Health Affairs Chief Trumpets TRICARE Successes; Says Much Still to Be Done

Winkenwerder pointed out that, "Tens of thousands of Americans have deployed to the Gulf region; families have bid farewell to their loved ones from almost every naval harbor in the country; 37,000 American soldiers are sitting on point at Camp Bonifas at the Demilitarized Zone and throughout the Korean Peninsula; our reserve component service members continue to join their active duty counterparts in significant numbers as one fighting force."

He noted that military medical professionals at last year's conference set four major goals for the military health system: to improve force health protection and readiness; improve TRICARE; further outreach, coordination and collaboration; and to improve provider recruitment and retention.

Reflecting on performances in achieving these goals and outlining what needs to be done this year, the secretary said, "The most important step we took in 2002 was to restart a strategic planning and governance process for the entire military health system."

Crediting the surgeons general and senior DoD leaders with spending a lot of time putting together a shared vision and strategy for the coming years, Winkenwerder said, "We took a fresh look at what it is we do, those we service, and the values that our service represents and then redefined what is expected of us.

"Much has been accomplished," he added. This, he said, includes the resumption of the anthrax vaccination and initiation of smallpox immunizations.

DoD's top doctor emphasized that only a few critics remain since anthrax vaccinations were resumed in June 2002. "Bad information has been beaten by a military force, including a DoD leadership, better informed about the threats posed by biological agents and a communications effort that has been second to none," he said.

Winkenwerder stood with President Bush on Dec. 13, 2002, when the president announced smallpox vaccinations for military members and first responders in the civilian medical community.

"The Department of Defense immediately initiated vaccination of selected service members," he noted. "As a physician, I know that the smallpox vaccine has a risk profile that merits heightened awareness. But as your assistant secretary of defense for health affairs, I know that our experience with this vaccine sets a standard for safety for the rest of the country and the world. There's no other medical system in the country or on the planet with the documented experience and successful outcomes that we have."

From 1945 to 1990, DoD immunized millions of service members against smallpox and didn't experience any deaths, the doctor emphasized.

"How?" he asked, then answered, "With great professional attention and the finest basic medical care -- careful screening before vaccination and close monitoring after the sticks. While military service members are healthier than the general public, our experience should serve as a guide to the civilian community, and you should take this message back home."

To critics who argue that the threat isn't clear, therefore, the vaccination program isn't necessary, Winkenwerder said, "I can' tell you whether the likelihood of a smallpox attack is 1/10th of 1 percent or 75 percent, but we know that the former Soviet Union weaponized smallpox and produced it in significant quantities.

"We don't know if it's all accounted for," he said. "Others may also have produced and stored it."

Consequently, Winkenwerder said, DoD made the right choice in taking pre-emptive action to protect American troops. "We've attacked and neutralized the top two biological threats against the forces of freedom," he said. "But the work doesn't end with vaccination against anthrax and smallpox. We have much more to do in the coming year to improve protection against a number of biological, chemical and other threats from weapons of mass destruction."

The secretary said the successes were significant in the improvement of TRICARE. Last year's successes include kicking off the TRICARE for Life benefit, fixing computer glitches, and data sharing with Medicare. As a result, he said, "the TRICARE for Life program truly represents and industry benchmark for how to reach out to consumers, including sitting down with people, "one-by-one and telling them how their benefits work.

"This is about trust," he continued, "and you restored that trust. You also enrolled more than 100,000 seniors into TRICARE Plus, providing a health system far superior to the previous 'space-available runaround.'"

Winkenwerder told the audience that quality improvement in TRICARE and patient safety are paramount. More than 50,000 potentially life-threatening adverse drug interactions were prevented in the Pharmacy Data Transaction Service.

"It's fast, accurate and saves lives," he said.

"Another program we're closely monitoring is the TRICARE On-Line initiative," the secretary said. "We're out in front of much of the industry on providing our enrollees and other beneficiaries with quality Web-based support. In the year ahead, we'll deploy TRICARE On-Line to almost all of our military treatment facilities."

The secretary also said TRICARE is launching an obstetrics initiative. "Congress has amended nonavailability statement requirements for women not enrolled in TRICARE Prime, providing expanded patient choice," the doctor said. "We have a story to tell about the high-quality of our obstetric care and about the customer-oriented services we pledge to deliver."

He said DoD is studying the possibility for patients to e-mail and consult electronically with their healthcare providers.

In a final note on TRICARE, Winkenwerder said new contracts were released during summer 2002 that will change the way the program is administered -- for the better. This includes simplifying administration, increasing accountability and improving customer service. TRICARE is also moving from seven contracts to three contracts and from 11 regions in the U.S. to three regions.

"Every one of the issues I raised here is about our leadership responsibility -- greater accountability for performance in quality and optimized facilities; greater simplicity in management and patient administration; and in patients that are pleased with getting their care from their military health system," Winkenwerder said.

"Our beneficiaries also have expectations that their private medical information is secure," he said. Winkenwerder said DoD is tightening security and accountability for all sensitive information, particularly health information.

"We must remember that here in the Department of Defense, electronic and physical security is required to protect our patients, and to promote national security," he said. "We all have responsibilities."