Brigadier General W. Bryan Gamble
Deputy Director

TRICARE Management Activity

 

Brigadier General W. Bryan Gamble assumed the duties of deputy director, TRICARE Management Activity (TMA) in October 2011.

Gamble commanded the Dwight D. Eisenhower Army Medical Center, Fort Gordon, Ga., from July 2009 to October 2011, and served as commander, Southeastern Regional Medical Command, from July 2009 to October 2009. During this tour, he increased patient satisfaction, improved support for the rehabilitation of wounded, ill and injured servicemembers in collaboration with the Department of Veterans Affairs, established a pilot site for reserve component integrated physical disability processing, and established an integrated approach for inpatient drug/alcohol rehabilitation, pain management, post-traumatic stress/traumatic brain injury care and physical/occupational therapy—the Fortitude Center concept. Gamble concurrently served as deputy commander, Southern Regional Medical Command and Readiness from October 2009 to October 2011 while commander of Dwight D. Eisenhower Army Medical Center.

Gamble’s distinguished U.S. Army medical career began in 1987 with his first assignment to Bassett Army Community Hospital as a general surgeon. In 1989, he began training in plastic and reconstructive surgery at Walter Reed Army Medical Center and deployed with the 85th Evacuation Hospital during the first Gulf War. Upon completion of his training, Gamble joined the teaching staff at Walter Reed, was named assistant professor of surgery at the Uniformed Services University of the Health Sciences and appointed consultant at the National Institutes of Health’s National Cancer Institute. Gamble then served as deputy commander for clinical services at the U.S. Army Aeromedical Center (USAAMC), Fort Rucker, Ala., from 1995 to 1997, and was appointed as consultant to the Army surgeon general for plastic and reconstructive surgery from 1995 to 2002. While at USAAMC, he deployed in support of the Bosnian and Macedonian missions. In 1997, Gamble served as division surgeon, 3rd Infantry Division (Mechanized), Fort Stewart, Ga., deploying for Bright Star and Intrinsic Action missions. In 1999, he served as medical director and director of clinical operations for TMA in the office of the assistant secretary of defense for health affairs. Assigned in 2000 as command surgeon at the National Defense University, Fort McNair, Va., he subsequently attended the Industrial College of the Armed Forces and earned a Master of Science in national resource strategy. In 2002, he assumed command of U.S. Army Medical Department Activity–Alaska at Fort Wainwright, Alaska, and upon completion of that tour, Gamble served as the assistant deputy for health policy for the assistant secretary of the Army for manpower and reserve affairs from 2004 to 2005. In 2005, Gamble commanded Landstuhl Regional Medical Center, Germany, which serves the U.S. European Command region. During this time, he oversaw the establishment of the first American College of Surgeons-accredited Level II Trauma Center outside the United States. Upon completing his tour of duty at Landstuhl in 2007, Gamble served as the CENTCOM command surgeon at MacDill Air Force Base, Fla., where he was responsible for joint and coalition health services for military operations comprising 27 nations on the Arabian Peninsula, Horn of Africa, Red Sea and in Central Asia, including Operations Enduring and Iraqi Freedom from 2007 to 2009.

Gamble graduated from Pennsylvania State University in 1978 with degrees in food science and pre-medicine, and entered the Army through the Health Professions Scholarship Program. He earned his Doctorate of Medicine from Jefferson Medical College in 1982 and completed a residency in General Surgery at Saint Elizabeth’s Hospital of Boston in 1987.

Gamble is a graduate of the U.S. Army Medical Department Advanced Course, Command and General Staff College and the Senior Service College. He earned the Flight Surgeon and Expert Field Medical Badges and has earned board certification in general surgery and plastic surgery.

Q: Can you describe your role as Deputy Director of TRICARE Management Activity?

A: As deputy director of TRICARE Management Activity [TMA], I assist the Honorable Dr. Jonathan Woodson, director of TMA and Assistant Secretary of Defense for Health Affairs, in managing and directing the Military Health System operations for our uniformed servicemembers, retirees and their families. I see my role as helping link together the components of our health care plan and system—direct and purchased care—while seeking collaboration with Department of Veterans Affairs [VA] health care to create a cohesive and responsive system for all who use it.

I ensure our commitment to achieving the Quadruple Aim remains paramount as it provides a construct for improving patient health and experience while responsibly managing cost, with readiness as our central focus.

I take my role here very seriously. Our health care system is an integral part of the all-volunteer force and national security, while also serving as a way ahead for a healthy and fit American society. I’m invested in this system, as are many of my colleagues in the Military Health System [MHS], because so many of us and our families are beneficiaries as well. We have a large stake in the health care program we manage, delivering the benefit today and planning for the future.

Q: What are some of the major accomplishments TMA has seen in the past year?

A: My predecessor, Rear Admiral Christine Hunter, led dynamic, monumental progress for TMA and the TRICARE benefit during her tenure as deputy director. A major accomplishment is the commencement of TRICARE Young Adult [TYA]. This program was created to address the requirements of President Obama’s Patient Protection and Affordable Care Act of 2010 and added coverage for young adults up to age 26. TYA ensures these beneficiaries, who previously aged out of the TRICARE benefit at 21 or 23, depending on student status, do not fall through health care coverage cracks early in their adulthood. TYA is an affordable, comprehensive health care option. We expanded the program in January 2012 to include care at military hospitals and clinics with a TRICARE Prime option.

Another accomplishment is the continued growth in the past year of the TRICARE Pharmacy Home Delivery mail order pharmacy program. Home delivery not only is a convenience for our patients, it also provides the Department of Defense with significant fiscal savings. Pharmaceutical expenditures are a significant part of our budget, so these savings can greatly impact maintaining the health care benefit.

In August 2011, TRICARE expanded the availability of preventive vaccines at retail network pharmacies. Before that, the majority of vaccines were only covered when patients received them at a physician’s office. Now you can get any number of vaccines at one of the thousands of retail network pharmacies with no copay. I can personally attest to the value of this benefit as my own family has taken advantage of this new convenient preventive health care option. This accomplishment is one that helps all TRICARE beneficiaries, near or far from a military hospital, especially during flu season and back to school time.

This past summer TMA also implemented the Moving Made Easy program. This program allows active duty servicemembers and their families to transfer their TRICARE Prime enrollment by phone when they are moving to a new location. This enhanced portability of TRICARE coverage during moves is important for the continuity of care and ensures access for military families during an often difficult time.

In the past year, there has also been significant growth in communicating benefit information to our beneficiaries through social networking and mobile websites. The TRICARE pharmacy contractor and all three of our managed care support contractors now have mobile websites or applications to help our beneficiaries find providers or get health care information right on their mobile phones and the tricare.mil mobile website will be launched soon. Using these social media tools allows TRICARE beneficiaries of all ages easy access to the information they need however they like to receive it. For example, if you’re away from home and need to find an urgent care facility, a mobile website or app would make it easier to find an appropriate provider in an urgent care situation.

Q: What will your priorities be as deputy director?

A: All of our priorities at TRICARE focus on the need to ensure readiness, including the training, sustainment and deployability of our health care resources. We are focused on meeting the needs of the servicemember, whether they are active duty or Reserve component, as well as the families, line commanders, retirees and veterans.

Our security as a nation depends upon a robust, efficient and effective military health care system that can sustain an all-volunteer force and meet the challenges of 21st century conflicts. I see the MHS, with our direct care and purchased care systems, along with the health care provided by the VA, as a longitudinal federal health care system that ensures continuity and superb quality health care to our beneficiaries currently in uniform and those who retire or leave the service. Improving interservice and VA integration through aligning policies, procedures and functions will ensure greater consistency along this longitudinal system.

To sustain the all-volunteer force, TRICARE must be committed to a patient-centered, outcomes- based model for providing care while shaping the benefit to meet the realities of the current economic and fiscal climate.

This is an evolving process that has been underway since before I came on board, and I look to continue the excellent work of my predecessor, Rear Admiral Hunter. This includes initiatives like the patient-centered medical home; developing new metrics to better understand how our beneficiaries use their benefits; standardizing clinical practice guidelines for direct care, purchased care and the VA; and pursuing an integrated, lifetime electronic health record.

On a more personal level, I want to ensure that we have in place professional training and mentoring programs for the entire TRICARE Management Activity staff. Their successes, professionally and personally, will make our health care delivery system better for those we serve. This is especially important as the federal health care workforce is aging; we must make sure that our future health care leaders have the skill sets, energy and dedication to take over and drive this organization forward.

Q: Since starting at TMA, what unanticipated challenges have you encountered?

A: Since taking on the responsibilities of deputy director, I have been gratified and impressed by the skill and dedication of the hardworking individuals here at TMA. This was not unanticipated, but I do want to thank them for their work in making my transition smooth and helping me get up to speed right away on the many issues confronting TRICARE.

One area of concern that has arisen is data security and the protection of personally identifiable information and personal health information. Given the tremendous movements in technology, it’s critical to ensure the safety and security of our personal information is a focus by all every day. My new position offered me a crash course in just how broad, complicated and interconnected the entire MHS is, and how much information needs to move from one place to another safely and securely. This reinforces my commitment to bring the efforts to bear as we modernize the system, creating an integrated electronic health record that can follow an individual throughout their life safely and securely.

TMA has to work continually to build, nurture and improve the trust of our beneficiaries. Our unique mission of serving the men and women of the armed forces, their families and military retirees means we need to anticipate circumstances and situations of medical needs and expectation, and then to respond with solutions to build strong and enduring relationships with our beneficiaries.

Q: What is the major focus of TMA in 2012?

A: We are certainly in a tough economic environment. In this time and in the future, we will continue to focus on costeffectiveness, a component of the Quadruple Aim. We’ll also continue to focus on the patient-centered medical home and improve how that model works with specialty care delivery. We’ll work toward developing meaningful metrics that will help us determine the value of this new health delivery paradigm. We are only now scratching the surface to understand the complete value of patient-centered care.

In 2012, TMA will help nurture and support the forthcoming integrated health record between DoD and the VA. There is a lot of work that must be done, but I believe that we will develop a highly capable, worthy product. The integrated health record will not only benefit DoD and VA, but also other health care systems in the federal government and across the nation.

We’re also focused on developing the next generation of managed care support contracts, which is called T-4. We are determined to continually improve the delivery of care for both the patients and providers, in both the direct care and purchased care systems.

TMA will continue to improve how we develop, train and mentor young providers through the graduate medical education [GME] system, which I believe to be a cornerstone of the MHS. Investing in our health care professionals ensures that we have an enduring system of quality care and comprehensive standards of care for many years to come. Sustaining and improving the GME system makes the MHS an important resource for the nation as well as the military population for health safety and quality.

Q: How do you balance care with cost?

A: Considering the value of our care, we must understand that value is driven by outcomes. Outcomes should drive our decisions, as well as a patient’s decisions in how care is delivered, the venue it is delivered in and the services he or she wants.

In health care, we are returning to a time when we are focusing on patients. The patient-centered medical home brings instruments of care to one setting for the patient, rather than having the patient get their care in several different venues for one issue or problem.

As I mentioned earlier, we must develop appropriate metrics for this paradigm shift, so that we can account for this new business model, as well as outcomes, so that we may reduce variance, streamline efficiencies and provide a better product to patients and families.

Another aspect we are continuously focused on is access to preventive services. The model of care we are moving away from—delivering care in many venues and focusing on acute problems—is typically more expensive, less constructive and less comprehensive for patients in the long run. Keeping our patients in a state of health maintenance or wellness by managing care is less expensive and more beneficial to our patients.

A great example of the mutually beneficial value of preventive services is our recently expanded vaccine coverage at retail pharmacies. Vaccines are a cost-effective, preventive service that are good business for pharmacies and convenient for patients. TRICARE Pharmacy Home Delivery, which I discussed earlier, has many of the same features of convenience, cost-effectiveness and prevention through greater medication adherence for patients with chronic conditions.

Q: How can contractors help make TMA more efficient?

A: Our contractors can help us to be more efficient by being good business partners, helping bring forth best health practices and focusing on health outcomes. Contractors also make the organization more efficient in their delivery of services, such as TRICARE Pharmacy Home Delivery, which has proven to be a cost savings.

A good example of business partnership is the involvement of our managed care support contractors in deployment and redeployment activities, which are especially beneficial for Reserve component servicemembers. The contractors actively help make appointments and consultations before deployment and after demobilizing. This helps servicemembers receive needed care and avoid gaps in health care services during critical times like reintegration to their homes and communities. TMA regional offices are working tirelessly with the contractors to provide this essential benefit to our servicemembers. I applaud them for their work in improving efficiency and “leaning forward.”

Q: What are the most pressing needs of TMA?

A: Given the significant pressures on our system from the constrained fiscal environment, health care reform and advances in technology, our most pressing need is to keep our focus on patients. We must stay true to the Quadruple Aim and focus on the readiness of our servicemembers and all beneficiaries.

With mounting fiscal pressures on TRICARE, it is particularly important to ensure our beneficiaries understand what they have with their TRICARE benefit—understand that it is a high value, quality and comprehensive health care benefit. I mentioned this earlier, but it bears repeating, that many of us here at TRICARE are more than stewards of this health care program; we and our families are TRICARE beneficiaries. We hope that those we serve understand that we want to provide the best benefit possible for our families and our future.

Q: How have your previous assignments benefitted you in your current role?

A: I am very fortunate to have had a diverse set of career assignments, including clinical experience, teaching, field operations, administration, and command experience stateside as well as overseas. This broad spectrum of experience keeps me focused on the fact that our work is about those we serve, readiness and about supporting our uniformed servicemembers, families and those who have served previously.

My appreciation of the role of outcomes measures is strongly based on my experience in trauma care at Landstuhl Regional Medical Center in Germany. We established clinical practice guidelines at Landstuhl and the Joint Theater Trauma System that reduced variance in care and improved survivability of wounded servicemembers recently off the battlefield. Today, these practices have been taught and implemented across the MHS. Not only have we seen improved servicemember survivability as we improve MHS capability, but we are also seeing improved survivability standards in the civilian health care environment as they adopt what we have learned to their practices.

Most recently, as commander of Dwight D. Eisenhower Army Medical Center in Georgia, we improved support for the rehabilitation of wounded, ill and injured servicemembers in collaboration with the VA. This heightened my awareness of and concern about our wounded, ill and injured warriors. After more than 10 years of conflict, we must provide avenues of care for our wounded, ill and injured warriors to receive the care they deserve and have earned through their sacrifices and that of their families.

Q: Should servicemembers or their families be concerned about the future of TRICARE, given recent cost changes and rumors that TRICARE will be targeted for cost cutting?

A: At the time this article was written, there were a number of proposals about the future of TRICARE being discussed, but nothing in concrete. We remain ready to proceed when directed by senior leaders to make any adjustments, but we should not and will not lose focus on our mission to provide the safest, best quality, most comprehensive and compassionate care possible to our servicemembers, retirees and their families and veterans.

Q: Is there anything else you would like to say that I have not asked?

A: TRICARE Management Activity is maintaining our focus on our patients. As a beneficiary myself, I understand that behind each policy, regulation, piece of legislation is a patient. We must never lose sight that the patient and their family are the reason for our existence and that we are here to serve them. ♦

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