Strategy Management in the Military Health System: Achieving the Quadruple Aim

Ms. Paula EvansOffice of Strategy Management

Office of the Assistant Secretary of Defense for Health Affairspaula.evans@tma.osd.mil

27 July 2010

Goals for this briefing

At the conclusion of the session, participants will beable to:• Understand the MHS Quadruple Aim• Understand the MHS Strategic Imperatives • Understand the Pt Centered Medical Home• Understand the critical importance of MEPRS in

monitoring strategic performance

The Quadruple Aim

4

MHS Quadruple Aim

• Readiness– Pre- and post-deployment– Family health – Behavioral health – Professional competency/currency

• Population Health– Healthy service members, families, and retirees– Reduced tobacco, ETOH and unhealthy eating

• A Positive Patient Experience – Quality healthcare outcomes– Patient and family centered care, access, satisfaction

• Cost– Responsibly managed– Focused on value

• Performance is a characteristic of a system• Every system is perfectly designed to achieve exactly the results

it gets • Design leads to performance; reliability leads to excellence • So if you want different performance, you need a different

design

• Process-by-process, change-by-change we can get better and improve across all six areas that described experience of care (Crossing the Chasm, 2001):

• Safe• Effective • Patient-Centered • Timely • Efficient • Equitable

• But, we need data…..

Source: “Achieving the Quadruple Aim – Military Health Leading the Nation”, Don Berwick, MD, MPP, MHS Conference, January 27, 2010.

Achieving Excellence in the Delivery of Care

Deliver patient centered primary careand optimize performance around:

• Improve health (HEDIS)

• Enhance access and continuity (reducing no shows, ER visits)

• Care is rewarding to patient and provider (satisfaction, retention, staff turnover)

• Synchronize direction and incentives for TRO/MTF/Regional Commander, including initiatives that are:

– Facility-specific– Good for entire region or service– Good for all military patients– Beneficial to the MHS as a whole

Prevention Enrollment ContinuityER

UtilizationPatient

Satisfaction

Direct Care

Purchased Care

PMPM

PMPM (Focus on pharmacy)

Aligning the Incentives: Rewarding Both Outputs and Outcomes

MHS Strategic Imperatives

Strategic Imperatives

• The MHS has developed a set of strategic imperatives that we believe will positively impact the Quadruple Aim

• Strategic Imperatives are the things that will yield the greatest return from the finite resources available

Strategic Imperatives are the critical few things we must do to achieve the Quadruple Aim

Strategic Imperatives are the critical few things we must do to achieve the Quadruple Aim

Each Strategic Imperative has one or more performance measures

Each Strategic Imperative has one or more performance measures

As an organization, we will align resources and focus management efforts on our Strategic Initiatives over the next 1-5 years

As an organization, we will align resources and focus management efforts on our Strategic Initiatives over the next 1-5 years

• Each measure has specific targets for FY10, FY12, FY14 • The difference between our current performance and target

performance is our performance gap• Each imperative will have an Executive Sponsoring Coalition

(i.e. one of the Integration Councils)

• To close our performance gap – we will concentrate efforts on a few strategic initiatives (i.e. Patient Centered Medical Home)

Strategic ImperativeExec

Sponsor Performance MeasureDevelopment

StatusCurrent

PerformanceCurrent Target

Target

(2012)Target (2014) Strategic Initiatives

Rea

din

ess

Individual and Family Medical Readiness

FHPC Individual Medical Readiness 71% 80% 82% 85%

IMR programs (e.g., addressing dental class 4, overdue PHAs, etc.)

TBD Measure of Family Readiness (i.e., PHA for families) - - - -

Psychological Health & Resiliency

FHPC PTSD Screening, Referral and Engagement (R/T) 44%/69% 40%/65% 40%/65% 40%/65%

Psychological HealthFHPC

Depression Screening, Referral and Engagement (R/T)

60%/73% 40%/65% 40%/65% 40%/65%

Pop

ula

tion

Hea

lth

Engaging Patients in Healthy Behaviors

CPSCMHS Cigarette Use Rate (Will transition to: Percent of Patients Advised to Quit Tobacco Use)

22% 20% 18% 16%

Healthy Behaviors/Lifestyle Programs

CPSC Body Mass Index - - - -

CPSC HEDIS Index – Preventative Screens 12 12 13 14

Expe

rien

ce o

f Ca

re

Evidence-Based Care

CPSC HEDIS Index – Clinical Practice Guidelines 8 8 9 10Evidence Based Care

Wounded Warrior Programs

Patient Centered Medical Home

Disability Evaluation System Redesign

CPSC Overall Hospital Quality Index (ORYX) 87% 88% 90% 92%

Wounded Warrior Care

CPSC MEBs Completed Within 30 Days 30% 80% - -

CPSC MEB Experience Rating 46% 45% 55% 65%

CPSCEffectiveness of Care for Complex Medical/Social Problems

- - - -

24/7 Access to Your Medical Home

JHOC 3rd Available Appointment (Routine / Acute) 77%/63% 90%/75% 92%/77% 94%/79%

JHOC Getting Timely Care Rate 74% 78% 80% 82%

Potential Recapturable Primary Care Workload for MTF Enrollees

- - - -

Personal Relationship with Your Doctor

JHOCPercentage of Visits Where MTF Enrollees See Their PCM

45% 60% 65% 70%

JHOC Satisfaction with Health Care 59% 60% 62% 64%

Per C

apita C

ost

Align Incentives to Promote Outcomes and Increase Value for Stakeholders

JHOC Impact of Deployments on MTFs - - - -

Evolution of Performance PlanningCFOIC Annual Cost Per Equivalent Life (PMPM) 10% 6% - -

CFOIC Enrollee Utilization of Emergency Services 72/100 65/100 60/100 55/100

Le

arnin

g &

G

row

th

Effective Knowledge Management

CPSC User Assessment of EHR - - - -EHR Way Ahead

Centers of Excellence

BRAC / Facility Transformation

Using Research to Improve Performance

CFOICEffectiveness in Going from Product to Practice (Translational Research)

- - - -

Fully Capable MHS Workforce

CFOIC Human Capital Readiness - - - -

CFOIC Staff Satisfaction / Team Function - - - -

Design Phase

Approved FundedConcept OnlyMeasure Algorithm Developed Current Performance Known and

FY10 Target ApprovedOut-Year Targets Approved

MHS Strategic Imperatives Scorecard

How Do We Support Change in the Right Direction?

• Understand desired end-state– Balanced approach to Quadruple Aim

– Readiness maximized

– Healthy Outcomes and Patient Experience improved

– Sustainable Costs• Emergency Department Use• Retail Pharmacy

• Agree on goals– One size does not fit all

– Year over year improvement

• Facilitate and incentivize the change

Balance

Key MHS Initiative for Achievingthe Quadruple Aim is the

“Patient Centered Medical Home (PCMH)”

•Improve phone and electronic appt scheduling•Open access for acute care•Emphasis on coordination of care •Proactive appointing for chronic and preventive care

•Secure mode of e-communication •Creation of education portal•Reminders for preventive care•Easy, efficient tracking of population data

PatientCentere

dMedical Home

•Creation of Clinical Micropractices •Appropriate utilization of medical personnel•Improve communication among team members Population

Health

•Emphasis on preventive care •Form basis of productivity measures•Evidence-based medicine at the point of care

Patient-Centered Care•Empower active patient

participation •Seamless communication•Encourage patient participation in process improvement

Refocused Medical Training

Patient & Physician Feedback

Advanced IT Systems

Access to Care

Team-Based Healthcare Delivery

•Real-time data•Performance reporting•Patient feedback•Partnership between patients and care teams to improve care delivery

•Emphasize health team leadership•Incorporate patient-centered care•Focus on quality indicators •Evidence-based practice

Decision Support Tools

•Evidence-Based Training•Integrated Clinical Guidelines•Decision Support Tools at the point of care

Model adapted from the NNMC Medical Home

MHS PCMH Journey

MHS PCMH HA PolicySep 2009

MHS Conference (Enterprise-Wide Communications)

Jan 2010

ASD/HA and SG Congressional Testimony (for

Stakeholders Buy-in)Feb 2010

Services Develop PCMH Policy &

GuidanceApr– Jul 2010

Resources Aligned in

2012-17 POMJun 2010

Performance Planning Pilots

BeginOct 2010

Enterprise-Wide Secure Messaging

Capability Available

Jan - Mar 2011

Services Present Early Results of

PCMH Performance

Aug 2009 (R&A)

“Framework for Analysis” Approved (i.e. Measures and

Standards)Dec 2009

NNMC PCMH Pilot

BeginsJun 2008

Edwards & Ellsworth FHI PilotsAug 2008

2,634,614 Enrollees in a

Level II PCMH End of FY 2012

1st MHS PCMH SummitSep 2009

2nd MHS PCMH SummitOct 2010

• Reduce visits/person• Maintain total “touches” (visits + non-visits)• Increase enrollment• Increase market share• Recapture PSC (savings)• Increase preventive services

• Right number of providers for enrolled population

• Right number of support staff per provider

• Right space for efficient operations• Right information systems• Train our people to more effectively

function as a team

What do we need to do?What should PCMH accomplish within Primary Care?

• Reduce ER demand (savings)• Reduce inpatient demand (savings)• Reduce specialty demand (savings)

What should PCMH accomplish outside of Primary Care?

PreventionEnrollmentContinuityER

UtilizationPatient

Satisfaction

Direct Care

Purchased Care

PMPM

PMPM (Focus on pharmacy)

Business Case to Support PCMH

• Standard: An established norm or requirement; usually manifested in a formal document that establishes uniform specifications, criteria, methods, or practices

• Measure: A number or quantity that records an observable value or performance

Standards & MeasuresWhat They Are & Why They Are Different?

Example: Hybrid Car

Standards•Uses two or more distinct power sources to move the vehicle•Low emissions (i.e. SULEV rated [Super-Ultra-Low-Emission Vehicle])

Measures •Fuel economy (mpg city/hwy) •Acceleration (time from 0-60 mph)

In this example, standards distinguish hybrids from other cars while measures allow consumers to compare the performance hybrids against other cars.

Why Do We Need Standards and Measures?

• Standards and measures allow us to test a hypothesis: – Hypothesis: “The PCMH is a model of primary care that will have a significant

positive impact on MHS’ pursuit of the Quadruple aim: enhanced patient experience, improved population health, better managed per capita cost, and increased medical readiness.”

• Standards allow us to differentiate medical homes from traditional models for primary care

– Standards describe the key characteristics required for a practice to qualify as a medical home

– Standards do not force “one-size-fits-all”; they are simply a set of fundamental criteria that must be met

– Without standards, the term medical home can be used loosely, potentially damaging the credibility of the medical home initiative

• While standards can be used to determine what a medical home is, measures allow us to determine how they are performing

– Performance versus control groups (Are medical homes doing better than traditional models for primary care?)

– Longitudinal performance (How is a medical home doing over a span of time?)

– Best performers (Where are the opportunities for best practice transfer?

Tracking PCMH Implementation

1. We have standards that define the patient centered medical home

2. We have measures and targets that describe the outcomes we want to achieve

3. We should articulate the number of patients that will migrate to a patient centered medical home, and by when

Number and percentage of enrollees getting their care from a Level 2 Patient Centered Medical Home

17

PCMH Enrollment Projections“THE TARGET”

Notes: HCSC = Health Care Support Contractors (X) = % of enrolled population with Plus

Total MHS Prime Enrollment

With Plus (2009)

Projected PCMH Prime Enrollees with Plus (end of

FY 2010)

Projected PCMH Prime Enrollees

with Plus (end of FY 2011)

Projected PCMH Prime Enrollees with

Plus (end of FY 2012)

Air Force 1,218,891 304,723 (25%) 731,335(60%) 1,103,864 (88%)

Army 1,407,531 47,856 (3.4%) 281,506 (20%) 633,389 (45%)

Navy 780,486 132,683 (17%) 390,243 (50%) 597,361 (75%)

HCSC 1,500,000 45,000 (3%) 135,000 (9%) 300,000 (20%)

Total 4,906,908 530,262 (11%) 1,538,084 (31%) 2,634,614 (54%)

Estimated Overall Impact of PCMH on the Quadruple Aim

% of Enrollees Getting Care from

Level 2 PCMH

ExpectedPerformance from

Level 2 PCMH

Overall Impact on Quadruple AimX =

(XX) Denotes FY12 target

Beneficiary Satisfaction: 59% 64% (62%)

Getting Timely Care: 74% 81% (78%)

PCM Continuity: 45% 53% (60%)

ER Utilization: 72/100 60/100 (60)

Beneficiary Satisfaction: 59% 62% (62%)

Getting Timely Care: 74% 78% (78%)

PCM Continuity: 45% 49% (60%)

ER Utilization: 72/100 66/100 (60)

Beneficiary Satisfaction: 59% 59% (62%)

Getting Timely Care: 74% 75% (78%)

PCM Continuity: 45% 46% (60%)

ER Utilization: 72/100 70/100 (60)

Beneficiary Satisfaction: 59% 60% (62%)

Getting Timely Care: 74% 76% (78%)

PCM Continuity: 45% 47% (60%)

ER Utilization: 72/100 69/100 (60)

R

Y

Y

Y

Y

Y

R

R

G

G

G

Y

Y

Y

Y

G

50%50%

25%25%

10%10%

5%5%5%5%

75%75%

2.5M -

1.25M -

500K -

250K -

3.75M -

Current Performance

Measure Expected Improvement

IMR ↑ TBD

HEDIS – Preventive

↑ 7%

HEDIS – Evidence Based Guidelines

↑ 4%

Beneficiary Satisfaction

↑ 10%

Time to Next Available Appointment

↑ 15%

Getting Timely Care

↑ 14%

PCM Continuity ↑ 16%

PMPM ↓ TBD

ER Utilization ↓ 24

R

Y

G

R

Y

G

R

R

Y

54%

31%

Projections 2012 Projections 2011

11%

Projections 2010

Importance of MEPRS in All This

The MHS Value Equation for Measuring PCMH Success

21

Creating a high value Military Health System is predicated on defining and measuring value.

Value =

ReadinessExperience

of CarePopulation

Health+ +

Cost (Over a Span of Time)

Strategic ImperativeExec

Sponsor Performance MeasureDevelopment

StatusCurrent

PerformanceCurrent Target

Target

(2012)Target (2014) Strategic Initiatives

Rea

din

ess

Individual and Family Medical Readiness

FHPC Individual Medical Readiness 71% 80% 82% 85%

IMR programs (e.g., addressing dental class 4, overdue PHAs, etc.)

TBD Measure of Family Readiness (i.e., PHA for families) - - - -

Psychological Health & Resiliency

FHPC PTSD Screening, Referral and Engagement (R/T) 44%/69% 40%/65% 40%/65% 40%/65%

Psychological HealthFHPC

Depression Screening, Referral and Engagement (R/T)

60%/73% 40%/65% 40%/65% 40%/65%

Pop

ula

tion

Hea

lth

Engaging Patients in Healthy Behaviors

CPSCMHS Cigarette Use Rate (Will transition to: Percent of Patients Advised to Quit Tobacco Use)

22% 20% 18% 16%

Healthy Behaviors/Lifestyle Programs

CPSC Body Mass Index - - - -

CPSC HEDIS Index – Preventative Screens 12 12 13 14

Expe

rien

ce o

f Ca

re

Evidence-Based CareCPSC HEDIS Index – Clinical Practice Guidelines 8 8 9 10

Evidence Based Care

Wounded Warrior Programs

Patient Centered Medical Home

Disability Evaluation System Redesign

CPSC Overall Hospital Quality Index (ORYX) 87% 88% 90% 92%

Wounded Warrior Care

CPSC MEBs Completed Within 30 Days 30% 80% - -

CPSC MEB Experience Rating 46% 45% 55% 65%

CPSCEffectiveness of Care for Complex Medical/Social Problems

- - - -

24/7 Access to Your Medical Home

JHOC 3rd Available Appointment (Routine / Acute) 77%/63% 90%/75% 92%/77% 94%/79%

JHOC Getting Timely Care Rate 74% 78% 80% 82%

JHOCPotential Recapturable Primary Care Workload for MTF Enrollees

- - - -

Personal Relationship with Your Doctor

JHOCPercentage of Visits Where MTF Enrollees See Their PCM

45% 60% 65% 70%

JHOC Satisfaction with Health Care 59% 60% 62% 64%

Per C

apita C

ost

Align Incentives to Promote Outcomes and Increase Value for Stakeholders

JHOC Impact of Deployments on MTFs - - - -

Evolution of Performance PlanningCFOIC Annual Cost Per Equivalent Life (PMPM) 10% 6% - -

CFOIC Enrollee Utilization of Emergency Services 72/100 65/100 60/100 55/100

Le

arnin

g &

G

row

th

Effective Knowledge Management

CPSC User Assessment of EHR - - - -EHR Way Ahead

Centers of Excellence

BRAC / Facility Transformation

Using Research to Improve Performance

CFOICEffectiveness in Going from Product to Practice (Translational Research)

- - - -

Fully Capable MHS Workforce

CFOIC Human Capital Readiness - - - -

CFOIC Staff Satisfaction / Team Function - - - -

Design Phase

Approved FundedConcept OnlyMeasure Algorithm Developed Current Performance Known and

FY10 Target ApprovedOut-Year Targets Approved

MHS Strategic Imperatives Scorecard & MEPRS Data

MEPRS Code

Input OutcomeOutput

Work Center

• Surveys• M2• Pop Health Portal

• CHCS• SIDR• SADR

• DMHRSi• DMLSS• Local Financial Systems

Magic Linkage

What PCMH questions do we need answered that MEPRS would help on?

• How many people are enrolled to a PCMH?• What are the demographics of those enrolled to a team?• What is the enrollment ratio, i.e. enrollee to providers?• What is the demand rate for those enrolled in PCMH?• How much primary care of those enrolled in PCMH is not

seen by providers within the PCMH team?• How much primary care seen by the team is for those

not enrolled in the team?• What is the productivity of the team?• What is the overall cost of the team?• What is the PMPM of individuals enrolled in PCMH?

• Having aggregate measures isn’t enough—we need information at the team level to evaluate performance and support best practice transfer of PCMH

• At a fourth level MEPRS, data can be aggregated and analyzed by medical home team within a given MTF

• A PCMH’s performance can then be compared with others.

• We believe that as teams learn from each other, their performance will improve over time

• Leadership has asked OSM to propose a single approach for measuring all aspects of a PCMH team and present to the JHOC on 11 Aug 10

MEPRS Based Data is Essential for Knowledge Transfer

Our Challenges

• Labor intensive to create individual identification of teams

• Lack of standard implementation rules• Not so simple; very complicated • Inefficient processes for data entry• Inadequate training of staff to appropriately

account for time• IM/IT disconnects

Pay Off by Measuring Individual PCMH Teams

• Identify top performers• Report to our investors using hard evidence

(facts) on the results of the PCMH initiative• Prove something that no one has proven in the

country• Share best practices and eliminate unwarranted

variation

What Will It Take?

• Agreement to work together to find an optimal solution

• Skill in designing efficient processes and procedures to capture data and allocate resources

• Pilot testing to avoid unintended consequences• Willingness to act quickly and get to yes

29

““It is not the strongest of the It is not the strongest of the species that survives, nor the species that survives, nor the most intelligent, but the one most intelligent, but the one most responsive to change.”most responsive to change.”

- Charles Darwin- Charles Darwin

Back-up Slides

Definitions – Strategic Imperatives

31

Quadruple Aim

Strategic Imperative Definition Performance Measures

Readiness Individual Medical Readiness

Increasing the proportion of the Total Force (Active and Reserve Components) across six elements that define IMR: Periodic Health Assessment (PHA), no deployment-limiting conditions, dental readiness, immunization, readiness laboratory tests, and individual medical equipment.

•Individual Medical Readiness•Measure of Family Readiness (i.e., PHA for families)

Psychological Health Improving health outcomes for the 20-30% of OIF/OEF Service member that report some form of psychological stress. Continued focus on research into and adoption of evidence-based care treatments for PTSD and TBI.

•PTSD Screening, Referral and Engagement (R/T)•Depression Screening, Referral and Engagement(R/T)

Population Health

Engaging Patients in Healthy Behaviors

Encouraging and incentivizing patients and families to take a more active role in their health. Promoting a shift from “healthcare to health” by fostering the adoption of healthier lifestyles, particularly the reduction/elimination of tobacco and alcohol usage, increase in physical activity, and improvement in nutrition.

•MHS Cigarette Use Rate (Will transition to: Percent of Patients Advised to Quit Tobacco Use)•Body Mass Index•HEDIS Index – Preventive Screens

Experience of Care

Evidence-Based Care Transitioning from intuitive medicine to precision medicine through the development, proliferation, and adherence to evidence-based guidelines. Achieving lowest decile performance in the Dartmouth Atlas measures by reducing unwarranted variation.

•HEDIS Index – Clinical Practice Guidelines•Overall Hospital Quality Index (ORYX)

Coordinated Care for Complex Cases

For medically and socially complex patients, establishing partnerships among individuals, families and caregivers, including identifying a family member or friend who will be supported and developed to coordinate services among multiple providers of care.

•MEBs Completed Within 30 Days•MEB Experience Rating•Effectiveness of Care for Complex Medical/Social Problems

24/7 Access to Your Team

Patients are provided information about how to access medical care at any time, 24 hours per day, every day of the year. The Medical Home ensures on-call coverage (pre-arranged access to a clinician) when the Medical Home is not open.

•3rd Available Appointment (Routine / Acute)•Getting Timely Care Rate•Potential Recapturable Primary Care Workload

Personal Relationship with Your Doctor

All patient medical home visits are with the same team which is responsible for providing for all the patient’s health care needs or taking responsibility for appropriately arranging care with other qualified professionals (i.e. whole-person orientation). The physician listens carefully to the patient and, when appropriate the patients caregivers. Compassionate and easy-to-understand instructions are provided about taking care of health concerns.

•Percentage of Visits Where MTF Enrollees See Their PCM•Satisfaction with Health Care

Per Capita Cost

Value-Based Incentives and Reimbursement

Shifting from volume-driven to value-driven health care. Disincentivizing fragmented approaches of care delivery to performance-based payments and enhanced value that can improve health outcomes and decrease costs.

•Impact of Deployments on MTFs•Annual Cost Per Equivalent Life (PMPM)•Enrollee Utilization of Emergency Services

Learning & Growth

Deliver Information to Enable Better Decisions

Improve the Electronic Health Record family of applications and support to create a comprehensive, fast, easy to use, and reliable system that meets the MHS goals of improving quality, safety, readiness, outcomes and customer satisfaction.

•User Assessment of EHR

MHS Contribution to Medical Science

Reducing the research-to-practice divide by focusing the R&D portfolio on the areas that will have the greatest impact on our strategic imperatives.

•Effectiveness in Going from Product to Practice (Translational Research)

Capable Medical Workforce

Ensuring a thorough understanding of the job families most critical to our strategic initiatives and then developing/recruiting the right people.

•Human Capital Readiness•Staff Satisfaction / Team Function

Strategic Imperative Definitions

Mission Outcome Strategic Imperative Definition

Improved Mission Readiness

Individual Medical Readiness

Although we continue our pursuit of all aspects of readiness we will focus on increasing the proportion of the Total Force (Active and Reserve Components) that has a known readiness status and on reducing the rate of deployment limiting conditions.

Increased Resilience and Optimized Human Performance

Psychological Health Improving health outcomes for the 20-30% of OIF/OEF Service member that report some form of psychological stress. Continued focus on research into and adoption of evidence-based care treatments for PTSD and TBI.

Healthy Community / Healthy Behavior

Engaging Patients in Healthy Behaviors

Encouraging and incentivizing patients and families to take a more active role in their health. Promoting a shift from “healthcare to health” by fostering the adoption of healthier lifestyles, particularly the reduction/elimination of tobacco and alcohol usage, increase in physical activity, and improvement in nutrition.

Health Care Quality Evidence-Based Care Transitioning from intuitive medicine to precision medicine through the development, proliferation, and adherence to evidence-based guidelines. Achieving lowest decile performance in the Dartmouth Atlas measures by reducing unwarranted variation.

Effective Medical Transition

Coordinated Care for Complex Cases

For medically and socially complex patients, establishing partnerships among individuals, families and caregivers, including identifying a family member or friend who will be supported and developed to coordinate services among multiple providers of care.

Strategic Imperative Definitions (Cont’d)

Mission Outcome Strategic Imperative Definition

Access to Care 24/7 Access to Your Team

Patients are provided information about how to access medical care at any time, 24 hours per day, every day of the year. Access may be in-person, by phone or by secure messaging using enhanced technology.

Beneficiary Satisfaction

Personal Relationship with Your Doctor

We seek to ensure that all primary care visits are with the same provider or team which is responsible for providing health care needs or arranging care with other qualified professionals. Care is personal, the PCM and the entire team listen carefully to the patient and, when appropriate the patient’s caregivers. Compassionate, individualized and easy-to-understand education is part of every encounter.

Performance Based Management

Value-Based Incentives and Reimbursement

Shifting from volume-driven to value-driven health care by implementing performance-based payments focused on improving health outcomes over time.

Deliver Information to Enable Better Decisions

Functional EHR Improve the Electronic Health Record family of applications to create a comprehensive, fast, easy to use, and reliable system that supports the quadruple aim by enabling better decisions, especially at the point of care.

MHS Contribution to Medical Science

Using Research to Improve Performance

Reducing the research-to-practice divide by focusing the R&D portfolio on the areas that will have the greatest impact on our strategic imperatives.

Capable Medical Workforce

Fully Capable MHS Workforce

Ensuring a thorough understanding of the job families most critical to our strategic initiatives and then developing/recruiting the right people to be a part of our team.