Note from MOAA: This column from Lt. Gen. Ronald Place, USA, director of the Defense Health Agency, is a response to MOAA's Jan. 22 article, Military Families Need a Safety Net During Military Health System Reform.  

My highest priority as director of the Defense Health Agency is great outcomes for every patient we care for – and not only great by our definition, but by the standards our patients set for us. Listening to our beneficiaries – directly and through groups like MOAA that represent them – is an essential part of achieving those great outcomes. When military service and veterans support organizations speak, we listen.

I was concerned recently when senior MOAA representatives raised public questions about the DHA’s management of military hospitals and clinics. As I understand it, MOAA’s concerns center on four issues:

• A fear that we lack the ability to track, identify and resolve problems when they arise system-wide or in specific locations.
• The lack of an online reporting tool for patients to report access-to-care issues.
• A desire to see facility-by-facility metrics for access to care.
• The belief that patients should be able to switch to TRICARE Select’s civilian networks at any time if dissatisfied with their military provider.

It’s important to note that this first issue – the need to track issues of quality, safety, or access to care across the system – is precisely why we’re unifying military hospitals and clinics under the DHA. A single, unified system is able to set best-in-class standards, monitor performance, and ensure accountability. The DHA is working to do just that. In September, the DHA issued a manual for managing clinical quality and safety which established – for the first time in the Department of Defense – a single, high standard for all military health care facilities. Similarly, we are standardizing access to care criteria across the system using both military and civilian high-performing facilities as examples. And we are monitoring system-wide performance to ensure we are meeting those high standards.

I wholeheartedly agree with MOAA leaders when it comes to public transparency on access to care for each facility. In fact, our actions verify these intentions as the Military Health System already posts this data on our Transparency website (https://www.health.mil/transparency). This site provides public access to survey data from each MTF, including showing the percentage of surveyed patients who are satisfied with their ability to get needed care. It also includes access to TRICARE Consumer Watch reports for nearly 100 hospitals and clinics with annual and quarterly reports on access to care. This is in addition to reporting a wealth of quality and safety metrics in the Hospital Compare system, allowing a side-by-side comparison with our civilian counterparts. Finally, the DHA began submitting all of our in-patient facilities for analysis in Leapfrog’s Hospital Safety Grade system last year. Our record on transparency far exceeds those of civilian health systems, which is entirely appropriate given the population we serve. We will continue to expand the information available to help our patients assess our performance and make decisions about their health care.

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When patients feel they aren’t getting the access to care they need, they’re encouraged to report those issues to on-site patient advocates, beneficiary counseling and assistance coordinators, or facility staff. The Agency’s healthcare operations staff is developing standard customer service and patient advocate processes to improve patient experience and facilitate resolution of patient concerns. Again, our move to a unified system allows us to enforce those standards for all facilities. One component of the new patient advocate processes is a requirement for our hospitals and clinics to upload access and other concerns into an existing DHA portal. The agency’s healthcare operations staff will use that information to monitor compliance, identify trends, and more importantly, develop solutions.

Creating a patient-facing online reporting tool for access issues is worthy of strong consideration; however, we would need to find the resources within our existing budget to employ and manage such a tool. I’ve asked my staff to explore options and report back to me so we can determine its feasibility now and into the future.

Lastly, MOAA has advocated for allowing beneficiaries to switch from receiving care in military facilities to the TRICARE Select network at any time – even outside the annual Open Season enrollment period. It’s important for our patients to understand why Congress instituted the annual enrollment requirement for TRICARE, just like a huge majority of private insurance plans. Simply put, annual enrollment allows us to project and plan what capabilities we need to provide for the health needs of our beneficiaries.

Knowing the number of patients enrolled in our facilities allows us to allocate scarce medical resources and be ready to augment our uniformed staff with civilian or contract personnel. We are much better able to plan for providing you the best possible care if we’re able to accurately project the demand for care. If we can’t accurately project that demand, it’s harder to provide the care each of you deserve. If patients in our facilities are dissatisfied with their care, I want to know about it, and believe me, our facility directors want to know about it too. We want the chance to address a patient’s issue and each of our directors has the authority they need to meet your needs.

Every day, we work diligently to meet the high expectations of our patients. Groups like MOAA are essential to helping us. I am grateful for their input and assistance communicating to our patients. Together, we can ensure the health care we provide through the military health system meets our highest standards.