Health Service Support in a Globally Integrated World- How ... · (FY 2009-FY 2016) $40 $45 $50 $55 $60 $65 $70 $75 FY 2009 Actuals FY 2010 Actuals FY 2011 Actuals FY 2012 Actuals

1UNCLASSIFIED / FOUO Leadership. Energy. Execution.

Health Service Support in a Globally Integrated World- How the Military Healthcare System Leverages Relevance and Readiness for

the 21st Century

Keynote and Moderator: MG Jonathan Woodson, MD, Commanding General, Army Reserve Medical Command;

Panelists: Maj Gen Lee Payne, MD, Assistant Director, Combat Support, Defense Health Agency; BG Paul Friedrichs, MD, Joint Staff Surgeon, Office of the Joint

Staff; BG Lisa Doumont, Commanding General, Medical Readiness and Training Command


Disclosures

• None

• Opinions expressed are mine and do not represent the official policies of the U.S. Government, U.S Army or the U.S. Army Reserve

• Presenter’s has no relevant financial or non-financial interests to disclose.

•This continuing education activity is managed and accredited by AffinityCEin collaboration with AMSUS. AffinityCE and AMSUS staff as well as Planners and Reviewers, have no relevant financial or non-financial interests to disclose.

• Commercial Support was not received for this activity


Agenda

• What are the forces shaping the future of the Military Health System .

• What implications do the changes in the MHS have for total medical force management-particularly the RC.

• Joint Concept of Health Support-meeting future COCOM needs

• How does the emerging DHA combat support agency role focus resources to support medical response to the new strategic defense environment.

• How do we prepare the workforce and joint “medical units of action” for mission success


Learning Outcomes

1. Summarize the medical support concepts contained in the Joint Concept for Health Services.

2. Recognize medical capabilities provided by the Reserve Component to the Joint Force.

3. Apply collective training and clinical skills development methods in a Joint Force environment.

4. Describe ways to enhance the relevance of Health Service Support to the Combatant Commander.

5. Describe gaps and opportunities within the US healthcare system in the ability to provide capacity to support major military conflict or national level disaster.

Select Verb list for writing measurable learning objectives.


Team of Teams- McChrystal

“Today’s rapidly changing world, marked by increased speed and dense interdependencies, means that organizations everywhere are now facing dizzying changes, from global terrorism to health epidemics to supply chain disruption to game changing technologies. These issues can be solved only by creating sustained organizational adaptability through the establishment of a team of teams.”


MHS Mission

National Defense Strategy (2018)

“ We are facing increased global disorder, characterized by decline in long-standing rules-based international order-creating a security environment more complex and volatile than any we have experienced in recent memory…The increasingly complex security environment is defined by rapid technological change, challenges from adversaries in every domain….”

National Military Strategy (2018)

“To achieve advantage over competitors and adversaries, the NMS introduces the notion of joint combined arms, defined as the conduct of operational art through the integration of joint capabilities in all domains.”


MHS Mission

• Medically ready force

• Ready medical force

But…

Senate

“The committee believes that the current organizational structure…paralyzes rapid decision-making and stifles innovation in producing a modern health care system.”


Forces Shaping the future of Health and Health Care


Moving from Health Care to Health


“When health is absent, wisdom cannot reveal itself, art cannot manifest, strength cannot fight, wealth becomes useless, and intelligence cannot be applied.”

Herophilus (325-255 BC)


The “Holy Grail”-What do we want?• Safe- “Do no harm”

• Effective- evidence based therapy leading to best outcome

• Efficient- limits waste of resources

• Patient-Centered- respectful, responsive, values-based

• Equitable-quality care for everyone in need

• High performing/Learning

• Connected- Link patient, provider care teams, provider organizations and broader political-

economic communities…all pulling in the same direction

• Medically ready force and ready medical force



What value? What Costs?(imperatives for change)

Value= Access+ Outcomes

Costs

• HC-3 trillion/yr. (18% GDP); 30% wasted

• 8.6% (27.3 million) uninsured (2016)

• Only 50% of patients received evidenced-based care

• Ranked 37th world outcome metrics

• Millions uninsured or underinsured

• HC expenses #1 cause of personal Bankruptcy

• Limited portability and interoperability of health data

• 2000-98,000 medical error; 2016-250,000


Putting it in Perspective: Unified Medical Program (FY 2009-FY 2016)

$40

$45

$50

$55

$60

$65

$70

$75

FY 2009Actuals

FY 2010Actuals

FY 2011Actuals

FY 2012Actuals

FY 2013Actuals

FY 2014Actuals

FY 2015Enacted

FY 2016Estimate

Actuals PB 2008 Projection

Between 2009 and 2016, the UMP went up a total of 2.5%, or 0.35% per year on average.


The Digital World

Trustees Presentation

15

12/11/2019


Health Systems Innovation

Data

Biotech

Health System Design

Leader Development

Policy

Workforce Development

Population Health

Trustees

Incremental

Progressive

Adaptive

Disruptive


Disruptive Technologies

17

Additive Manufacturing

3D scanning, digital design,

and 3D printing digitize the

creation/ distribution of

products, including body

parts

Synthetic Biology &

Nanotechnology

The ability to produce

synthetic tissues and organs

creates new opportunities for

surgical therapy and device

production

Genomics & Proteomics

Understanding the gene

structure, function, evolution,

and mapping of all living

organisms

Digital Medicine

Digital medicine offers smart

medication, continuous

monitoring, behavior

modification, and

personalized interventions

Permission for use from Dr. Meera Kanhouwa



Virtual / Augmented Reality

Immersive 3D representations

to what a person sees to allow

advanced simulation or

digitally-enhanced problem

solving

Ambient Computing

Ecosystem of “things” that

intelligently respond in real

time to business needs

through connectivity and

sensing

Data Democratization

Seamless information

exchange facilitating

interoperability between

payer, provider, pharmacy,

and patient

Cognitive Computing

Artificial intelligence,

natural language

processing, semantics

computing, predictive

algorithms, dark analytics,

and machine learning




Robotics

Next generation robotics and

automation technologies that

can work alongside or replace

humans

Telemedicine

Technology-enabled care

delivery that allows for

remote communication,

diagnosis, and treatment with

a physician

Blockchain

Distributed data repository

that brings transparency,

disintermediation, trust, and

auditability capabilities

API / Gig Economy

New ways to engage with

both communities and

individuals through unique

platforms to extract untapped

value and harness a changing

workforce



Digital Disruption of Healthcare: The Digital Health Matrix

• Every industry is becoming digital.

• Incumbents must think about how they

compete and collaborate with digital

giants(e.g. Amazon, Google).

• Every organization think

about their future in the

digital age.

• Organizations must break

free of traditional modes

of doing business.


Adapt or Die

• Kodak

• Blockbuster

• Borders Books

• Kroger

• Blackberry

*Consumed by fast moving tech companies with innovation in their business

DNA


New Ecosystems and Models of Healthcare

• CVS/Aetna

• Aetna/Apple

• Walmart/Humana

• Amazon/Berkshire Hathaway

• Apple/IBM/JNJ/Metronics

• Microsoft

• Alibaba/Tencent

• United HC/DaVita/Optum

• Big Data Analytics/PGHD

• Cognitive computing

• AI/machine learning

• Personal Health Records

• Precision Medicine

• Patient Engagement

• IO(M)T-sensors/monitors/DA

• Chronic Disease Management


“Digital Health is the convergence of digital and genomic technologies with health, healthcare, living, and society to enhance the efficiency of healthcare delivery and make medicine more personalized and precise.”

• Multi-disciplinary• Engage

patients/customers• Amplify/augment human

capabilities• Optimize clinical care and

administrative process• Transform health

• Precision Medicine• Wearable computing• Telehealth/Telemedicine• M-Health/e-health• Patient engagement• Big data/Cloud

computing• gamification



From Tobeitz, G. A New Partnership between Humans and Machines. The Healthcare Nerd & The Digital Strategist.

Retrieved from Https://medium.com/the-healthcare-nerd-the -digital-strategist/a-new-partnership-between-humans-and-machines-in-healthcare-b

Augmenting and Amplifying Human Performance- Man and

Machine

https://medium.com/the-healthcare-nerd-the


From Halvorson, G. et al. The Digital Dimension of Healthcare.

Retrieved from: https://xnet.kp.org/.../docs/The %20Digital%20Dimension%20of%Healthcare.pdf


Leading in a VUCA World



From OldWolf, B. Chaos Theory : A Starter Guide. Owlcation, Feb. 2018


Wicked Problems

• Complex

• Extend outside of authority lines

• Detrimental effects of organizational silos

• Simple solutions often make the problem worse

• Formal networks often do not provide a path to solutions


Effective Leadership

• Help organizations pivot and thrive in a consumer driven fee for value environment

• Creates enthusiasm for change

• Recognizes the accelerated pace of change

• Assesses the disruptive influences coming from outside the industry

• Make the right strategic investments

• Cultivates the right partnerships

• Develops the workforce to be part of the solution

• Embraces “wicked problems”


Innovation and Leadership

• Move away from directing outcome to developing forum for validating the

development of questions and pathways to solutions

• Involves increased risk- may not know where you when end up when you

start

• Is taxing emotionally and intellectually

• Involves diverse collaborators

• May feel unnatural


The Future of Military Medicine

Documents

Health Service Support in a Globally Integrated World- How ... · (FY 2009-FY 2016) $40 $45 $50 $55 $60 $65 $70 $75 FY 2009 Actuals FY 2010 Actuals FY 2011 Actuals FY 2012 Actuals