Q&A: Dr. Stephen L. Jones
Health Monitor:
Charting the Course for TRICARE Beneficiaries
Dr. Stephen L. Jones
Principal Deputy Assistant in the Office of Health Affairs
TRICARE
Dr. Stephen L. Jones came to the Department of Defense following 30 years of administrative liaison experience in public, legislative, educational and private settings, and as a consultant in government relations, business development and strategic planning.
Following graduation from college and service in the U.S. Army, Jones became the first full-time director of the Greenville, SC, Commission on Drug Abuse in 1972. He merged that commission with another organization to form the Commission on Drug and Alcohol Abuse. In this role, he administered the county’s programs, managed grant development and lead strategic planning efforts. He left South Carolina in 1974 to become executive assistant to the Honorable Senator Strom Thurmond, and a staff member of the Senate Judiciary Subcommittee for Administrative Practices and Procedures. Following this position, he became chief of staff and administrative assistant for the Representative Thomas F. Hartnett in 1981, and then, in 1982, became chief of staff and administrative assistant to the Honorable James B. Edwards, Department of Energy. At DoE, he assisted the secretary in formulation of department policies on nuclear waste legislation and natural gas deregulation and assisted with the department’s reorganization efforts.
From 1982 to 2001, Jones served as chief of staff for the president and director of Federal and External Relations, and then director of Federal Relations and Economic Development for the Medical University of South Carolina, an academic health science center with a staff and faculty of 8,000, a budget of nearly one billion dollars, five hospitals and other associated outpatient facilities, and a student body of 2,800.
Jones holds a Bachelor of Science degree from Clemson University (1968), a Master of Social Work from the University of South Carolina (1972), and a Doctor of Health Administration from the Medical University of South Carolina (1999). He is a member of the board of directors for the South Carolina Federal Credit Union, the South Carolina Biotechnology Incubation Program and the Scenic Black River Advisory Council. He served as a U.S. Army military intelligence officer from 1968 to 1970, with tours in Washington, DC, and Turkey.
Interviewed by MMT Editor Jeff McKaughan.
Q: How has the level of operational tempo, especially in southwest Asia impacted TRICARE’s ability to manage and maintain its health care services to its members? Has it created any funding, staffing or technology issues?
A: We have not experienced any shortages of services available to our members, either in Southwest Asia or anywhere else, due to an increase in operational tempo. Any funding requirement for increased health care services provided to our members has been fully addressed by the department. In fact, I cannot imagine a more exciting or demanding time to be part of military medicine. The men and women within the Military Health System [MHS] provide health services across the continuum of military operations better than any other health system could ever achieve. We continue to improve and I believe we are shaping a health system that is characterized by tremendous adaptability and is exceptionally responsive to a very complex and volatile national security environment. Our new health care contracts, which we fully implemented in FY 2005, use best-practice principles to enhance quality of care, emphasize patient safety, improve beneficiary satisfaction and control private sector costs.
The department has expanded the TRICARE benefit to offer much-needed coverage to our Reserve members. We launched TRICARE Reserve Select last year; a premium-based health care plan, at very attractive rates, available to eligible members who have been activated for a contingency operation, on or after September 11, 2001. More than 36,000 Reserve component members and their families have already applied for enrollment in TRICARE Reserve Select.
We are beginning the full implementation of the post-deployment health reassessment, another vital tool that monitors the well being of the men and women who serve our country, including reservists and guardsmen. The intent of this program is to help determine the health status of the servicemember with a focus on discovering any readjustment issues or problems. This new disciplined and caring process will reach those who may need help and make a real difference where and when it is needed.
Q: Perhaps more than just the black and white facts of the BRAC, what are the most significant aspects of the realignment as they relate to TRICARE, its providers and members?
A: The BRAC [Base Realignment and Closure] recommendations will improve use and distribution of our facilities nationwide, and profoundly affect health care delivery and medical training across the MHS. The overall intent of the Medical Joint Cross Service Groups recommendations, which were approved by the BRAC Commission, was to reduce excess infrastructure and to align our resources to enhance the quality care for our beneficiaries in the most efficient manner. Three of our multi-service markets—the National Capital Region [NCR], the San Antonio market area and the Colorado Springs market area—will undergo the most innovative and transformational changes as a result of BRAC. Beneficiaries will continue to receive the same amount of care in all three regions. The difference is that the care will be provided within jointly staffed military medical facilities whose infrastructures have been designed and correctly sized to match the population served.
The consolidation of medical centers in the National Capital Area and San Antonio will not only improve operations by reducing unnecessary infrastructure, rationalizing staff, but provide more robust environments to support graduate medical education. The NCR will gain the Walter Reed National Military Medical Center that will offer a world-class setting ideal for providers and patients alike along with expanded capability at Fort Belvoir, to parallel the expanded growth of our beneficiary population into the southern part of market.
With the remaining BRAC actions within the MHS, we found only a small amount of inpatient care being provided at seven hospitals. By discontinuing the inpatient care at those facilities we were able to reduce infrastructure and focus on the delivery of high-quality ambulatory care while maintaining the same amount and quality of care to the beneficiaries through our partnership with the managed-care support contractors. We hope to further grow this partnership through arrangements at some of the locations that allow military providers to provide care to our beneficiaries at participating civilian hospitals within their area. We are also working with the VA to access markets where they have a facility and may provide needed services. The consolidation of medical centers and the elimination of inpatient services at smaller facilities will produce a stronger and more efficient MHS. We are truly shaping our infrastructure and our future.
Q: AHLTA, the Military Health System’s global electronic health record system, has recently been launched. Can you give me an overview of the system, what it replaces and what it means for the future?
A: AHLTA, launched November 21, 2005, is the largest electronic health record system in the nation, serving the 9.2 million MHS beneficiaries. When fully deployed in December 2006, it will provide a centralized repository of beneficiary health information for use by care providers throughout the MHS.
Previously known as CHCS II, AHLTA marks a new era in health care for TRICARE beneficiaries and stands as the single greatest implementation of an EHR [Electronic Health Records] in the nation. AHLTA’s capabilities will ultimately replace MHS legacy systems, including the Composite Health Care System [CHCS], and replace or upgrade the inpatient system solution known as the Clinical Information System. However, the robust, standards-based interoperability provided by AHLTA allows seamless connectivity to our deployed forces, complex medical surveillance capabilities and electronic health data sharing with the Department of Veterans Affairs.
AHLTA’s powerful, patient-centric focus provides support for our beneficiaries and providers with instant access to patients’ health records 24 hours a day, seven days a week. When minutes matter most, this can mean the difference between life and death. It also is a single, complete, legible, life-long, portable health record for beneficiaries—an exceptionally valuable tool for a population that is highly mobile.
AHLTA is also a secure system, allowing only authorized users access, protecting beneficiary data from loss by natural or manmade disaster—an example is Hurricane Katrina. Hundreds of patients who were forced to flee without health records received almost seamless health care, thanks to health care providers being able to access AHLTA. AHLTA includes a medical surveillance capability that allows early intervention for our beneficiaries in the event of disease outbreak.
Finally, AHLTA provides exceptional continuity of care for our military forces from the battlefield to their home stations—and beyond, should they transfer to the VA for care.
AHLTA is leading the way to a significant new era in health care for the MHS and the nation.
Q: Can you identify any technological advances that TRICARE will benefit from in the next 12 months?
A: Other than AHLTA, which we have just discussed, I can identify a number of technological advances.
Information Sharing: DoD and the VA are engaged in a number of information-management and technology initiatives that are significantly enhancing the ability of the departments to securely share health information. These initiatives improve health care delivery to beneficiaries and the continuity of care for those who have served our nation.
Federal Health Information Exchange [FHIE]: Enables the transfer of protected electronic health information from DoD to VA when the service member separates. DoD transmits to VA on a monthly basis: laboratory and radiology results, outpatient pharmacy data, allergy information, discharge summaries, consult reports, admission, disposition and transfer information, elements of the standard ambulatory data records and demographic data on separated service members.
Bi-directional Health Information Exchange [BHIE]: Enables real-time sharing of allergy, outpatient pharmacy, demographic, laboratory and radiology data between DoD and all VA treatment facilities for patients treated in both DoD and VA. BHIE is now operational at Madigan Army Medical Center, William Beaumont Army Medical Center, Eisenhower Army Medical Center, Naval Hospital Great Lakes, Naval Medical Center San Diego, and the National Capital Area to include Walter Reed, Bethesda, Dewitt and others. Deployment to additional sites in FY06 is being coordinated with the services, and local DoD/VA sites.
Pre- and Post-Deployment Health Assessments: Building on the success of FHIE, DoD is now sending electronic pre- and post-deployment health assessment information from the Defense Medical Surveillance System [DMSS] to the VA. The historical data extraction was completed in July 2005 resulting in approximately 400,000 pre- and post-deployment health assessments being sent to the FHIE data repository at the VA Austin Automation Center. Monthly transmission of electronic pre- and post-deployment health assessment data to the FHIE data repository began in September 2005 with the transfer of more than 52,000 pre- and post-deployment health assessments, and an additional 28,000 sent in October. The total number of separated service members with pre- or post-deployment health assessment data sent to the FHIE data repository is over 236,000. VA was scheduled to have the capability to retrieve the data in December 2005. DoD plans to initiate activity to add post-deployment health reassessment information in FY 2006.
Clinical Data Repository/Health Data Repository [CHDR]: Establishes interoperability between DoD’s Clinical Data Repository [CDR] and VA’s Health Data Repository (HDR). The departments successfully tested the exchange of computable outpatient pharmacy and allergy data in a laboratory environment in September 2004. This test demonstrated the ability to do drug-drug and drugallergy checking using outpatient pharmacy and allergy information from both departments. DoD and VA are working on the ability to exchange outpatient pharmacy and medication allergy data on shared patients in the DoD CDR and the VA HDR in FY 2006. This data will be computable allowing the DoD and VA systems to perform drug interaction checking and drug allergy checking. The outpatient pharmacy data being exchanged utilizes DoD Pharmacy Data Transaction Service [PDTS] so that DoD pharmacy data includes military treatment facility pharmacy, retail pharmacy and mail-order pharmacy. Following implementation of pharmacy and allergy domains and the CHDR infrastructure, the work necessary to exchange laboratory data between the repositories will be completed.
Laboratory Data Sharing Initiative [LDSI]: Facilitates the electronic sharing of laboratory order entry and results retrieval between DoD, VA and commercial reference laboratories. LDSI is available for use throughout DoD. It is actively being used daily between DoD and VA at several sites where one department uses the other as a reference lab. Either department may function as the reference lab for the other with electronic orders and results retrieval.
ePrescribing: One of the most significant benefits TRICARE has in the area of patient safety is the real-time integration of individual beneficiary prescription drug profiles from facilities, mail-order and retail pharmacy points of service. The PDTS links prescriptions given to our entire population anytime-anywhere, whether those prescriptions were provided in our hospitals or clinics or through our mail-order system, or in our 54,000 retail network pharmacies. PDTS enhances patient safety and quality of medical care by reducing the likelihood of adverse drug-to-drug interactions, duplicate drugs prescribed to treat same condition, or same drugs obtained from multiple sources. To date, PDTS has identified and resolved more than 158,000 potentially life-threatening drug interactions, and will continue to do so in 2006.
eScheduling: TRICARE’s eHealth program is the leading edge of a revolution in health care that is forging an ever-closer relationship between health care providers, patients and clinical managers. TRICARE Online.com [TOL] provides beneficiaries access, via the internet, to make real-time appointments with primary care providers from anywhere in the world, any time. Beyond eScheduling, TOL also serves as a personal health record, an Rx checker and a source of plentiful, trusted health and wellness information— 18 million pages. Future enhancements for patients include access to tailored information from their Electronic Health Record, secure messaging between themselves and their providers, and self assessments on health issues.
Q: Can you describe the progress and status of the Healthy Choices for Life program? What other initiatives are key to TRICARE’s push to improve health through healthy living?
A: The Healthy Choices for Life program is TRICARE’s foremost initiative to create a DoD culture that values healthy lifestyle choices. The main thrust of this program comprises three new projects: the TRICARE Management Agency [TMA] Tobacco Cessation Demonstration Project, the TMA Weight Management Demonstration Project, and the TMA-supported Alcohol Abuse Prevention Education Pilot Project. Additionally, TMA has implemented marketing campaigns related to tobacco cessation and alcohol abuse prevention. Finally, TMA is involved in several other initiatives that target health lifestyles, including the DoD Alcohol and Tobacco Abuse Council and the White House-directed Interagency Working Group on Obesity and Overweight.
Q: Could you go into a little more detail some of those specific efforts, starting with the tobacco programs?
A: The TRICARE Tobacco Cessation Demonstration Project is a four-state effort that will provide telephone- and internet-based behavioral counseling and includes the optional use of pharmacotherapy. Lockheed Martin and Dallas-based Wellplace Inc. were selected as contractors in September 2005. Outcome metrics include short- and long-term quit rates, utilization rates, patterns of use and total cost of use per participant, provider and program participant feedback and subgroup analysis of effectiveness. Field staff and personnel are presently being selected and recruitment is expected in early 2006.
The Alcohol and Tobacco Abuse Council meets quarterly to discuss TRICARE and the services’ new and continued efforts to reduce tobacco use among active duty personnel.
Finally, TRICARE has instituted a $1 million tobacco cessation marketing campaign. This is a tobacco cessation marketing campaign that conducts social marketing research (i.e., literature review, focus and key information group testing) to develop the most effective messages to reduce tobacco use among active duty personnel. ORC Macro was selected as the contractor in October 2005.
Q: How about the weight management efforts?
A: Healthy Choices TRICARE DeCA collaboration promotes patient education about nutrition and fitness in military commissaries through: commissary tours, shelf talkers, identifying healthier food choices and articles in DeCA newsletters.
NEXCOM Healthy Vendor Program stocks and promotes healthy food items in NEXTCOM vending machines
There is a four-state Weight Management Demonstration Project which will include a telephone/internet behavioral weight-management program and a pharmacotherapy arm. RTI/ Cooper was selected as contractor in September 2005. As of now, study design and materials are being finalized, and field sites and personnel are being selected. Recruitment is expected to begin in early 2006.
The DoD/DVA Obesity and Overweight Clinical Practice Guideline was completed in summer 2005 and is currently being reviewed by services and VA subject-matter experts. This guideline will be coordinated through final approval by DoD and VA in winter 2006.
The Air Force and Army are testing internet weight management interventions for active-duty servicemembers, remote, National Guard and Reserve use. The Air Force new combined weight management and fitness programs have both been well received with increased unit and personal physical activity reported by servicemembers. Each military service has an on-going active-duty multi-disciplinary weight management program for servicemembers.
Finally, the DoD is participating in a White House-directed interagency working group on obesity and overweight.
Q: And how about the alcohol abuse prevention project?
A: The eight-installation Alcohol Abuse Prevention Education Pilot Project is a web-based educational program geared toward active-duty personnel. Research Triangle Institute International was selected as the contractor in September 2005.
Outcome metrics include percentage of participants at 3- and 6-month intervals achieving and maintaining a reduction in binge drinking, heavy drinking, alcohol-related serious consequences and alcohol-related productivity loss. Recruitment is expected to begin in the spring of 2006.
The $1 million Alcohol Abuse Prevention marketing campaign will conduct social marketing research—literature review, focus and key information group testing—to develop the most effective messages to reduce alcohol abuse among active duty personnel. Fleischman-Hillard was selected as the contractor in October 2005.
The Alcohol and Tobacco Abuse Council meets quarterly to discuss TRICARE and services’ new and continued efforts in reducing alcohol use among active duty personnel.
Finally, the Office of the Chief Medical Officer continues to work with HPA&E in developing questions related to tobacco use and weight management for inclusion in the Health Risk Behavior Survey for active duty personnel and their families
Q: SARS was a big concern in recent years, now there is the fear of a pandemic from the avian flu. Have you looked at changing any major component of the health care system to be in a better position to detect, prevent and then treat any large populationwide outbreaks?
A: The DoD has been actively engaged in pandemic influenza planning for a number of years. Although the department has had a pandemic influenza plan since 2004, we are currently revising our plan to facilitate integration with recent national and international planning initiatives. These initiatives include the National Influenza Pandemic Strategy and the Department of Health and Human Services Influenza Pandemic draft plan both released this past November as well as the World Health Organization’s [WHO] revised influenza pandemic plan. Current plans reflect our expanded mission from fighting our nation’s wars to providing support to the nation during times of crisis.
The department continues to participate in interagency global pandemic influenza planning processes with initial emphasis on surveillance and early containment. Current activities are focused to ensure that DoD planning is well-integrated in the overall national response to pandemic influenza. This integration represents both foreign and domestic support roles for the department.
Installations have been tasked with developing pandemic influenza plans that are specific to their locale. Public health emergency officers are in place at each DoD installation with the role of coordinating the installations public health emergency activities both internally as well as interfacing with the local community.
Each combatant command has also been tasked with developing individual pandemic influenza plans. Recently, the Pacific Command conducted a tabletop exercise to assess their plan. This exercise involved a wide range of DoD and interagency representatives at both the local and national level.
DoD has a palette of unique surveillance assets that provides us with both a national and global perspective. Our overseas laboratories are an integral part of pandemic influenza surveillance efforts conducted in conjunction with both the Centers of Disease Control and the WHO. DoD infectious disease research laboratories in Bangkok, Jakarta, Cairo and Peru collect and analyze influenza samples from both American and local national patients from more than 30 countries.
Here in the United States, DoD influenza surveillance activities have and continue to be a significant component in our national influenza surveillance and vaccine development programs. Specimens for the identification and culture of influenza viruses are obtained from DoD beneficiaries in the MHS worldwide, which provides a unique asset for tracking the global and national spread of influenza. We are currently developing an integrated DoD surveillance network that will serve to integrate all of our surveillance efforts into one coordinated activity.
To protect those entrusted in our care, DoD has purchased the antiviral medication, Tamiflu, as well as an avian influenza vaccine. We will begin to receive Tamiflu this December and will preposition it across the globe to ensure ready access to our servicemembers. We are developing guidelines for appropriate use of this limited resource. Supplies of vaccine should be available by the spring of 2006. At this time, we do not plan to administer this vaccine prior to FDA approval. We are also conducting an in-depth assessment of our current assets that might be utilized in response to a pandemic. As deficiencies are recognized, appropriate efforts will be initiated to attain optimal readiness to both preserve our ability to provide for national defense and, if called upon, to support other government agencies.
Pandemic planning is a complex and multi-faceted endeavor. As we progress in our planning activities we have enlisted the assistance of subject-matter experts both within and outside of the department to ensure our provision of the best care possible for our beneficiaries.
Q: Do you look into the future and see a point of concern with regards to the level of services you want to be able to provide to active and retired servicemembers and the level of funding that you anticipate having available? Will there be enough?
A: We continue to monitor the future growth of the cost of health care services in the MHS based on additional beneficiaries using the system, increase in the demand for health care, inflation and the benefits enacted by Congress. To reduce the impact of increasing health care costs we seek to control costs through performancebased budgeting in the military treatment facilities to align resource requirements to health care productivity; established new streamlined TRICARE regional managed-care support contracts for care in the private sector; strengthened the governance of the MHS through the establishment of the TRICARE regional offices to integrate the health care provided in the military treatment facilities and the private sector; partnered with the VA in areas where it is beneficial to share resources and capability; worked with VA on joint procurement opportunities, and established a tiered pharmacy benefit. In addition, the 2005 Base Realignment and Closure Commission recommendations approved by Congress provide the MHS with the opportunity to consolidate key operations and gain efficiencies. It remains our core objective to provide the appropriate level of services to our beneficiaries so that they have accessible, quality, cost-effective health care services. However, as the health care budget within DoD continues to increase at a greater rate than the DoD top line, sound stewardship requires that various options and proposals must be considered.
Q: Do you foresee partnering with civilian health care providers and facilities and a blurring of the lines between then civilian and military health care arenas?
A: Our federal partnership with the VA continues to produce a greater range of joint services. We are working with the VA and are now using the same explicit clinical practice guidelines to improve patient outcomes. We have also modified our current high-cost equipment contracts to open them for use by the other departments. As the current contracts expire, they will be replaced by joint contracts with awards alternating between the departments.
We are also successfully improving seamless care by sending the VA the electronic pre- and post-deployment health assessment information for separated service members. Moving further toward interoperability, DoD and VA continue to develop the Clinical Data Repository/Health Data Repository, which will provide us the ability to exchange computable health information.
The MHS is actively exploring opportunities to increase our partnerships with civilian health care providers and facilities. The objective of this effort is to increase the efficiency of health care delivery and joint force health protection operations by eliminating the barriers that prevent the full use of uniformed and government civilian personnel across services, government agencies and the private sector.
MTFs do not always support the maintenance of all of the clinical skills required for joint force health protection operations. In addition, there may be an imbalance of clinical skills within a market area that can be addressed by sharing resources more broadly across the MHS. Eliminating the barriers that prevent the greater use of military medical personnel across the services and with the private sector will help to maintain and upgrade medical service providers’ skills while reducing costs and potentially boosting health care personnel retention rates. The Defense Business Board Task Force on Healthcare for Military Retirees has also endorsed this approach in their recommendation to enhance the cross-agency commitment between Health and Human Services, the VA, and the MHS; and a separate recommendation to increase outreach to private industry.
We are observing the progress of pilot studies, for example Fort Drum and Newport, which propose more cost-effective options for maintaining clinical proficiency by placing mission-essential personnel in other joint, federal and private sector health care settings.
In addition, we are exploring the potential for DoD to contract for health care and health care management services on a military installation. In certain circumstances, it may be possible for DoD to save money by contracting out health care services on military installations. A contractor could either build and operate a new facility on the installation, or operate from an existing government facility.
Our intent is not to blur the boundary between civilian and military health care but, to use our resources in the most effective and efficient manner to both deliver the TRICARE benefit and provide medical support for the full range of military operations.
Q: How are your people holding up? Attention is always focused on the deployed warfighter, while you have staff deployed and back here that are working tirelessly to provide care and comfort. Has that impacted your retention and recruitment efforts?
A: Over the past year, the DoD has become increasingly involved in humanitarian assistance, disaster relief, stability operations and reconstruction operations around the globe, all while supporting our current military missions in Iraq and Afghanistan. Military medicine has been in the forefront of these activities, bringing our civil-military medicine resources and expertise to the effort. I am very proud of the men and women who serve in the Military Health System; they represent the best in the world and do an extraordinary job ensuring the health of our beneficiaries and many others in need around the globe. The MHS staff is prepared to be in whatever support role that is necessary to ensure our members who are in harms way and their families have available to them any health care services they need. If there has been any limitation in health care services at our military hospitals because of deployed health care providers, we have a vast number of civilian providers in the community who are network providers ready to provide the needed care. At this time, we are not aware of any negative retention or recruitment impacts as a result of the war.
Q: Is there anything else you would like to add?
A: One of the many issues we must address is the rising costs of health care. We currently face the difficult challenge of managing our benefit in a fiscally responsible manner while continuing to provide a very rich benefit for our beneficiaries. Our program has essentially doubled in size in just the past four years, from about $18 billion to more than $37 billion. Further, it now appears that our total budget will exceed $50 billion within the next four to five years. The facts show that the expansion of health benefits, such as those for our senior retirees, underlies this growth—growth that could put today’s operations and sustainment at risk. The expansion of the benefit has also led to an increase in pharmacy costs; our total pharmacy program has increased 500 percent since 2001 to more than $5 billion this year. The current cost growth is not sustainable and will encompass 12 percent of the entire DoD budget by 2015 if left to current trends.
To deal with rising costs, some in the private sector have turned to health savings accounts or consumer-driven plans that reward individuals who manage spending and take greater responsibility for their health. We too must find the solutions that will allow us to sustain a fiscally sound health benefit for all beneficiaries over the long term. The leadership of the department and the military services have agreed—we must find a way to sustain the benefit. To sustain our benefit we must transform it. We anticipate that the transformation process will assist us in identifying and implementing necessary and needed solutions.
We have a singular opportunity to shape the future MHS into the premier health care system in the world. One that excels in cost-effective and quality health care delivery and a health system that provides health services better than any other government or private sector health system in existence today. What does it take to be the best health system on the planet? We must be able to excel at three key missions. The first is to shape a healthy, fit and performance-enhanced military force. The second is to shape and deploy a medically ready force. And the third is to deliver the highest quality health benefit in the world in a cost-effective manner. The counterintuitive aspect of these missions is that the ability to deliver the third mission with all its education and training characteristics directly influences the ability to deploy a medically ready and a healthy, fit military force. To be successful, we must be able to do these three missions better than anyone— each are interdependent and cannot be separated into its component parts.
Given the complexities we face, the nature of our national security threats, we must embark on truly transformational change. This type of change is disruptive, extremely difficult, yet imperative if we are to succeed. Specifically, we must transform the force, transform the business, transform the benefit, and transform the infrastructure to realize our vision. The process is designed to provide the armed forces with world class operational medicine capabilities while delivering the outstanding TRICARE benefit to our beneficiaries. Secretary Rumsfeld has described transformation as “a process that shapes the changing nature of military competition and cooperation through new combinations of concepts, capabilities, people and organizations that exploit our nation’s advantages and protect against our asymmetric vulnerabilities to sustain our strategic positions, which underpin peace and stability,” We are not alone in undergoing this transformation; in fact the entire department is participating in a transformation process to make the U.S. military an elite fighting force that is both efficient and effective.
In closing, let me say what an honor it is to serve our nation by working in DoD and health affairs. Our leadership is exceptional, our health care providers are skilled and dedicated, and those we serve have accepted the challenge to protect our nation and advance freedom around the world. It is a privilege to be associated with such a team. With the continued interest and support of our efforts in Congress, I know that great things are coming on the path ahead for our MHS staff and our beneficiaries.
Also, thank you for allowing me to address your questions and to provide your readers with a few of the issues the MHS is ♦