    g
                                              E Me y
                                                 nd d
                                                      o        ic
                                           F cri i ne
                                              am n
                                                             o
                                                   i ly lo
                                           G M gy
                                              as e
                                                  tr di
                                          G oi n cin
                                             en te e
                                                 er st
                                                      a in
                                           H l S al
                                              em u
                                      In           e rg e
                                          fe           O ry
                                             ct           n
                                                io co
                                                   us lo
                                          In                        g




                                                                                 100% pass rate
                                             te Di s y
                                                rn            ea
                                                    al            s
                                                        M e



                                                                                18 specialties with
                                                 N ed
                                                    eo          ic
                                                        na i ne
                                                            t
                                                  N olo
                                                      ep g
                                                          hr y
                                                              o
                                         N Ne l og
                                           uc             u y
                                                le ro
                                                  ar lo
                                                        M gy
                                                          ed
                                                               ic
                                                                  in
                                             O O e
                                                ph b
                                                     th        G
                                                        al yn
                                                          m
                                                                                                                                                   Board Pass Rates: AF vs. National Average




                                                 O ol
                                                     rth og

Integrity - Service - Excellence
                                            O o                       y
                                               to pe
                                                  la
                                                      ry dic
                                                         ng s
                                                                                                                                                                                               Combined Aeromedical-Family Medicine initiative




                                                              ol
                                                      P og
                                                        at y
                                                           ho
                                                      P log
                                                        ed y
                                                            ia
                                                    P tric
                                                       sy            s
                                              P ch
                                                 ul
                                                    m ia tr
                                                        o           y
                                              R na
                                                 he ry
                                                                                                                                                                                               Restoration of GME programs at Keesler AFB after Katrina




                                                      um C
                                                          at C
                                                              ol
                                                                 og
                                                         U y
                                                           ro
                                                               lo
                                                                  gy
                                                                                                                                                                                               BRAC integration & maturation of civilian-military partnerships
                                                                                                                                                                                                                                                                             (GME) Success
                                                                                                                                                                                                                                                                  Graduate Medical Education




                                                                                                                                                                                               Expansion of GME sites- Nellis, UC-Davis, Portsmouth, Ft Belvoir




          44
Health Professions Scholarship Program (HPSP)
       and Financial Assistance Program (FAP) Fill Rates

                                AF Census by Year
100%                                                                            1,666

                                                                     1,599

80%
          1,298


60%

                                                                                  HPSP/FAP
40%

20%

 0%
          2006        2007        2008       2009        2010        2011
 Following the increased resourcing of student-based accession sources across
 the FYDP, the AFMS is approaching 100% in HPSP and FAP annual census.


                       Integrity - Service - Excellence
Civilian Trauma
                                                  Collaboration



   BALTIMORE       CINCINNATI        ST LOUIS             UC- Davis
                                                      Sustaining Trauma
   Center for Sustainment of Trauma And
                                                      And Resuscitation
               Readiness Skills
                                                       Skills-Program
                    (C-STARS)                             (STARS-P)
      Trauma & Surgical Skills (Baltimore)          Travis/UC Davis MC
      Advanced CCATT (Cincinnati)                   W-P/Miami Valley
      Trauma Skills (St. Louis)                     Luke/Scottsdale HC &
                                                      Maricopa County
                                                     Nellis/Univ. MC

Keeping Medics Ready Through Civilian Partnerships & Programs
                   Integrity - Service - Excellence                          46
711 HPW & USAFSAM
                                              Wright-Patterson AFB, OH

     Research
        Modeling & Simulation of UAS Operators
        Stress & Fatigue Survey of RPA Community
        JSF/F-35 Life Support System Testing & Development

     Education & Training
        Attended 6-wk European Air Gp Adv Aerospace Med Course
        Defense Institute of Medical Operations (DIMO)
             To date, 7000 foreign medics trained from 124 countries
         Adv Aerospace Medicine for International Med Officers
          (AAMIMO)
             110 countries have participated…37 students became SG equivalents
         Exchange Officer Programs

Fostering Interoperability, Integration, & Ultimately…SYNERGY!
                      Integrity - Service - Excellence                            47
Modernization


Enroute   Expeditionary Force Health      Health        Human       Operational
 Care       Medicine     Protection    Informatics    Performance    Medicine
                Supports Full Spectrum of Medical Care

           Mission                                   Product Lines
    Provide policy, guidance,              Medical Requirements
  resources, and oversight to              Strategic Medical Acquisitions
                                           Medical Innovations
    integrate technology and
                                           Clinical Research Projects
 deliver enhanced solutions to             Medical Technology Development
the AFMS, our warfighters, and             Medical Technology Testing
   the beneficiary community               Medical IM/IT Services, Operations


   Delivering The Future Today…One Project At A Time!
                  Integrity - Service - Excellence                                48
Shaping the Future of Military Healthcare

            Synergy-                       Patient-Centered
        Joint & Coalition                        Care




  Organizational                                      Precision
     Agility                                          Healthcare




                             Technology
                             Integration


Working Together, Achieving Success Through A Common Vision
                   Integrity - Service - Excellence
Mission Ready Medics
                                  Serving Proudly

                 Doctrinally Aligned
                   Healthy, Fit Force
                   Resilient Families
              Operationally Focused Medics




Joint, Interoperable, Interdependent…Mission Effective!
                          Results
           The Trust of Our All Volunteer Force
 The Trust of Our Nation to Care for Its Sons & Daughters
              Integrity - Service - Excellence
TRUSTED CARE ANYWHERE”




           Integrity - Service - Excellence   51

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Introduction to the Air Force Medical Service (AFMS)

  • 1. Engagement Guidance  Theme: Introduction to the Air Force Medical Service (AFMS 101)  Purpose: Provide an approved and standardized slide deck to communicate the AFMS organization, infrastructure, strategies, and mission capabilities  Design: Organized around the AF/SG’s key strategies, which highlights our three primary strategies to accomplish our integrated mission areas by addressing strategy, common practice, and culture  Format:  Unclassified  Envisioned Uses:  Serve as a template for executive officers, staff officers, commanders and chiefs to use when sharing the AFMS message with key audiences  Intent is for slides to be tailored/customized to the particular audience or venue. While some slides convey duplicate/similar information, this is intentional to provide multiple options to create your unique briefing  Intended audience include:  Internal and external customers  Stakeholders and employees Integrity - Service - Excellence 1
  • 2. Headquarters U.S. Air Force Integrity - Service - Excellence Introduction to the Air Force Medical Service (AFMS) Rank First Lastname Position CAG-v6 (3 Jan 2012)
  • 3. Air Force Medical Service MISSION: Seamless Health Service Support to USAF and Combatant Commanders  UPdateTotal Force Personnel  Deployed (MOC)  32,487 Active Duty  >92K patients moved out of  6,818 Civilians CENTCOM since 10 Oct 01  3,750 Contractors  1,362 medics deployed to 30  15,469 AF Reserve/Guard countries in 49 locations  Update FY11  Homestation (AFMOA/SGHC) Budget/Infrastructure  ~2.5M eligible beneficiaries (AF)  $6.3B (all programs)  ~6.5M visits/40K admissions/yr  75 Medical Facilities  Investing in our Future  63 CONUS  Education & Training  12 OCONUS  Research & Development Air Force Medicine…Delivering “Trusted Care Anywhere!” Integrity - Service - Excellence 3
  • 4. We’re All In AF Mission The mission of the United States Air Force is to fly, fight and win…in air, space and cyberspace AFMS Mission AFMS Vision Seamless Health Service World-Class Healthcare Support to USAF and for Our Beneficiaries Combatant Commanders Anywhere, Anytime Through Global Vigilance, Reach, and Power! Integrity - Service - Excellence
  • 5. Alignment of Priorities Air Force AFMS Continue to Strengthen the Deliver Best Medical Reliability Nuclear Enterprise for the Nuclear Mission Partner with Joint and Coalition Enhance Full Spectrum Medical Team to Win Today’s Fight Capabilities to Support Winning Today’s Fight Develop and Care for Airmen Implement Patient-Centered Care and their Families to Sustain Healthy and Resilient Airmen & Families Modernize our Air, Space, & Advance Medical Capabilities Cyber Inventories, through Research & Organizations & Training Infrastructure Recapitalization Recapture Acquisition Build Interoperability & Medical Excellence Acquisition Expertise Integrity - Service - Excellence 5
  • 6. Joint, Coalition, & Interagency Team Provide Opportunity for Innovation Mis-Information JOINT Cooperation COALITION Inter- INTER- AGENCY Operability Collaboration SYNERGY Integrity - Service - Excellence
  • 7. Operational Command Structure Command & Control Manpower Secretary of the Air Force Chief of Staff of the Air Force Major Command NAF Commanders Wing Commanders Medical Treatment Facilities AIR FORCE MAJOR COMMANDS (MAJCOMs) Command & Control With Seamless Total Force Integration Across MAJCOMs Integrity - Service - Excellence 7
  • 8. Unified Command Structure FUNCTIONAL REGIONAL COMMANDS COMMANDS Supporting Our Combatant Commanders Integrity - Service - Excellence
  • 9. Scope Of Operations Mc Cho Fair rd chil Mal Min Lakenheath Ramstein AFB d mstr om ot Grand AFB Forks AFB RAF Croughton Landstuhl AFB Mountain AFB Ellswor Hansco m AFB Mildenhall Pirmesens Kadena Beale Home AFB th AFB Yokota AFB Travis AFB Hill FE McGuire Spangdahlem Misawa AFB Buckley Warren Offu AFB tt Wright AFB Dover AFB Andrews Lajes Vanden USAF AFB Nellis AFB Peterson Academ McConn AFB White man Scot Patterson AFB Bolling AFB AFB Langley Asbgabat berg y AFB t Edwards ell AFB AFB AFB Seymour AFB Los AFB Angeles Luke Kirtlan d AFB Canno Vance AFBTinker Littl AFB Pope Shaw AFB Johnson AFB Pristina Manas Altu AFB AFB AFB Davis- Monthan Hollo n AFB s Sheppa Dyes AFB rd AFB e Rock mbu Barksdale Colu Ro bin AFB Charlest on AFB Incirlik Bagram AFB man s Goodfell AFB s Maxwel Eielso AFB AFB ow AFB AFB E s Moody Keesler AFB gll AFB AFAFB Kandahar n AFB Elmen Hicka Laugh Randol AFB in Tyndall Hurlburt B AFB Patrick Aviano Kabul Osan dorf AFB m AFB lin Lacklan AFB dph AFB AFB Field AFB A F AFB AFB MacDill Kuwait Kunsan B Qatar Khost Eskan Village Andersen Honduras Djibouti Curacaco Monrovia Jolo Baghdad Mosul Manta City Bogota Balad Camp Victory Kirkuk Basrah-Magal Tallil/Ali Al Ramadi Al Taji 42,000 AFMS Personnel 63 Facilities in 34 States, DC, And Guam 12 Medical Treatment Facilities In 7 Countries 1,362 AF Medics Deployed In 30 Countries In 49 Different Locations Integrity - Service - Excellence
  • 10. Medical Treatment Facilities (MTFs) 63 MTFs in 34 states, the District of Columbia, and Guam McChord AFB Fairchild AFB Malmstrom Minot AFB AFB Grand Forks AFB Mountain Home AFB Hanscom AFB Ellsworth AFB Beale AFB FE Warren AFB McGuire AFB Travis AFB Hill AFB Offutt AFB Dover AFB Buckley AFB Wright Patterson AFB Andrews AFB USAF Academy Bolling AFB Whiteman AFB Nellis AFB Peterson AFB Scott AFB Vandenberg AFB McConnell AFB Langley AFB Edwards AFB Seymour Johnson AFB Kirtland AFB Vance AFB Los Angeles AFB Pope AFB Luke AFB Tinker AFB Cannon AFB Little Rock AFB Shaw AFB Altus AFB Davis-Monthan AFB Sheppard AFB Columbus AFB Charleston AFB Holloman AFB Dyess AFB Robins AFB Barksdale AFB Maxwell AFB Goodfellow AFB Eglin AFB Moody AFB Eielson AFB Keesler AFB Tyndall AFB Laughlin AFB Hurlburt Patrick AFB Elmendorf AFB Hickam AFB Randolph AFB Field AFB Lackland AFB MacDill AFB Integrity - Service - Excellence
  • 11. Forward Operating Locations & Overseas Military Treatment Facilities Ramstein Lakenheath Landstuhl RAF Croughton Pirmesens Mildenhall Spangdahlem Asbgabat Kadena Lajes Yokota Pristina Manas Misawa Aviano Incirlik Bagram Kandahar Osan Kuwait Kabul Kunsan Qatar Khost Honduras Eskan Village Andersen Curacaco Djibouti Monrovia Jolo Manta City Bogota Baghdad Mosul Peru Balad Camp Victory Kirkuk Basrah-Magal Tallil/Ali Al Ramadi Al Taji AFMS Operates 12 Military Treatment Facilities In 7 Countries (blue) 1,362 AF Medics Deployed In 30 Countries in 49 Different Locations >92K Patients Moved From CENTCOM Since 10 Oct 2001 Integrity - Service - Excellence
  • 12. FY11 Budget Dollars & MilCon AFMS FY11 Budget Execution ($ Billion)* DHP Office of the Secretary of Defense (OSD) Operations & Operations & Maintenance, MILCON, $0. OASD(HA) $3.056 Management 165 Health Affairs $2.554B Air Force AFMOA Surgeon General Provides direct reach- War Reserve (AF/SG) back capability for Materiel, $0.0 clinical processes, resource execution, and Military 67 Major Command administrative Personnel, $ Procurement, management supporting Surgeons medical activities 3.002 $0.056 (MAJCOM/SG) PAD 07.13, Jan 2008 RDT&E, $0.0 40 Medical Treatment Facility Aligned with Local Mission(s) * End of Year Execution as of 30 Sep 2011 Integrity - Service - Excellence 12
  • 13. Air Force Medical Service FY12 Personnel Authorizations Active Guard Reserve Facility Commanders 77 89 46 Medical Corps (MC) 3,776 507 547 Dental Corps (DC) 960 89 170 Nurse Corps (NC) 3,447 870 1,583 Medical Service Corps (MSC) 1,040 426 425 Biomedical Sciences Corps (BSC) 2,411 422 404 Officers (subtotal) 11,711 2,314 3,129 Enlisted Corps (subtotal) 19,714 3,673 6,959 Civilian – Defense Health Program (DHP) 6,818 - - Contractors 3,750 - - Line Officers - DHP Funded 279 - - Line Enlisted - DHP Funded 1,885 - - TOTAL 42,457 6,229 9,007 *As of 1 Dec 11 Integrity - Service - Excellence
  • 14. Personnel by Component & Corps Manpower Active Duty Personnel Guard Reserve Line- 11% 16% Nurse DHP Medical Corps, 3,447, 1% Corps, 3,776, 11% 11% Contract 6% Biomedical Sciences Enlisted Corps, 2,411, Officers Corps 8% 19% 19,714 Civilian- 64% DHP Medical 12% Service Enlisted Corps, 1040, 35% Dental 3% Corps 960 Defense Health Program (DHP) 3% Integrity - Service - Excellence 14
  • 15. Office of the Surgeon General Leadership Team Lt Gen Green Maj Gen Travis CMSgt Cole MAJCOM SG Staff Surgeon General Deputy Surgeon Chief Medical General Enlisted Force (SG1) (SG3) (SG8) Strategic (AFMSA)* (AFMOA)** Medical Force Health Care Medical Plans, AF Medical AF Medical Development Operations Programs & Budget Support Agency Operations Agency Maj Gen Col Brig Gen Brig Gen Brig Gen Siniscalchi Collier Miller Carroll Ediger *AFMSA includes Acquisitions, IM/IT, & Modernization Divisions **AFMOA is the operational execution arm working w/MTFs Integrity - Service - Excellence 15
  • 16. Our Framework For The Success… Strategies Overlapping Mission Areas Transform Deployable Capability Rapid Response to Any Worldwide Contingency Fit Force Build Patient-Centered Care Continuity & Prevention to Optimize Health Invest in Education, Training & Research Sustain Our Future Capabilities Strategy  Common Practice  Culture Integrity - Service - Excellence
  • 17. Our People are the Key to Success …at Home and Deployed HOME AF Medics Sustain GLOBAL STATION OPERATIONS Full Spectrum Operations Readiness is Job # 1 We exist to deploy clinically current medics and keep AF personnel deployable for global operations Delivering Home Station Healthcare Underpins Readiness Peacetime care sustains clinical skills and continuity to do Job #1 Integrity - Service - Excellence 17
  • 18. TRANSFORM DEPLOYABLE CAPABILITIES Integrity - Service - Excellence 18
  • 19. Aeromedical Evacuation: The Lifeline Home Scott Ramstein Andrews EUCOM Travis Wilford Hall Kadena CENTCOM PACOM Hickam C-17 Empty Air Ambulance Airborne ICU Transport Aircraft Cargo Hold Configuration Capability Continuing or increasing levels of care… from point of injury to resuscitation to definitive care! Integrity - Service - Excellence 19
  • 20. Aeromedical Evacuation: Total Force Effort!  Critical component of AF Global Mobility  Joint, interoperable, and interdependent ANG: 10 AE Squadrons  Modular A/E units / CCATT  Modular MASFs and CASFs  Aircraft independent Percentage Engaged in AD: 4 AE Squadrons Today's Fight AFRC: 18 AE Squadrons Over 92K Wounded Warriors Transported Home To The Best Care! Integrity - Service - Excellence 20
  • 21. Continuous Advances in Casualty Care WWII 30% Learning From Coalition Partners, We Leveraged Trauma Registry Data To Build Innovative Solutions > 80 Patients Moved as of Nov 11 Combat Mortality Rate Korea 25% Tactical Critical Care Evacuation Team (TCCET) Vietnam 24% INTERFLY AGREEMENT Applying Lessons Learned From the C-17 *AeroSpace Interoperability Council Persian Gulf 24% Creating a “patient staging” continuum Modular Aeromedical Staging Capability (MASC) OIF/OEF New CASF Activated at SAMMC <10% Re-engineering Global Patient Staging Expeditionary IOperations eEvolvingxtoe Save eLives Globally ntegrity - S rvice - E c llenc
  • 22. In Pursuit of Lighter & Leaner Medical Response Humanitarian Assistance Health Response Team (HRT) Rapid Response Team (HARRT) Airlift Deployment Requirements: Earthquakes Indonesia < 24 HRS + C-17’s Rapid Response Medical Capabilities: Emergency, Resuscitative, & Surgical Care Earthquakes Chile T+0 hrs Operational Results: Immediate Care < 20 min ER Earthquakes < 2 hrs Haiti OR & ICU < 3 hrs T+3 hrs Pursuing Perfection in Medical Response Capability Integrity - Service - Excellence
  • 23. Building Partnerships and Partnership Capacity AFRC ANG PACOM AFRICOM SOUTHCOM CENTCOM EUCOM Integrity - Service - Excellence 23
  • 24. BUILD PATIENT-CENTERED CARE Integrity - Service - Excellence 24
  • 25. National Health Reform and Military Health System Quadruple Aim READY (Readiness): Enabling a medically ready force and a ready medical force; transform deployed capabilities BETTER CARE (Experience of Care): patient centered care; providing patients with care they want, when they want it, and where it is most convenient; safe care BETTER HEALTH (Population Health): Improving quality and health outcomes for a defined population; preventive and precision care BEST VALUE (Per Capita Cost): managing the cost of providing care; direct and indirect costs or savings; value in terms of service, quality, safety; capitalizing on technology integration or the right reasons AFMS Imperatives Align With Quadruple Aim Integrity - Service - Excellence
  • 26. Delivering World Class Care: A “Day” in the Life of the AFMS Maintaining Currency Through Homestation Care  17,808 Outpatient Visits  109 Inpatient Admissions  50 Surgery Procedures  41,408 Prescriptions Filled  21 Babies Delivered  20,477 Lab Procedures  6,365 Dental Encounters  5,374 Rad Procedures Delivering the Benefit and Providing Compassionate Care Integrity - Service - Excellence 26
  • 27. Medical Home Performance Index (MHPI)  Objective: recognize and reward strong performance and significant improvement in AF Medical Home  Focus outcomes:  Satisfied patients  High continuity of care  Consistent application of appropriate preventive measures  Coordinated, effective management of disease AF Surgeon General’s target: “Reward Outcomes” Integrity - Service - Excellence 27
  • 28. MHPI BLUF  IAW AF/SG Direction, MHPI is designed to use financial and non- financial incentives linked to Patient-centered performance improvements  Financial incentives are focused on  Improving Patient Satisfaction  Increasing Continuity  Improving HEDIS  Decreasing ED/UCC Utilization  Non-Financial incentives will recognize superior performance and innovative care practices and encourage teamwork  Supports Medical Home Panel Mission and PCMH imperatives to transform Primary Care capabilities through the provision of patient-centered, effective and appropriate medical care Integrity - Service - Excellence 28
  • 29. MHPI 3Q FY2011 Satisfaction FHT Continuity FHI Avg FHI Avg 93% 85% Goal 95% Goal 90% ED/UC Rate HEDIS FHI Avg FHI Avg 5.4/100 enrollees 3.4 Goal <3 Goal 4 Creating Incentives To Achieve Our Goals! Integrity - Service - Excellence 29
  • 30. AFMS Strategies – Medical Home  Family Health Clinics Implemented – 69 DATE MAJCOM MTF Purpose  Enrolled FH Population – 661,461 29 Nov AETC Altus PCMH SC Visit  Pediatric Clinics Implemented – 35 30 Nov AFMC Tinker PCMH SC Visit Seymour  Enrolled Population – 112,461 6 Dec ACC Johnson PCMH SC Visit 6 Dec AETC Vance PCMH visit #2  Total Population Enrolled –773,887 PCMH GO Visit 6 Dec USAFE Lackenheath  82% of AFMS Enrollment 8 Dec AMC MacDill PCMH SC Visit  94% FH Enrollment 7 Dec USAFE RAF Croughton PCMH GO Visit  48% Pediatric Enrollment 8 Dec USAFE RAF Upwood PCMH GO Visit 12 Dec USAFE Ramstein PCMH GO Visit 13 Dec USAFE Spangdahlem PCMH GO Visit 14 Dec USAFE Geilenkirchen PCMH GO Visit 15 Dec AFGSC Whiteman PCMH SC Visit Effective 1 Dec11 1/5/2012 Integrity - Service - Excellence 30 Data from DSS enrollment numbers Sep 11
  • 31. Incentive Distribution Timeline  Example: Incentive to be distributed quarterly based on previous quarter’s performance (3 month lag) Q4 Q1 Q2 Q3 Payout Payout Payout Payout Q1 Data Compiled Q2 Data Compiled Q3 Data Compiled Q4 Data Compiled Q1 Q2 Q3 Q4 Q1 Fiscal Year 1 Fiscal Year 2 Integrity - Service - Excellence 31
  • 32. Measures Measure Weight Goal Definitions Roll-up (Average ) of SDA questions 1,3,4,5, and 6. Satisfaction Measure: Patients answering either a 4 or 5 on a 5-point 10% 95% w/visit Likert scale / Total responses. Average of FHT “Team” continuity from patient Continuity perspective. Number of empanelled patient visits with 40% 90% team / total number of empanelled patient PC visits (Team) (excludes T-Con and non-count visits) Average of the HEDIS composite from FHI Push Report (Diabetes LDL Screening, Diabetes LDL Control, HEDIS Diabetes HbA1C Screening, Diabetes HbA1C Control, 30% 4 Asthma Meds, Colorectal Screening, Cervical Cancer Average Screening, Breast Cancer Screening) (max 5 points) (BGA* pts only) ED visits with Emergency E&M and BIA MEPRS for DC or Place of Service = 23 for network. UC visit without ED/UC Emergency E&M and BHI MEPRS for DC or Place of 20% <3/100/mo Service = 20 for network. rate/100 Integrity - Service - Excellence 32
  • 33. Maximum Possible Quarterly Earnings Measure Weight MTF A MTF B Improvement Sustainment Improvement Sustainment Potential Quarterly 100% Payout $9,400 $19,100 $47,200 $95,800 Satisfaction w/visit 10% $940 $1,910 $4,720 $9,580 40% $3,760 $7,640 $18,880 $38,320 Continuity (Team) 30% $2,820 $5,730 $14,160 $28,740 HEDIS Average ED/UC rate/100 20% $1,840 $3,820 $9,440 $19,160 Integrity - Service - Excellence 33
  • 34. Innovation & Insight to Recapture Care  Delivering Patient-Centered Care To Our Beneficiaries  Creating Currency Opportunities To Support Travis AFB, CA Langley AFB, VA Readiness  Allowing Medics To Practice Full Scope Of Care  Tackling Per Capita Cost Through Targeted Nellis AFB, NV Elmendorf AFB, AK Investments Eglin AFB, FL Keesler AFB, MS WPAFB, OH Specialty Hospitals Focused on Currency and Recapture Integrity - Service - Excellence 34
  • 35. Establishing Partnerships to Enhance Capabilities Physician/Dentist Education (GME/DME)  Stand alone programs  Masters with civilian universities  Integrated/affiliated with Federal partners Nurse Education (Transition Program)  New sites include: Cincinnati, OH & Scottsdale, AZ Nurse Enlisted Commissioning Program (NECP) USAF Dental Hygiene Program Research Partnerships are Vital Tools to Build & Sustain Medical Services Integrity - Service - Excellence 35
  • 36. Operating Room Throughput and Modernization Road Map Tomorrow Metrics Standardized Parameters Of Throughput Now Uniform Standard Scheduling Software & Method Defined 9 Platforms Evaluated Today Improved Throughput = Improved Currency Seizing The Future Today Through Modernization Integrity - Service - Excellence 36
  • 37. E-Health Initiatives MEDICAL AND MODELING AND SIMULATION Integrity - Service - Excellence 37
  • 38. eHIP Background  eHealth Initiatives Project (eHIP)  10 initiatives in various stages of maturity using electronic media  Three overarching goals:  Activate patients to achieve their health needs and goals  Optimize PCMH operations  Recapture specialty care  eHIP Co-Champions:  AF/SG and AFMOA/CC Integrity - Service - Excellence 38
  • 39. Leveraging Medical Informatics DATA INFORMATION KNOWLEDGE WISDOM CHANGE Better Care TMDS Clinical Through Practice Evidence Based Guidelines DEERS Practice CarePoint Medication Better Health PDTS Health Alerts Enhanced Patient Services Registries Data Safety $ / M2 Warehouse User Home Best Value (HSDW) Interfaces Sensors Healthy Behavior DMHRS i Better Care Expedited EHR Test Results Improved Patient Experience Decision Support is No Longer Just for Our Providers Integrity - Service - Excellence
  • 40. Transforming Data Into Knowledge Ready Better Health Better Care Patients receiving Diabetic patient massive infusions of > educated on 10 pints experienced “remote mortality of 33% monitoring” glucometer Clinical Study Readings Practice registry MTF calls automatically Guideline to identify patient to sent to developed trends discuss healthcare management team Conclude infusing whole blood Uncontrolled sugar reduced mortality levels Identified to less than 20% Using Informatics to Accelerate Change in Practice Patterns & Behavior Integrity - Service - Excellence 40
  • 41. INVEST IN EDUCATION, TRAINING AND RESEARCH Integrity - Service - Excellence 41
  • 42. Building Our Capabilities Goals  Increase Capacity and Department Currency of Staffs of Defense  Build “Win-Win” Partnerships in Training, Research and Development Trained  Recapture Care CIVILIAN Current ACADEMIA HOSPITALS Deployable Effects  Improves Quality of Care  More Patient Choices  Retains Providers VETERANS AFFAIRS  Reduces Cost  Saves Lives Coordinated Care to Deliver Expertise and Value Integrity - Service - Excellence 42
  • 43. Enduring Academic Partnerships Physician/Dentist Education (GME/DME)  Stand alone and integrated programs  Masters with civilian universities  Integrated/affiliated with Federal partners  Advanced Education General Dentistry- 91 slots/yr  Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)  188 trained students in FY11  New sites include: Ohio and Arizona Nurse Enlisted Commissioning Program (NECP)  45 per year with school of their choice Research USAF Dental Hygiene Program  10 scholarships per year  Diabetes  Trident Technical College (SC)  Telepathology  St. Petersburg College (FL)  Teleradiology Education & Research – Absolutely Critical to Building & Sustaining the AFMS! Integrity - Service - Excellence 43
  • 44. A do le s A ce n     er os t M 60% 65% 70% 75% 80% 85% 90% 95% 100% pa e A ce dic l le i rg Me ne y d Im i c m i ne un A o lo A ne g ne sth y st es he ia si a C a CC AF RATE C rdi yt ol op og NAT'L RATE at y D h ia De ol o gn rm g y E ost ato m ic lo er R ge a gy nc dio y lo g E Me y nd d o ic F cri i ne am n o i ly lo G M gy as e tr di G oi n cin en te e er st a in H l S al em u In e rg e fe O ry ct n io co us lo In g 100% pass rate te Di s y rn ea al s M e 18 specialties with N ed eo ic na i ne t N olo ep g hr y o N Ne l og uc u y le ro ar lo M gy ed ic in O O e ph b th G al yn m Board Pass Rates: AF vs. National Average O ol rth og Integrity - Service - Excellence O o y to pe la ry dic ng s Combined Aeromedical-Family Medicine initiative ol P og at y ho P log ed y ia P tric sy s P ch ul m ia tr o y R na he ry Restoration of GME programs at Keesler AFB after Katrina um C at C ol og U y ro lo gy BRAC integration & maturation of civilian-military partnerships (GME) Success Graduate Medical Education Expansion of GME sites- Nellis, UC-Davis, Portsmouth, Ft Belvoir 44
  • 45. Health Professions Scholarship Program (HPSP) and Financial Assistance Program (FAP) Fill Rates AF Census by Year 100% 1,666 1,599 80% 1,298 60% HPSP/FAP 40% 20% 0% 2006 2007 2008 2009 2010 2011 Following the increased resourcing of student-based accession sources across the FYDP, the AFMS is approaching 100% in HPSP and FAP annual census. Integrity - Service - Excellence
  • 46. Civilian Trauma Collaboration BALTIMORE CINCINNATI ST LOUIS UC- Davis Sustaining Trauma Center for Sustainment of Trauma And And Resuscitation Readiness Skills Skills-Program (C-STARS) (STARS-P)  Trauma & Surgical Skills (Baltimore)  Travis/UC Davis MC  Advanced CCATT (Cincinnati)  W-P/Miami Valley  Trauma Skills (St. Louis)  Luke/Scottsdale HC & Maricopa County  Nellis/Univ. MC Keeping Medics Ready Through Civilian Partnerships & Programs Integrity - Service - Excellence 46
  • 47. 711 HPW & USAFSAM Wright-Patterson AFB, OH  Research  Modeling & Simulation of UAS Operators  Stress & Fatigue Survey of RPA Community  JSF/F-35 Life Support System Testing & Development  Education & Training  Attended 6-wk European Air Gp Adv Aerospace Med Course  Defense Institute of Medical Operations (DIMO)  To date, 7000 foreign medics trained from 124 countries  Adv Aerospace Medicine for International Med Officers (AAMIMO)  110 countries have participated…37 students became SG equivalents  Exchange Officer Programs Fostering Interoperability, Integration, & Ultimately…SYNERGY! Integrity - Service - Excellence 47
  • 48. Modernization Enroute Expeditionary Force Health Health Human Operational Care Medicine Protection Informatics Performance Medicine Supports Full Spectrum of Medical Care Mission Product Lines Provide policy, guidance, Medical Requirements resources, and oversight to Strategic Medical Acquisitions Medical Innovations integrate technology and Clinical Research Projects deliver enhanced solutions to Medical Technology Development the AFMS, our warfighters, and Medical Technology Testing the beneficiary community Medical IM/IT Services, Operations Delivering The Future Today…One Project At A Time! Integrity - Service - Excellence 48
  • 49. Shaping the Future of Military Healthcare Synergy- Patient-Centered Joint & Coalition Care Organizational Precision Agility Healthcare Technology Integration Working Together, Achieving Success Through A Common Vision Integrity - Service - Excellence
  • 50. Mission Ready Medics Serving Proudly Doctrinally Aligned Healthy, Fit Force Resilient Families Operationally Focused Medics Joint, Interoperable, Interdependent…Mission Effective! Results The Trust of Our All Volunteer Force The Trust of Our Nation to Care for Its Sons & Daughters Integrity - Service - Excellence
  • 51. TRUSTED CARE ANYWHERE” Integrity - Service - Excellence 51

Notas do Editor

  1. Source CSAF Vector 2011
  2. Integrated and Synergistic: The Joint, Coalition, &amp; Interagency TeamThe Air Force is a part of a much bigger team doing the nation’s businessWe Organize, Train and Equip our Airmen to support joint, interagency and coalition partnersIn doing so, we must maintain interoperability as well as become an interdependent forceAll these organizations are our allies in this war on terror…we must seek to partner with them at every opportunity  Jointness: Jointness refers to the mutual support and doctrinal understanding that must exist within all military services. Jointness is a state of mind as well as a statement of fact. It predisposes those who share its goals to emphasize the unique capabilities of the Nation&apos;s military services in planning and operations that are by design, from beginning to end, synergistic, cooperative, and interdependent.  We are an integral part of a Joint team; jointness is really about synergy of the parts” Joint Connotes activities, operations, organizations, etc., in which elements of two or more Military Departments participate. To improve, we must build partnerships and interoperability to advance cradle to grave health deliveryThe best form of C2: collaboration and coordination  As an AFMS we can expect to participate in more joint operations The AFMS has proven to be a vital partner within the USAF and with Joint Forces. Our vision confirms…and our record of performance demonstrates…we can and will provide quality healthcare and health service support anywhere in the world at anytime to support all of our military family, be they active duty, retired, or a family member. Let’s talk about our vision of the future and highlights of current operations.
  3. Unified Combatant Commands (UCC): HQsRegional Responsibilities:United States Africa Command (USAFRICOM): Kelley Barracks, Stuttgart-Mohringen, GEUnited States Central Command (USCENTCOM): MacDill AFB, Tampa, FLUnited States European Command (USEUCOM): Patch Barracks, Stuttgart-Vaihingen, GEUnited States Pacific Command (USPACOM): Camp H. M. Smith, Honolulu, HIUnited States Northern Command (USNORTHCOM): Peterson AFB, Colorado Springs, COUnited States Southern Command (USSOUTHCOM): Doral(Miami), FLFunctional Responsibilities:United States Joint Forces Command (USJFCOM): Norfolk, VAUnited States Special Operations Command (USSOCOM): MacDill AFB, Tampa, FLUnited States Strategic Command (USSTRATCOM): Offutt AFB, Omaha, NEUnited States Transportation Command (USTRANSCOM): Scott AFB, ILOur mission is to provide seamless health services support to AF and Combatant Commanders, leveraging our joint capabilities to provide “Trusted Care Anywhere!”
  4. AF Medical Service operates a total of 75 medical facilities throughout the world. We have 63 military treatment facilities (MTFs) in 34 states (including AK, HI) , the District of Columbia, and the US Territory of Guam.
  5. Although our Command and Control system is through the Line (from the Wing Commander to the MAJCOM/CC to CSAF) , our budget dollars and MILCON funding comes from OASD(HA) Health Affairs. Our FY11 operating budget was $6.3B dollars allocated across the 6 areas.
  6. Total Force: (SG8P, ANG, AFRC)Officers 17,154Enlisted 30,346Total 47,500Military:Active Duty 31,425Guard 5,987Reserve 10,088Total 47,500
  7. Our integrated and overlapping mission areas of Fit Force, Casualty Care, and Resilient Families capture the three unique and dynamic environments in which the AFMS operates. Our homestation care to our beneficiaries underpins our readiness, builds resilient families and supports our Combatant Commanders by keeping our warfighters healthy and ready to deploy. In the deployed setting, AF medics provide both routine care and life-saving casualty care for our Joint and coalition forces. Additionally, AF medics also operate across the full spectrum of operations to include disaster response, humanitarian assistance, and partnership building with other nations. As a result, AF medics must be highly skilled and adaptable to operate in any environment under any condition. The relationship between Strategy, Common Practice and Cultureis the foundation of our framework for the future. Our Strategy ensures that we are properly aligned to achieve our vision. Our Common Practice reduces variability, improves organizational efficiency, and ensures we deliver the best care across the enterprise. Ultimately, through our Strategy and Common Practice, we create the environment and build the Culture that will enable us to sustain our high performing patient-centered organization and continue to deliver “Trusted Care Anywhere”. The three strategies to achieve our vision include:Transform deployable CapabilityBuild Patient-Centered CareInvest in Education, Training, and Research  StrategyMust have plan for the present, near future and distant futureMust analyze risk, operational requirements, and future threats/demandsMust leverage personnel, resources, and partnerships for mission accomplishmentMust integrate Strategy, Culture, and Common Practice to create a sustainable organization Common PracticeReducing variability so that our customers get the same great service/outcome every time…no matter where they receive their careApplying EBM/lessons learned to deliver the best care  CulturePatient Centered CareOur People are our most important resource and enable mission successContinuous improvement/learning organization Live each day…with the simple goal of making a difference some else’s life…a passion to simply leave your office, your next patient, the world better than you found it
  8. Our People are the Key to Success: The AFMS exists to support the Combat Commanders both at home and abroad by deploying clinically current medics and keeping AF personnel mission ready for global operationsThe key to mission success is “Our People”…with all the technology in the world…nothing can replace the dedicated professional men and women who take care of our countries most precious resource. Additionally, through effective knowledge transfer, we are applying state-of-the-art procedures developed stateside to our global operations…with life-saving results. Similarly, our deployed care operations provide valuable lessons learned which in turn positively impact home station health care delivery. Through this cycle…our innovations can be sustained. 
  9. As of 15 Nov 2011 // Since 10 Oct 2001: &gt; 92K patients moved AFCENT Reports 92% Survival Rate Aug 10 – Jul 11Tactical Critical Care Evacuation Team, or “TCCET” is a mission specific medical personnel and equipment package to execute inter-facility movement of post op, ICU-level casualties between forward surgical teams (FST) and theater hospitals via rotary-wing or tactical fixed wing aircraftTCCET: Fast-tracked concept development, equipment build, operational and safe-to-fly testing, and training of 2 teams (primary and alternate) in less than 9 months-- TCCET designed to fill the critical care gap with personnel OT&amp;E to provide the critical care support necessary to maintain the continuum of care en route-- First team deployed (3 pax) June 2011 for 179 days, in place co-located with rotary-wing transportation assets at multiple OEF locations; ALREADY FLYING MISSIONS; As of 15 Nov 11 80 patients movedInterfly agreement with Canada, United Kingdom, Australia, and New Zealand. Our interoperability was the foundation of a unique operation involving two critical care teams…one CCATT from the US and one CCAST from the UK working side-by-side in the back of a HC-130P.  INTERFLY AGREEMENT (Only for C-17s at this time...ASIC is looking to expand to other air frames like C-130/Chinook)Partners provide more options to bring our heroes home with “Interfly” on US/UK C-17s Expands capability of critical care patient movement; Increases capability to respond to worst case eventOvercame equipment approval challenges; CCATT Equipment has UK OEC clearance /waiver to fly US equipment on UK C-17sCCAST Equipment: Feb ‘10 approval for flight on US C-17s; Teams to share ideas common practices &amp; exploit interoperability opportunities
  10. It started in PACAF with the deployment of our newly Humanitarian Assistance Rapid Response Team to respond to the earthquake in Indonesia in Oct 2009. The HARRT was a tremendous success providing medical care to those affected by the7.6-magnitude earthquake: Total Patients:1945, Acute care: 1224, Minor surgery: 36, PrevMed encounter: 32, Prescription filled: 3519Earthquake (Haiti) Jan – Feb: Additional lessons learned…Earthquake (Chile) Feb – Mar: After these three HA missions in less than 6 months…we challenged ourselves…and asked “Can we do better?” How about Care upon arrival…1st patient in less than 1 hour, 1st surgery in less than 4 hours. EMEDS WAY AHEAD: Force Development Evaluation (FDE) Feb 2011, Travis AFB - ACC (SG), Travis (MDG/CRG), HAF/SG3, pilot units, AFMESA, C-NAFs, NHRC, &amp; Combat Camera participation – COMPLETEFA-HUM 11 (SOUTHCOM) Apr 2011, Trinidad &amp; Tobago – ACC (SG), Travis (MDG/PA), McGuire CRG, &amp; AFMESA participation – COMPLETE FY11/12 – build nine (9) additional EMEDS HRTs Personnel and equipment packages FY14 – strategic/POM review of all EMEDS platformsFurther notes:-EMEDS HRT (Healthcare Response Team) is a medical only package. MDG+CRG teams at Travis; built on PACAF CRG HARRT and Operational AARs and successfully exercised in Apr 11. BOS support remains an A4/A7 responsibility. ACC/SGX and HAF/SGX are engaging with A4/A7 to develop a BOS capability scaled to support EMEDS-HRT, although we do not know what the pkg will look like, from HARRT, operational lessons learned, plus exercise, it is projected the BOS + HRT will be logistically supported for movement on two C-17s. Transition from Alaska Shelters to UtilisAK Shelter Compatible; Decreased Build Time Joint Program Testing w/ Collective Protection Developing “Portable” Functional Supply System (ER/OR/ICU/Peds/GYN/etc)Improved Storage/ShippingSecure/Weather Proof Versus Triwalls/RopakStandardized Packing Portable Drawer Modules
  11. The AFMS has always conducted BP missions and is committed to further synchronize its effort to support ACS’ highly mobile, rapid, flexible, robust and integrated mission.Building Partnerships (BP) became a USAF core function in 2008; BP is now a Joint Capability Area (JCA) (one of 9 JCAs); SecAF &amp; CSAF signed the AF Global Partnership Strategy (AFGPS) in Dec 2008. AFGPS establishes ends, ways and means to support CCDR objectives. Medical is listed under SSTR mean. For example, to Generate Goodwill or Gain Access, we conduct MEDCAP/DENCAP. To Build Trust, we conduct Subject Matter Expert Exchanges (SMEE). We establish Influence---conduct Train-the-trainer courses/share medical operating procedures and doctrine. Develop Capable Partner—Aerospace Medicine exchanges. Directly Intervene—HA/DR (HARRT)Global Health Engagement is one of the means the Air Force uses to partner with other nations to achieve health security cooperation, building partnerships and partner capacity objectives through health related activities and exchanges.  Global health engagement activities allow for the AF Medical Service and Partner Nation (PN) armed forces, or foreign civilian authorities or agencies to build trust and confidence, share information, coordinate mutual activities, and maintain influence and achieve interoperability with PN.  The Air Force uses the full spectrum of health capabilities and disciplines in both Mil-Mil and Mil-Civ engagement activities to build partner capacity, support security cooperation, and meet humanitarian objectives. Health engagement activities may include training, mentoring, planning, consultation, direct healthcare, and exercises in conjunction with national and international partners. Specific Health Engagement may include: Mil-Mil and Mil-Civ consultation and training in public health and preventive medicine, disaster/outbreak response, combat casualty care, aeromedical evacuation, expeditionary medical support, exercises, disease surveillance, medical and dental civic action programs, force health protection, veterinary medicine, health system, and medical logistics, facilities, and equipment repair. For FY09, our air components conducted over 40 missions treating over 100,000 patients. In addition, they conducted 3,500 optometry and 4,000 dental exams, and performed approximately 5,000 dental extractions. We also saw over 11,000 pediatric patients. Furthermore, our medics trained over 1,200+ host nation or partner nation medics. The Defense Institute for Medical Operations conducted 21 mobile courses, which resulted in the training of 850 foreign medics. Air Components are globally engaged: Medical Civic Action Programs; US Military Medical Training; Coalition Engagements; Theater Security Cooperation; Medical Readiness Training and Exercise
  12. The Military Health System’s Quadruple Aim highlights the 4 priorities of our healthcare system….In the fall of 2009, MHS leaders recognized that our plan is consistent with the concept of the Triple Aim proposed by the Institute for Healthcare Improvement (IHI) in October of 2007. The Triple Aim was intended to describe the kind of results that could be achieved when all of the elements of a true health care system worked together to serve the needs of a population. The MHS is a system dedicated to the health of the military family, and it seemed reasonable to adopt the Triple Aim with the addition of one key element – readiness. Readiness reflects our core mission and reason for being; it is first among our aims.ReadinessEnsuring that the total military force is medically ready to deploy and that themedical force is ready to deliver health care anytime, anywhere in support of the full range of military operations,including humanitarian missionsPopulation HealthImproving the health of a population by encouraging healthy behaviors and reducing the likelihood of illness throughfocused prevention and the development of increased resilienceExperience of CareProviding a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always ofthe highest qualityResponsibly Managing the Total Health Care CostsCreating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total costof care over time, not just the cost of an individual health care activity
  13. Data date range: FY11 Denominator: FY11 (excludes weekends &amp; holidays) (AFMOA/SGHC)Outpatient Encounters FY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)MEPRS1 = ‘B’ Appt Status Cd &lt;&gt; ‘6’ (No Tcons)Source: SADR, M2Surgery ProceduresCY107 Currency MTFsSourced from Dr. Mark Boston / Dr. JenningsBabies DeliveredFY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)Source of Admission = ‘L’ (Live Birth within MTF)Source: SIDR, M2Inpatient AdmissionsFY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)Source: SIDR, M2Prescriptions FilledFY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)Source: PDTS, M2Lab ProceduresFY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Lab, M2Rad ProceduresFY11Treatment DMIS Service F&amp;G (MTF &amp; ERSAs)MEPRS1, Ordering = ‘B’ (Excludes MH, Dental, etc.)Source: Ancillary Services, Rad, M2Dental (AFMOA/SGD)
  14. Institute for Health Care Improvement developed Triple Aim to focus improvement of care delivered in all areasMHS has adapted to develop QUADRUPLE AIM, with key component of readiness addedEnabling a medically ready force, a ready medical force, and resiliency of all MHS personnel.Improving quality and health outcomes for a defined population. Advocating and incentivizing healthy behaviors. Managing the cost of providing care for the population. Eliminate waste and reduce unwarranted variation; reward outcomes, not outputs. All metrics should sonehow point back to the Quadruple Aim
  15. - The measures chosen are central to the concept of PCMH and already in use. They are all currently being tracked via a PCMH push report through the SG EGL website.* While Team satisfaction is measured, the MHPI “Satisfaction” measurement only includes Patient Satisfaction.
  16. As of Dec 2011
  17. MHPI uses standard PCMH Push Report measures. Data is already available and scores are the average of the three monthly scores for each measures. HEDIS is the exception where we use the last month of the period as the snapshot for HEDIS Composite score. MHPI Scores are heavily averaged and weighted and are used as a means to award incentive funds.
  18. MTFs A and B are actual PCMH sites and the data is real.
  19. Elmendorf – Increased AccessOutpatient Visits +40%, Surgery +40%Eglin – Increased Surgical CapabilitySpecialty Surgery GrowthAdding Medical SpecialtiesLangley – Addition/Expansion $114M in Projects On-GoingNellis – Newest Medical CenterFamily Medicine ResidencySurgery Residency PlannedTravis – Surgical Recapture118% increase in Neurosurgery New Cardiac/Vascular Services
  20. GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include:   Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU &amp; VA programs 84 Advanced Education General Dentistry-1 slots/yr Dental Specialty certificate/Masters program opportunities  Nurse Education (Transition Program)11 sites; 166 trained in FY08; Increasing to 241 in FY09Sites Include: Cincinnati, OH &amp; Scottsdale Healthcare, AZ  Nurse Enlisted Commissioning Program (NECP)50 per year Nursing School of their Choice  ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB USAF Dental Hygiene Program10 Scholarships/year
  21. In many of our larger facilities, we have launched our Surgical Optimization Initiative, conducting process improvement evaluations with the goals of improving OR efficiency and throughput, enhancing surgical teamwork, and eliminating waste and redundancy.
  22. Leveraging Technology via Applied Clinical Epidemiology (ACE) - Deliver Best Evidence-Based Medicine To The Hands That Need It! Transform Health through Personalized MedicineReduce generalization risk when applying best evidence Shorten timeline of evidence discovery to evidence in clinicPopulation-based screening guidelines must not preclude targeting prevention to those that carry the preponderance of risk.Target our resources most effectively—prevent rather than treat—give the right patient, the right treatment, at the right time CarePoint: Data Transparency &amp; Simplified ReportsWeb-based application which leverages the MHS Population Health PortalIt provides near real-time data to expedite evidence-based preventionEnables targeted prevention directly to the provider and patient. “Transforming Data into Actionable Information”Personal Health Record and Secure Messaging Improves ContinuityPersonalizing care with patient-provider communication optionsWeb-based Microsoft HealthVaultPilot test at Elmendorf AFBPatients selected by presence of select medical conditionsPatients control their own health and wellness record Benefits:Improved communication &amp; relations; provider can coach the patientEmpowers patient to achieve ownership for outcomes and health Reduces ‘phone tag’, frustration, and unnecessary visitsImproves utilization of clinic health team to focus on patient care
  23. Over the past decade, the military medical community has seen a dramatic growth in the volume of data collected within our system. This data represents a treasure trove of information that can be translated into knowledge and used for decision support. As we move forward with improving provider decision support systems like CarePoint, we must not forget about our patients. By Integrating WiFi and remote sensing devices or mobile applications with medication alerts or patient information, we can transform data into wisdom and ultimately change.
  24. Our Joint Theater Trauma Registry is a great example of how we have used technology to build a database which has provided critical insights into how we manage our casualties. These lessons learned have been translated into clinical practice guidelines and are now being used across the DoD and have been shared with our civilian counterparts. Advances in remote monitoring and improvements with patient provider communication systems hold great potential for improving disease management thus supporting both better care and better health.
  25. GME: Since early 1970’s, many AF GME programs have been affiliated with civilian universities. Advantages: civilian faculty stability, exposure to diverse educators, broad spectrum clinical teaching sites. Master Affiliations with UTSA, Wright State Univ, Univ of MS, Univ Nebraska, St Louis University, UC Davis: they serve as sponsoring institutions for residencies. In addition, some of our stand alone residency programs have agreements for rotations at civilian sites. The AF has also integrated/affiliated with Army and Navy GME programs and has rotations at VA hospitals. Each service retains their specific identity within the integrated structure. The use of simulation labs is expanding. Expanding available teaching seats to 241. More specific examples include:  Physician/Dental Education (GME/DME) Stand alone programsMaster Affiliations with UTSA, Wright State , U Miss, UC- Davis, Univ Neb, St Louis UnivIntegrated/affiliated with Army, Navy, USU &amp; VA programs Advanced Education General Dentistry- 91 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program)188 trained in FY11Sites Include: Cincinnati (OH); Lackland AFB;Scottsdale Healthcare (AZ); and Miami (FL) * Nurse Enlisted Commissioning Program (NECP)45 Graduates in FY11*Nursing School of their Choice  ResearchDiabetes: UPMC, WHMCTelepathology: UPMC, Keesler AFB, Eglin AFBTeleradiology: UPMC, WHMC, WPAFB, MacDill AFB, Scott AFB
  26. 6 week long European Air Group Advanced Aerospace Medicine Course; in fact, this was the first time a USAF flight surgeon was able to attend this course, and did so by utilizing a British &quot;training slot&quot; in the course, which they graciously gave to us.  Numerous international physicians, nurses, aerospace physiologists, and enlisted technicians coming to USAFSAM for training in our all of our courses, which certainlygreatly increases &quot;...interoperability, integration, interdependence&quot;, hence: synergy.  And there is also the USAFSAM Defense Institute of Medical Operations (DIMO) that travels to many countries around the world, providing training for a variety of operational medical subjects, again building interoperability, integration, interdependence, hence: synergy.ALL of these are &quot;good news&quot; stories, including the graduation this week of the Advanced Aerospace Medicine for International Medical Officers (AAMIMO) Course which is celebrating its 50th anniversary, being the 50th course of its kind, the 1st class graduating in 1960. More than 110 countries have participated in this course, and of its graduates, 37 have gone on to become the Surgeon General equivalent of their nation&apos;s military, as well as countless others who have gone on to serve in very senior ranking positions within their nation&apos;s military health service.
  27. Modernization: Mission: Provide policy, guidance, resources, and oversight to integrate technology and deliver enhanced solutions to the AFMS, our warfighters, and the beneficiary community Six Modernization Thrust Areas(MTAs) are identified and codified in FY12-17 MPPG, based on the capabilities needed to support AFMS strategies. MTAs provide a key organizational mechanism to seek balance, continuity, and integration of the modernization portfolioEnroute Care: Continuum of care during transport of patients from point of injury to point of definitive care Expeditionary Medicine: Improving care during contingency ops; medical countermeasures against combat/operational stressorsForce Health Protection: Prevention of recognition injury/illness &amp; the early or detection of emerging threats Health Informatics: Enriched IT service quality and effectiveness at MTFs Health Performance: Enhancing performance of Airmen in challenging environments Operational Medicine: Definitive patient care/treatment in-garrison
  28. Shaping the Future of Military HealthcareDefinition of an &quot;imperative&quot;: a philosophical concept that implies an obligation. For example, we have an obligation to deliver patient centered healthcare under a medical home construct or strategy via FHI as a key means. An imperative is and how we will support our priorities and shape our approach to our mission.Specifically, to assure success today and tomorrow, we are focused on the following theme:Patient-Centered Care: Patients want someone who cares with reliable and universally accessible information that allows active participation in their health care.Technology Integration: Our AFMS must continually monitor all (not just medical) technologies; understand how they will influence our AFMS mission, and rapidly integrate them.Synergy-Integration – Joint, Coalition, and Interagency: We must build partnerships and interoperability to advance cradle to grave health delivery. Precision Healthcare: We must minimize the cycle time from implementation of evidence-based medicine to common practice, and create incentives for prevention. Organizational Agility – Light, Lean, and Life Saving Capabilities: An organization that is able to respond, adapt, and influence changing environments quickly through agile processes as seen by changing approaches to acquisitions, facilities, technology; changing approaches to programming process, policy, and law. Process to adapt to changes, influence, changes, funding processes within the fiscal year, to respond between POM cycles.