Leadership objectives of the Air Force Medical Service
Lt. Col. Allen Kidd, 436th Medical Operations Squadron commander and 436th Medical Group interim commander.
Commentary by Lt. Col. Allen Kidd
436th Medical Operations Squadron commander and 436th Medical Group interim commander
2/1/2011 - Dover Air Force Base, Del. -- For the past three months, I've had the pleasure and challenge of serving as the medical group commander while Col. Sharon Bannister has been deployed. It has been an honor and definitely an educational experience. One outstanding opportunity that came with the job was to attend, along with several other medical group leaders, last week's Military Health System conference in Washington, District of Columbia.
The conference brought together several thousand senior military and civilian medical leaders from the Department of Defense and all military services with the stated purpose of providing a platform for health care professionals to share knowledge and best practices.
Spending the majority of the week in "receive" mode, I heard directly from senior leaders such as Dr. Jonathan Woodson, Assistant Secretary of Defense for Health Affairs; Lt. Gen. Charles Green, Air Force Surgeon General; the other three service's Surgeons General; Chief Master Sgt. Charles Cole, Chief of the AF Medical Enlisted Force; and other military and civilian leaders and experts. Their unified purpose of refining the delivery was the best possible medical care to you and your family.
At the end of the week, I came away with a greater appreciation for our one-of-a-kind health system and the dedication and selfless service of our senior leaders - all 100 percent focused on providing the best healthcare for the world's greatest military.
The focus of this year's conference was on achieving the performance goals of the MHS "Quadruple Aim," a recently adopted construct that concentrates effort on four issues - medical readiness, experience of care, population health, and per capita cost of care. This directly impacts you and will soon alter the way you and your family receive medical care at Dover Air Force Base, Del.
The Air Force Medical Service has integrated the "Quadruple Aim" into daily operations, tailoring the strategy as:
1) Ready - enabling a medically ready force, a ready medical force, a resiliency of MHS personnel, and delivering health service support across the full spectrum of operations;
2) Better care - providing patient and family-centered care that is seamless, safe, highest quality and focused on care when and where needed;
3) Better health - improving quality and health outcomes through focused prevention and advocating and incentivizing healthy behaviors;
4) Best value - managing the cost of care by focusing on quality, waste elimination, reducing variation, and rewarding outcomes rather than outputs.
A key component of the "Quadruple Aim" is the concept of a Patient Centered Medical Home (PCMH). This concept, which is being implemented across the services in various forms, focuses directly on the better care and better health parts of the strategy and changes the way healthcare is delivered in two primary-care areas - Family Practice, soon to be known as the Family Health Clinic, and Pediatrics. The Air Force has named its version of PCMH as Family Health Operations (FHO) and it will be coming to a medical group near you in the near future.
So what does FHO do for you? One significant issue that PCMH and FHO is designed to correct is the poor continuity of care patients often receive in the military health system. You know how it goes - you have an assigned Primary Care Manager, but he or she is often on leave, Temporary Duty Assignment, or just not available for one reason or another. When you want an appointment, you have to see another provider who is unfamiliar with you and your health. In contrast, FHO demands high continuity of care.
How is this achieved? FHO is constructed using care-delivery teams made up of one physician, one physician extender (physician assistant or nurse practitioner), one nurse, and five medical technicians. The physician and PA/NP each have 1,250 patients assigned for a total of 2,500 per team; the rules require that you see your own PCM every visit or the PCM's teammate if he/she is unavailable due to leave or TDY. Cross-booking, or having patients seen by a provider on another team, is not allowed.
Another issue that FHO seeks to improve is poor appointment access. Multiple practice guidelines, or processes, are put into place that allows a PCM to focus only on his or her panel of patients, freeing the provider to creatively manage healthcare for his team. To assist in this process, FHO also employs several disease-management nurses whose primary role is to streamline and better coordinate care of the most chronically ill patients, eliminating needless. This effectively eliminates the need for a daily sick-call clinic, which, by the way, is one of the greatest contributors to poor continuity of care.
Finally, FHO mandates a focus on disease prevention and patient education. This work is done by the disease management nurses who not only work to improve the coordinated management of disease, but also pursue improving the health of our healthiest of patients.
The senior leaders of the MHS are intensely focused on improving the delivery of quality care to our nation's warriors and their families. The staff at your medical group are working hard to join in this effort and are currently training and learning the techniques of FHO - look for full implementation in July.
I invite you to partner with us as we seek to do our part in achieving our surgeon general's vision: "build the largest network of PCMH in the US; achieve better health and better care of our Airmen and their families through delivery of preventive and comprehensive care; and demonstrate best value through reduced emergency room visits, increased access, continuity of care, and patent satisfaction, and better information for providers and teams to make decisions."