The Military Health System (MHS) continually evolves to meet the needs of the force. In recent years, the MHS has responded to the high operating tempo and deployment cycle needs of service members and their families. Encompassing care through the pre-deployment, post-deployment and reintegration stages, the MHS readied itself for the significant increase in medical readiness requirements and rehabilitative care needs of service members due to contingency operations.
Recognizing the changing needs of the force, in 2007, President George W. Bush formed the Commission on Care for America’s Returning Wounded Warriors (Dole-Shalala Commission) and a Presidential Task Force on Returning Global War on Terror Heroes to examine the increasing prevalence of mental health conditions and issues surrounding the quality of care at MTFs. Following these reports and recommendations, the 2008 National Defense Authorization Act (NDAA) provided a congressional mandate for the creation of centers of excellence for the prevention, diagnosis, mitigation, treatment and rehabilitation of PTSD and TBI within DoD which resulted in the creation of the Defense Centers of Excellence for Psychological Health and Traumatic Brain Injury (DCoE).
In June 2011, the deputy secretary of defense chartered an MHS Governance Task Force to review the current MHS structure and provide options for governance of the multi-service models as well as the NCR health system. Based on the final report, the deputy secretary of defense issued a March 2012 memorandum titled “Implementation of Military Health System Governance Reform.” This memorandum delineated a new governance structure that separated policy making from execution while improving coordination of the MHS.
Military Health System
The overarching goals of the MHS are defined in the Quadruple Aim model which guides its current strategy:
Increased Readiness
Ensuring the total military force is medically ready to deploy and the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions.
Better Health
Moving “from health care to health” by reducing generators of ill health by encouraging healthy behaviors and reducing the likelihood of illness through focused prevention and the development of increased resilience.
Better Care
Providing a care experience that is safe, timely, effective, efficient, equitable, and patient and family centered.
Lower Cost
Creating value by focusing on quality, eliminating waste, and reducing unwarranted variation; we will consider the total cost of care over time, not just the cost of an individual health care activity. There are both near-term opportunities to become more agile in our decision making and longer-term opportunities to change the trajectory of cost growth through a healthier population.
Defense Health Agency
In October 2013, as part of this initiative, DoD established the Defense Health Agency (DHA) to manage the activities of the MHS.
The aim of DHA is to provide a “joint, integrated Combat Support Agency that enables the Army, Navy, and Air Force medical services to provide a medically ready force and ready medical force to Combatant Commands in both peacetime and wartime.”[1]
The DHA director is Vice Admiral Raquel C. Bono. Her three priorities for DHA include:
- Enhance our relationship with the services
- Evolve and mature our understanding of what it means to be a Combat Support Agency
- Optimize DHA operations
Strategic Direction
The MHS strategic direction shapes and influences care delivery, resources and priorities and is derived from several sources including:
- Executive Actions and National Defense Authorization Acts (NDAA)
- Recommendations from Federal Agencies including:
- Congressional Reports [2]
- Congressional reports originate from congressional committees and deal with proposed legislation and issues under investigation. There are two types of reports:
- House and Senate Reports: Reports of congressional committees concerning proposed legislation and/or contain findings on matters under investigation.
- Senate Executive Reports: Reports of the Committee on Foreign Relations relating to treaties between the United States and foreign nations which have been submitted to the U.S. Senate for ratification, or are reports of various Senate committees regarding nomination of individuals.
- Congressional reports originate from congressional committees and deal with proposed legislation and issues under investigation. There are two types of reports:
- Interagency collaboration between DoD and the Department of Veterans Affairs (VA)
- Integrated Mental Health Strategy
- Interagency Task Force on Military and Veterans Mental Health
- Cross-Agency Priority Goal
References
[2] The Defense Health Agency: Reflections on Our First Year and Future. (2014) Retrieved from http://www.health.mil/~/media/MHS/Report%20Files/DHA%20One%20Year%20Report_Final_508%20Compliant.ashx; Reports to Congress – Congressional activities and legislative priorities of the Assistant Secretary of Defense for Health Affairs [ASD(HA)] and the Defense Health Agency Director. Retrieved from http://health.mil/About-MHS/Defense-Health-Agency/Special-Staff/Congressional-Relations/Reports-to-Congress.