Health Care Champion
Interview with
S. Ward Casscells, M.D.
Assistant Secretary of Defense
for Health Affairs
Prior to his appointment as Assistant Secretary of Defense for Health Affairs on April 16, 2007, Casscells served as the John Edward Tyson Distinguished Professor of Medicine (cardiology) and Public Health at the University of Texas Health Science Center in Houston.
He was also the director of clinical research at the Texas Heart Institute, where his clinical practice and research programs, in collaboration with James T. Willerson, M.D., focused on prevention of heart attack and stroke using advanced diagnostic techniques to identify vulnerable patients early, so that treatment with lifestyle changes and medications decrease heart attack, stroke and need for surgery. In collaboration with colleagues John Mendelsohn, M.D. and Juri Gelovani, M.D. at M.D. Anderson Cancer Center, they established CABIR, the Center for Advanced Biomedical Imaging Research.
Casscells received the B.S. in biology (cum laude) from Yale in 1974, and the M.D. (magna cum laude) from Harvard Medical School in 1979. His residency in medicine was at the Beth Israel Hospital and Harvard Community Health Plan, and his cardiology fellowship at Massachusetts General Hospital, with a Kaiser Fellowship in clinical epidemiology at the Harvard School of Public Health.
From 1985 to 1991, Dr. Casscells served in the Cardiology Branch at the National Institutes of Health, followed by a sabbatical year at Scripps Institutes of Medicine and Science in La Jolla, California working under Nobel Laureate Roger Guillemin, M.D., Ph.D.
Dr. Casscells joined the University of Texas at Houston in 1992. From 1994 to 2000 he served as the Levy Professor and Chief of Cardiology at UT-Houston Medical School and Memorial Hermann Hospital.
Casscells served from 1992 to 2004 on the Board of Directors or Advisory Board of the American Heart Association’s Houston affiliate.
In 1997 Dr. Casscells was elected to the Association of University Cardiologists, and in 2000 to the American Clinical and Climatological Association. In January 2001 he was appointed to President Bush’s Healthcare Advisory Committee. In 2001 he received the first CIMIT award from Harvard Medical School, Massachusetts General Hospital and MIT.
The founding chairman of Defense Of Houston, which won the 2002 Best Practice Award from the U.S. Department of Health and Human Services, Casscells also led the U.S. Army’s T5 program.
Casscells has served on numerous local, state and national commissions on biosecurity. In 2004 he established the UT-Zogby poll on health issues. He was the medical honoree of the 2005 American Heart Association’s Heart Ball in Houston.
A colonel in the U.S. Army Reserve, Casscells was mobilized in 2005 and assisted in the Army’s response to Hurricanes Katrina and Rita, for which he was awarded the Army Achievement Medal. For guiding the Army’s avian influenza preparedness, he received the Meritorious Service Medal. In 2006 he was deployed to Iraq as the liaison from Multinational Force-Iraq to Ambassador Zalmay Khalilzad. He received the Joint Service Commendation Medal, and was made an Honorary Member of the Iraqi Medical Regiment.
Q: Good morning. With the recent Military Health System conference in January acting as a benchmark, have there been any significant accomplishments in the past 12 months? Looking in the other direction, what would you characterize as the most significant challenges that MHS faces in the coming 12 months?
A: Looking back, I know that part of our system of care failed, particularly, the disability evaluation process, our oversight of wounded service members in outpatient settings and our coordination shortcomings with the Department of Veterans Affairs [VA]. Since I arrived in April 2007, we have made substantive organizational policy and process changes to rectify the shortfalls. We are hiring, training and empowering case managers and patient advocates to ensure that every wounded warrior receives the right care at the right time, and that he or she receives all of the support necessary to heal properly. In addition, we are greatly expanding our mental health services and private sector support. We are committed to a partnership with the VA that ensures seamless treatment for all our wounded veterans. In December 2007, we announced the enterprisewide release of enhancements to the systems that allows DoD to share electronic health information with the VA, namely the Bidirectional Health Information Exchange and the Clinical Data Repository/Health Data Repository interfaces.
Our medical teams in the combat theaters, aeromedical evacuation, at sea and here at home perform heroically and historically. We measure their success in lives saved, reduced injury and illness, and simple acts of bravery and sacrifice. The care we deliver from the moment of injury or illness and throughout the journey back to home-station is unparalleled in the history of military medicine.
On the worldwide humanitarian front, our medics responded to the call quickly and effectively in Bangladesh, following the November 2007 typhoon. Over the summer, the USNS Comfort visited 12 Central American, South American and Caribbean countries where its medical crew provided free health care services to communities in need. The mission offered valuable training to U.S. military personnel while promoting U.S. goodwill in the region. In all, the civilian and military medical team treated more than 98,000 patients, provided 380,000 treatments, and performed 1,170 surgeries. These medical efforts showcase the finest attributes of the American military to citizens throughout the world.
Looking forward to 2008, we will not rest. Military medicine is not a 9-to-5 workplace. We continue to run a health system that serves 9.1 million Americans; forward deploys medics into combat theaters; engages in worldwide humanitarian and disaster relief; conducts medical research on everything from combat medicine to prostate cancer to vaccines to tropical medicine; operates a medical education system that graduates 28 percent of our military physicians, and trains nurses, medical technicians and other health care professionals; functions as an environmental and public health agency testing water, air and the ground for natural and man-made threats; and does this with an all-volunteer force.
In the coming year, we will offer even greater integration with the VA, as we near a decision on development of a joint inpatient health record. In addition to our medical staff and technicians, in 2008 we will introduce greater tools for our patients, so they can become even better managers of their own health. The better informed our patients are, the better off they will be. In our relationships with our private sector partners, we will award new health care contracts that build on the successes of the past while taking advantage of new ideas gleaned both from our own military medical commanders and the private sector.
This coming year represents an opportunity to renew our compact with the people we serve, make important advances in combat effectiveness, quality of care, technology insertion, and improved health for our beneficiaries. In addition, we will further the security of our nation through medical engagement throughout the world.
We will spend more than $43 billion from the defense budget on health care for our servicemembers, families and the people who served before them. Our challenge will be to sustain the excellence in our people to achieve the best outcomes for our beneficiaries. Our challenge is always to uphold the heritage and distinction of the Military Health System.
Q: With the level of injured warfighters coming back from Iraq, Afghanistan and elsewhere from the war of terror, what are the projections of the long-term health care costs for them and their families? The projections seem to indicate that the financial costs will become a significant percentage of the overall budget, perhaps drawing funding away from R&D and acquisition. How are some of these long-term issues being addressed?
A: Frankly, we do not yet have good estimates of what the long-term costs will be. Many of the health issues our wounded warriors face are slow to emerge and are extremely complex to fully evaluate and treat. Congress has been very generous in providing us with the resources we need to accurately identify all injuries and to develop new treatment modalities, but it will take some time to determine the efficacy of these new treatments and to identify their associated costs. Fortunately, Congress has seen fit to provide these funds through supplemental appropriations, and the department has not had to reduce other portions of its budget request in order to fund these critical requirements.
DoD and VA are working together to address these issues through a senior oversight committee [SOC], co-chaired by the deputy secretaries of each department. The SOC is developing implementation plans and future funding requirements for eight “lines of action” that address such issues as the disability system, case management, data sharing between the departments, facilities requirements, personnel and pay support, among other issues, as well as such wounded warrior health issues as traumatic brain injury and psychological health. The recommendations and decisions from this group are being implemented now and will drive future funding requests for both departments.
One example is our new Defense Center of Excellence for Psychological Health and Traumatic Brain Injury. This center will integrate quality programs and advanced medical technology to give us unprecedented expertise in dealing with psychological health and traumatic brain injuries. In developing the national collaborative network, the center will coordinate existing medical, academic, research and advocacy assets within the services, with those of the VA and Health and Human Services, other federal, state and local agencies, as well as academic institutions. The center will lead a national collaborative network to advance and disseminate psychological health and traumatic brain injury knowledge, enhance clinical and management approaches, and facilitate other vital services to best serve the urgent and enduring needs of our wounded warriors and their families.
Q: What are the issues most in need of addressing when it comes to the handover of servicemembers from the military health system to the VA?
A: The most pressing issues are being covered by the SOC and the DoD/VA Executive Councils. These senior-level people are looking at the recommendations from the various reports, such as the President’s Commission on Care for America’s Returning Wounded Warriors [Dole/Shalala] and the GAO [Government Accountability Office]. We are looking at eight main categories:
- The Disability System
- Psychological Health and Specialized Care
- Case Management
- DoD/VA Data Sharing
- Facilities
- Continuous Process Improvement
- Benefits and Staffing
- Legislation and Public Affairs
We currently have a pilot program in place to improve the disability process and implement one system that is jointly administered by both organizations. Our goal is to create a process that requires one exam and one rating, binding by both DoD and VA within current law. The new Disability Evaluation System pilot program, which began in late November, will provide smoother post-separation transition for veterans and their families—including medical treatment, evaluation and delivery of compensation, benefits and entitlements.
DoD and the VA have begun to improve the system of care for psychological health and traumatic brain injuries through comprehensive care and treatment, as well as focused clinical research, prevention, education and patient/family support. We need to remember that we have some amazing resources already available to us at the VA. There is already an abundance of research on such issues as TBI and PTSD that we can use to help improve the care we provide.
We are working to improve case management and standardize the delivery of care across the continuum—from illness or injury to recovery and beyond. We have started the process of hiring federal recovery care coordinators and signed an agreement in late October to work with the VA to hire coordinators together. The VA will provide the first group of federal recovery coordinators and will assign them to select military treatment facilities throughout the nation. The recovery coordinators will support existing military service and veteran programs and coordinate needed services between DoD, VA, state, private and voluntary organizations. This program is designed to be a life-long resource for wounded, ill and injured and their families who may have concerns about federal services or benefits.
DoD and the VA have made tremendous progress in our ability to share electronic health information, which greatly improves continuity of care for our wounded warriors and beneficiaries. VA is now able to view data—including outpatient prescription data, outpatient and inpatient laboratory and radiology reports, and allergy information on patients treated by both DoD and VA—from all DoD sites. Additionally, DoD providers can now view VA health data on shared patients through AHLTA.
In another step forward, theater clinical data are now viewable by all VA providers. This includes inpatient notes, outpatient encounters and ancillary clinical data (pharmacy data, allergies, laboratory results, radiology reports). Severely wounded, injured and ill servicemembers being transferred as inpatients from Walter Reed Army Medical Center, National Naval Medical Center Bethesda and Brooke Army Medical Center to VA polytrauma centers located in Tampa, Minneapolis, Richmond and Palo Alto now have digital radiographs and scanned medical records sent electronically prior to their transfer. With a focus on further improvements, DoD/VA subject matter experts have developed high-level requirements and plans for a pilot project to electronically exchange digital radiographs and other images, including those from theater.
The number of shared patients for whom DoD and VA sites exchange outpatient pharmacy and medication allergy data expanded from 3,770 to over 12,000. The information is exchanged in a format that supports drug-drug and drug-allergy interaction checking using the data from both departments. DoD continues to transfer electronic pre- and post-deployment health assessments, as well as post-deployment health reassessments on separated servicemembers and demobilized Reserve and National Guard members who have been deployed. We have increased the number of forms transferred from 1.5 million in February 2007 to more than 2 million in October 2007. We have increased the number of individuals with forms transferred from 640,000 in February 2007 to more than 811,000 in October 2007.
DoD has also made discharge summaries available to VA from 13 of DoD’s largest inpatient facilities. DoD/VA awarded a contract and began work to assess the requirements and best approach for a joint inpatient electronic health record that will ensure high-quality clinical care for the servicemember across the continuum of care, from the battlefield to the VA. DoD and VA continue to look for new ways that health information technology can benefit transitioning servicemembers. As we move forward, our goal remains to provide the best care possible for the men and women who serve and have served in our nation’s military.
We are identifying areas of opportunity for joint operations and facilities, including the federal facility in North Chicago. Both departments have demonstrated that joint operations and resource sharing improve the effectiveness and efficiency of health care services and benefits to veterans, servicemembers, military retirees and eligible dependents. We currently have a work group looking at the opportunities to expand sharing in multi-service market areas.
Q: From a budget perspective, how is the MHS budget projected to fare in the next few years, especially regarding research and development, and procurement? With the funds needed to take care of the expanding veterans base growing as the war-wounded population grows, is your budget growing to keep pace or will other services have to be curtailed to fund those expenses?
A: In the near term, the cost of care for wounded warriors is funded in addition to the base line Defense Health Program budget. The department has not yet determined how these funding issues will be addressed in future years, but I do not anticipate that other health care services will have to be reduced in order to care for our wounded warriors. I am especially interested in our medical research and development efforts and will work with the department leadership to ensure that we are appropriately funded to identify and treat servicemembers who suffer from psychological health issues and traumatic brain injury from the global war on terror.
Q: Are there areas where you believe that the military is setting the bar in medical research?
A: Absolutely! Research and medical publications—articles from peer-reviewed medical and scientific journals—are a vital part of the Military Health System. We have a medical research and development portfolio that continues to provide groundbreaking medical advances across the medical spectrum to our combatant commanders and servicemembers, as well as the nation as a whole. We are making advances in trauma medicine, malaria vaccine, cancer research and hundreds of other areas that will improve the lives and health of all Americans and citizens of the world.
We are re-investing in our research infrastructure, and we are increasing our collaboration with our federal partners in the VA, Health and Human Services, Homeland Security and Agriculture. Much of this is quite evident at our federal bio-defense campus that is expanding at Fort Detrick, Md., but it is taking place in federal facilities here in the United States and in our overseas laboratories.
The Telemedicine and Advanced Technology Research Center [TATRC] is leading the way in several medical technology fields, including development of a Web-enabled eye surgery system, electronic dog tags and autonomous casualty care robots” for the field. TATRC has been exploring and implementing telemedicine and other advanced medical technology solutions for more than 15 years. Currently, TATRC manages more than $250 million annually, primarily through congressional special-interest funding, and has expanded from its original office at Fort Detrick, Md., to a more global presence with offices in Georgia, California, Hawaii and Europe. Equally important has been TATRC’s partnership with numerous universities, commercial enterprises and other federal agencies that support approximately 500 ongoing research projects. TATRC’s vision is to create opportunities for technology transfer to the public sector and the battlefield. The Congressionally Directed Medical Research Programs [CDMRP] originated from a unique partnership among the public, Congress, and DoD. Grassroots advocacy organizations provided much of the impetus that led to a fiscal 1992 appropriation of $25 million targeted to funding research on the screening and diagnosis of breast cancer among military women and dependents. In response to continuing public requests led by the National Breast Cancer Coalition, Congress appropriated an additional $210 million in fiscal 1993. Since that time, the CDMRP has expanded to become second only to the National Cancer Institute as a source of funding for breast cancer research. After noteworthy success in managing the research program in breast cancer, we tasked the CDMRP to manage research programs in neurofibromatosis, prostate cancer, ovarian cancer, tuberous sclerosis complex, chronic myelogenous leukemia, and prion diseases, as well as other specified areas.
The Military Infectious Diseases Research Program [MIDRP] is charged with protecting the U.S. military against naturally occurring infectious diseases via the development of the U.S. Food and Drug Administration approved vaccines, drugs, and diagnostic assays and U.S. Environmental Protection Agency approved vector control protection systems [to prevent transmission of infections by insects, ticks, etc.] The Military Health System has had notable successes in this undertaking [since World War I, deaths from naturally occurring infections have not exceeded deaths due to combat injury in wartime]. MIDRP’s role continues to be important because such diseases as malaria, dengue, diarrhea and leishmaniasis have an adverse impact on military operations and the health of servicemembers.
MIDRP has supported HIV vaccine research and development since 1985, as HIV remains a significant threat to servicemembers deployed overseas and is a major source of regional instability in areas of U.S. force protection. The MIDRP HIV research program is heavily leveraged against efforts of other U.S. government agencies. National Institute of Allergy and Infectious Diseases is a major partner of MIDRP supported HIV vaccine development activities.
The DoD Deployment Health Clinical Center [DHCC] seeks to improve deployment health through optimizing deployment-related health care across the Military Health System. The DHCC uses a three-pronged strategy which includes clinical and health services research aimed at advancing the effective delivery of deployment-related health care. DHCC’s deployment-related clinical research is extramurally funded and self-sustaining. DHCC has successfully completed a wide range of projects that put science behind post-deployment health care delivery process improvement. Projects are competitively funded by the Centers for Disease Control and Prevention, the VA, DoD and the National Institute on Aging. DHCC’s scientists and staff complete scientifically credible work and publish regularly in peer-reviewed medical journals.
The Uniformed Services University’s nationally ranked military and civilian faculty conduct cutting-edge research in the biomedical sciences and in areas specific to the DoD health care mission, such as combat casualty, infectious diseases and radiation biology. The university is committed to technology transfer to ensure that the results of research are made widely available. The university currently holds more than 289 patents or pending patents.
The Naval Health Research Center [NHRC] serves as a leading medical research laboratory for DoD and the U.S. Navy. NHRC manages operational medicine research, development, test and evaluation programs for Naval Medical Research Command, Silver Spring, Md. [echelon IV], Naval Medicine Support Command, Jacksonville, Fla. [echelon III], and the Navy’s Bureau of Medicine and Surgery [BUMED, echelon II]. As the military operational medicine research leader for the Navy, NHRC promotes, protects, and maintains the health of Navy and Marine Corps personnel and beneficiaries through biomedical research and support of medical readiness. NHRC provides oversight for commands and detachment laboratories at: Naval Submarine Medical Research Laboratory, Groton, Conn.; NHRC detachment Naval Aerospace Medical Research Laboratory, Pensacola, Fla.; NHRC Detachment Environmental Health Effects Laboratory, Wright Patterson Air Force Base, Ohio; and NHRC Detachment Directed Energy Bioeffects Laboratory, Brooks City-Base, Texas.
As we look to the future, we know that PTSD and TBI are significant medical issues that require greater research, and Congress has been supportive of increased funding in this arena. But, DoD has already conducted ground-breaking research into these issues. We have been exceptionally forthright and transparent in what our clinical experts and researchers have found. We continue to update the health literature with our findings on pre- and post-deployment health. Our medical research teams are working to accelerate the bench-to-battlefield timelines so that we can take research findings and introduce new products, devices and clinical guidelines and put them into practice quickly and safely. I think we have an exceptional story to tell about our research activities.
Q: A lot has been written about recruitment and retention in the armed forces. Have those issues been mirrored in the military health services sectors? Is the draw to a civilian career creating staffing issues and retention problems? To continue along this same line, are incentives useful tools to retention?
A: Yes, there is a reason the private sector looks favorably to hire military veterans and retirees. Our system produces leaders at all levels. Combining both ethical and action-oriented decision-making traits, our military medical personnel represent the best this country has to offer. In the midst of our war on terrorism, it is more challenging for us to retain these trained and capable leaders. Recruitment of new personnel is also a challenge. We need to sustain the quality work force that is in place today. This year, the Congress has provided us with a new set of tools to address both recruitment and retention shortfalls, particularly among physicians, nurses and dentists.
We will use the financial incentives to help us in our efforts, but we all know that the decision to join or stay in the military is more than a matter of money. A sense of duty; a commitment to public service, and the ability to make a difference are critically important. Family circumstances and family happiness also matter. The Department is making investments in programs, people and families so we can keep those who truly want to stay.
Finally, on this subject, I want to emphasize that every person serving, and every one who has previously served in the Military Health System—whether in uniform or not—is a recruiter. Our experiences, our shared stories and our belief in the military will serve as differentiators for those who might follow, and will determine the quality of the next generation of our volunteer force. Together with the surgeons general, our entire leadership is dedicated to aggressively expanding our outreach efforts in our medical recruitment strategy.
Q: Is the Uniformed Services University looked at as one of the tools that helps attract the medical professional to military service?
A: Yes, USU is a superb institution and critical to the Military Health System. Of the 3,912 physician alumni, more than 75 percent currently serve on active duty in the Army, Navy, Air Force and U.S. Public Health Service. USU also awards doctoral and master’s degrees in the biomedical sciences and public health.
The F. Edward Hébert School of Medicine has a year-round, four-year curriculum that is nearly 700 hours longer than programs at other U.S. medical schools. These extra hours focus on subjects that relate to the unique requirements of career-oriented military and public health physicians. Doctoral and master’s degrees in the biomedical sciences and public health are awarded by interdisciplinary and department-based graduate programs within the School of Medicine. The Graduate School of Nursing offers a Master of Science in Nursing degree in nurse anesthesia, family nurse practitioner, perioperative nursing, and a Ph.D. degree in nursing science. Program strengths include infectious disease, neuroscience, psychology and preventive medicine research.
Students attending USU can focus on their education without the worry of incurring debt. Medical students enter the university as commissioned officers in one of the four uniformed services: Army, Navy, Air Force or Public Health Service. No prior service is required for admission to USU. Students pay no tuition or fees and, in fact, receive the full salary and benefits of a uniformed officer throughout their four years at the university in exchange for a seven-year active duty service commitment. Students in the Graduate Programs are a mix of both civilians and uniformed officers. They also pay no tuition or fees.
Civilian students may receive stipends, and uniformed graduate students continue to receive their active duty pay and benefits while attending school at USU. The Graduate School of Nursing students are all active duty uniformed nurses or nurses in federal civilian service. Neither pay tuition or fees at USU, and both continue to receive their regular salaries while students at the university.
Q: I understand that Army nurses began a pilot program with the University of Maryland School of Nursing to address the nationwide nursing shortage. Can you tell me how the program came about and are other similar programs being considered?
A: The Army and the University of Maryland School of Nursing have been working together since 1964 when the Army established the Walter Reed Army Institute of Nursing as a program under the University of Maryland School of Nursing.
More than 1,000 military nurses have graduated from the school including Major General Gale Pollock [BSN 1976, MBA, MHA, MS, CRNA, RN, FACHE], former acting Army surgeon general and current chief of the Army Nurse Corps [ANC]. Major General Pollock and Dean Janet Allan of The School of Nursing came up with the idea for the collaboration while discussing the U.S. nursing shortage. The nursing shortage is exacerbated by a lack of faculty, so the superbly trained and experienced Army nurses take on the role as faculty. The pilot program calls for up to eight ANC officers to act as undergraduate faculty, at no cost to the school, for a maximum of two academic years. Army nurses will be role models for student nurses who want to serve with the best, so the program will assist with recruiting. In addition, many of the nurses in the ANC want to teach and serve as faculty; therefore, an option such as this serves as an excellent retention tool. The pilot is too new to evaluate for success, as it began in June 2007.
Q: Although it’s a huge subject, what are the current bullets on BRAC progress? How are the major efforts proceeding? Are there any projects that are encountering difficulties or obstacles to progress?
A: These are exciting times in BRAC. The Clinical Base Realignment and Closures program, or Clinical BRAC, as we call it, is one of the largest and most complex undertakings in the entire BRAC portfolio.
Over the next three and a half years, this $3 billion program will build major new health care facilities in the National Capital Region [NCR] and San Antonio [SAT] while streamlining other facilities around the country. More important, as we build these new facilities, we are building a new paradigm for delivering military health care. BRAC was always intended to make our system more efficient, more joint and more sustainable. But we are going far beyond that. We are leveraging our BRAC investments to reset the military health system—to create world-class healing environments that advance the state of the art in caring for our nation’s wounded, empower patients and families and provide a superior workplace to attract and retain the best medical professionals in the world.
In San Antonio we are merging the world-renowned Brooke Army Medical Center and revered Wilford Hall Medical Center to create a single system with its hub at the new San Antonio Military Medical Center at Fort Sam Houston, Texas. At Keesler Air Force Base, Miss., by partnering with the Veteran’s Administration and sharing key services, we will convert the medical center into a robust community hospital. Elsewhere around the country, we are streamlining several smaller hospitals and converting them to ambulatory-care facilities. In the nation’s capital, we are combining two of the world’s preeminent medical institutions—the Walter Reed Army Medical Center and the National Naval Medical Center—into the single most powerful military medical platform in the world—the new Walter Reed National Military Medical Center at Bethesda.
As we design and build these new hospitals, we are no longer satisfied with facilities that are merely adequate—they have to be excellent! They have to be competitive. They have to create an unrivaled healing environment that brings out the best in our warriors, our families and our medical staff—fostering, protecting, sustaining and restoring health.
We have studied best practices in the private sector and collected the latest standards in evidence-based design (EBD) and environmentally friendly principles to develop an entirely new standard in health care design. We are using research and evidence to create patient-centered environments that are safer, therapeutic, supportive of family involvement, efficient for staff performance and restorative for workers under stress. For example, we know—from research—that private patient bedrooms with space for families increase social support, improve patient privacy, and improve patient sleep and speed the healing process. The evidence also tells us that high efficiency particulate air filters reduce airborne hospital-acquired infection rates. And we’ve learned that natural light and a connection to the nature reduce patient and family stress, and reduce staff fatigue. These are just a few evidence-based design principles that we are incorporating in our standards.
In the past year we have made major advances in the Clinical BRAC program in the National Capital Region, enhancing and accelerating the construction of the new Walter Reed National Military Medical Center at Bethesda, Md., and the new Community Hospital at Fort Belvoir, Va. With very generous support from Congress and others, we added nearly $700 million to the program to make these facilities truly world class and deliver them as fast as possible. Construction of the new community hospital is under way at Fort Belvoir. Bids are in on the construction contract for the Walter Reed National Military Medical Center and an award is imminent with construction expected to start in May 2008. The construction contract for the San Antonio Military Medical Center is out for bid with an expected award in the spring 2008. We are under way and on schedule thanks to a shared vision and the efforts of many.
I want to emphasize that implementing a program of this magnitude, complexity and far-reaching impact takes a tremendous amount of hard work, skill and creativity from everyone. It takes a coordinated team effort from the line Army, Navy, Air Force and Marine Corps, the service medical departments, the engineering community, the Veterans Administration, our private sector, philanthropic and local community partners and many others. We have enjoyed tremendous support from Congress throughout this process, in terms of the construction programs and in terms of supporting the highest quality health care throughout our system.
The communities that surround these new facilities have been extremely supportive, and we are working with them to minimize traffic and other challenges that come with these important new medical capabilities. They should all know—everyone who has been working to make this succeed—that we are enormously grateful for their support and hard work. They are part of something that is really bigger than all of us—something that will stand for generations, an achievement of which we will all be justifiably proud. These new facilities are the backbone of a new kind of military medicine that will be the envy of the world.
Q: Is there anything else you would like to add?
A: I would be remiss if I did not mention our new Website. The Military Health System is now using an interactive, revamped Website—www.health.mil—to share information between military medical personnel and other government agencies and organizations outside the government.
The site is a way to create a partnership for health that brings the servicemembers and family, the military leader and the medical provider-planner together with the objective of patient-focused health care. Visitors to the site can post comments, take surveys, watch Web cams, subscribe to podcasts and read unfiltered opinion from MHS leaders on our blog. They may find out about special events, educate themselves about important healthy lifestyle changes, and watch videos about the latest health care updates. Troops can use the site to post a comment about real-life experiences at military hospitals, military health care students can watch a podcast to prepare for a pandemic flu outbreak, and a health care specialist can read the diary of a senior Defense Department policy maker.
Finally, this coming year represents an opportunity to renew our compact with the people we serve, and to make important advances in combat effectiveness, quality care, technology insertion, improved health for our beneficiaries and the security of our nation through medical engagement around the world. I am the coach of a team with great potential. It is my job to unlock the potential our military medical forces do not know they have. ♦