A “TIPPING POINT” FOR MILITARY PSYCHOLOGY -- PERHAPS?
This spring the House Committee on Armed Services recommended the enactment of H.R. 4909, their Fiscal Year 2017 Department of Defense Authorization Act (NDAA), by a bipartisan vote of 60 to 2. Included was a proposed major reorganization of the Department’s health care system. The Military Officers Association of America (MOAA) proffered: “The most dramatic change would involve placing all military treatment facilities (MTFs) under the direction of the Defense Health Agency, effective Oct. 1, 2018, for purposes of unified policy, administration, and budgeting. MOAA has long supported this proposal based on the cost and inefficiency of building military health care programs around three separate systems for each of the services.” From a public policy perspective, this sounds very similar to the arguments over the past decade for developing a “purple suit” health care system, and/or integrating the public and private sectors to better serve the Department of Veterans Affairs (VA) beneficiaries.
“Reform of Administration of the Defense Health Agency and Military Medical Treatment Facilities. This section would require the Defense Health Agency to become responsible for management of military treatment facilities throughout the Department of Defense, while preserving the responsibilities of the commanders of such facilities for ensuring the readiness of the members of the armed forces and civilian employees at such facilities and for furnishing the health care and medical treatment provided at such facilities. The Defense Health Agency would establish an executive-level management office consisting of professional health care administrators to manage health care operations, finance and budget, information technology, and medical affairs across all military treatment facilities. In addition, this section would direct the Secretary of Defense to submit an interim report to the congressional defense committees not later than March 1, 2017, on the preliminary plan to implement these changes, and a final report not later than March 1, 2018. This section would also require the Comptroller General of the United States to review each of the plans submitted by the Secretary and to submit the Comptroller’s assessment to the congressional defense committees by September 1, 2017, and September 1, 2018 respectively.”
The House proposal further authorized (i.e., urged) the: “Secretary of Defense to develop and implement value-based incentive programs as part of the TRICARE contracts to encourage health care providers under the TRICARE program to improve the quality of care and the experience of the covered beneficiaries. [This represents the “Triple Aim” of former CMS (Centers for Medicare and Medicaid Services) Administrator Don Berwick.] Not later than 1 year after implementation of a value-based incentive program and annually thereafter through 2022, the Secretary of Defense would be required to brief the Committees on Armed Services of the Senate and the House of Representatives, and any other appropriate congressional committee, on the quality performance metrics and expenditures related to the incentive program.”
Those familiar with the evolving reimbursement changes currently being implemented by CMS, pursuant to President Obama’s Patient Protection and Affordable Care Act (ACA), should appreciate the importance of Practice Directorate Executive Director Katherine Nordal’s State Leadership conference charge for psychology to be “at the table” when and where important policy decisions are made. During our health policy seminar this year at the Uniformed Services University of the Health Sciences (USUHS), “Dr. Janet Heinrich, Senior Advisor at CMS’s Center for Medicaid and Medicare Innovation (CMMI), described the mission of CMS to promote healthcare that is better and smarter, as well as health care that ultimately leads to healthier persons. CMMI is pursuing this goal by developing, testing, and implementing new payment and delivery models that not only acknowledge disease symptoms, but also the ‘social determinants of health’ that place individuals at risk for specific diseases and serve to maintain symptomology” (Omni Cassidy, USUHS).
As of January, 2015 HHS announced its goals for value-based payments within Medicare fee-for-service as having payments tied to quality or value through alternative payment models at 30 percent by the end of 2016 and 50 percent by the end of 2018. And, fee-for-service payments tied to quality or value at 85 percent by the end of 2016 and 90 percent by the end of 2018. Medicare growth has fallen below GDP (Gross Domestic Product) growth and national health expenditures since 2010, due, in part, to these efforts. Currently 477 Accountable Care Organizations (ACOs) – another initiative established under the ACA to foster systems of organized care – have been established across the nation, with 121 new ACOs in 2016, which cover 8.9 million assigned beneficiaries. Pioneer ACOs were designated for organizations with experience in coordinated care and ACO-like contracts. These models demonstrated savings for three years in a row of $92, $96, and $120 million.
Change is definitely coming. The critical question for psychology and for nursing is: Whether their next generation of clinical providers and professional leaders are proactively visionary and willing to become personally engaged in the public policy process, focusing upon the real needs of their patients? Ray Folen, HPA Executive Director as of this year, notes that over the last 10 years, while at Tripler Army Medical Center: “I have written 3,178 prescriptions and my colleague Mike Kellar has written 5,780. No adverse events.” Decades ago U.S. Army Col. (Ret) Greg Laskow and Col. Tom Williams fortunately appreciated the importance of prescriptive authority for their Army colleagues. Aloha.
Pat DeLeon, former APA President – Division 19 – May, 2016
