Navy Medicine Flag/SES Conference

1. Navy Medicine Flag/SES Conference Total Force Update and Strategic Issues J. Jerry La Camera, Deputy Chief, M1 Director, Total Force 6-7 October 2009

2. Outline • We heard what you said . . . • Review of Flag Mtg input (M1) • Total Force Workshop: Highlights (M1) • Summary of Civilian and Military Personnel Initiatives (M1) • Military (M13) • MSC Growth (M1B) • Civilian/Contractor (M1) • Workforce Shaping/Career Mgmt: Mil vs Civ (M1) • Manpower/Force Development (M1B) • Data Integrity and DMHRSi • JHU/APL Model Progress Summary (JHU/APL) • Strategic Goals: Total Force (M1) • Summary and Strategic Discussion (Flags/SES)

3. At times . . . perception of… …how we set “HR” policy

4. We hope our approach… … is more proactive than this!!

5. What works well? Our People are personally and professionally prepared for deployment missions Our People are flexible and adaptable to changing missions and OPTEMPO. Quality, Dedication and Commitment of our People remains outstanding. They have a passion for the work. What is not working well? Our People don’t have background, training, or inclination to work “jointly”. Leadership positions are rotated too frequently – Stability needed. Sailors sent to deployments without the right training, preparation, support and understanding. Buying Manpower – Civilian hiring and contracting process is too cumbersome. Lack of understanding when and how to access our Reserve community. We Heard What You Said(People)

6. Total Force Workshop“Linking Total Force to Mission and Operations” • Total Attendees: 252 • NME: 73 • NMW: 39 • NMSC: 66 • NCA: 37 • HQ: 37 • Held at the National Conference Center, Leesburg, VA • Key Take Aways I • Critical link between Mission and Operations • Balanced inter-operable Total Force is a must • Data Quality – DMHRSi is here. Use it! • Conference Comments • “Great Info…Value added” • “Overall fantastic” • “On point, visionary” • “I was impressed…extremely valuable” • “Attendance should be a requirement for ALL officers” • Key Take Aways II • Manpower – it all begins with your AMD. Civilian and Contract data must be included. • Personnel – Use all available authorities • Ed & Training – Overarching Strategy Workgroup

7. BSO 18 BUSINESS PLAN BENEFICIARY POPULATION DRIVEN PERSONNEL TRAINING CNRC N13 RETENTION INCENTIVES / SPECIAL PAYS ACCESSIONS “A” SCHOOL IN-HOUSE SKILLS N15 POM / PR BSO 27 RECRUITMENT & STRENGHT PLAN BSO 18 BILLETS BSO 60/70 OPERATIONAL SCHOOLS CME WORKLOAD DEMAND SIGNALS PERSONNEL POLICY DIRECT CARE “C” SCHOOL SPECIALTY SCHOOLS TIFMMS EPA DATA SYS. PRIMARY CARE MANPOWER OPA RESIDENCY PROGRAMS SEAT PRIVATE SECTOR DUINS GDE SPECIALTY CARE OPERATIONAL DEPLOYMENTS MTF MANNING NMP FTOS GME TOMP EDUCATION FLEET OPERATION & USMC/FMF FORCES HEALTH CARE DELIVERY READINESS MISSION BENEFITS MISSION PATIENT & FAMILY CENTERED CARE

8. MILPERS DISCUSSION CAPT Jeff Macdonald

9. Banner Year in Officer Recruiting!!! Source: CNRC 1 Oct 09

10. Medical Corps Recruiting FY04 - FY09 Goals vs Accessions Recruiting Trends Dental Corps Recruiting FY04 - FY09 Medical Service Corps Recruiting FY04 - FY09 Nurse Corps Recruiting FY04 - FY09 Actual Inventory Source - BUMIS, PERS Billet Source - TFMMS extract 30 SEP of Applicable Year.

11. Overall Officer Retention Stabilizing Source: BUMIS Sep 2009

12. Mental Health Update • CNA contracted to develop a MH model for HA in 2008. • Services will have access to model late Oct 09 with ability to modify certain parameters. • Model will breakdown requirements by Command/UIC. • Model identifies requirements by provider type and does not differentiate between military, civilian and contractor..

13. Psychological Health Risk-AdjustedModel for Staffing (PHRAMS) • CNA has given initial briefs on their model to DoD and the Services. • Still some changes to the model are ongoing • Two parts to the model- hard and soft parameters • Hard parameters can not be changed by services. • Soft parameters can manipulated by the Servicers • Model breaks down requirements by Command/UIC • Requirements are by provider type and does not differentiate between military, civilian and contractor. • CNA to will release model to services sometime in October

14. Authorizations Gap AnalysisPsychological Health Risk-AdjustedModel for Staffing (PHRAMS):Version 2.0 Baseline Results Preliminary Results Source: Military BUMIS; Civilians DCPDS; Contractors NAVMEDLOGCOM

15. Current Inventory Gap AnalysisPsychological Health Risk-AdjustedModel for Staffing (PHRAMS):Version 2.0 Baseline Results Preliminary Results Source: Military BUMIS; Civilians DCPDS; Contractors NAVMEDLOGCOM

16. Change in Military MH Authorizations

17. Efforts to Increase Military MH Inventory • Medical Corps (Psychiatry) • Increased GME starts from 11 seats to 15 seats. • Difficulty filling GME seats and recruiting Directs and FAPs. • Medical Service Corps (Clin Psych and LCSW) • Increased LCSW internship and Directed Accession numbers. • LCSW Initiatives projected to increase community from 22 to 60 by FY12. • Direct accessed 8 fully licensed psychologists and 11 interns with goal of 8 fully trained and 12 interns in FY10 • USUHS - 2 CP students per year and 4 students to begin new post doctoral program in FY10. • New Clin Psych accession and retention bonus. • Nurse Corps (Mental Health NP (1973)/Psych Nurse (1930)) • significantly increased MH DUINS opportunity • Currently have 2 PHD, 9 NP and 7 Masters in DUINs with planned increases for future

18. Way Ahead • CNA to release model to Services sometime in Oct. • Will need to make changes to soft parameters. • Contracted AHLTA for make buy model to determine military, civilian and contractor staffing mix at each command. • Results will be sent to the Regions • Each command will need to validate results, especially in regard to command location and ability to hire from the local economy. • Model will need to be tied into MSC Growth initiatives.

19. MSC Growth Mr. Kevin Magnusson

20. Increasing Demand Signals • Operational Tempo • Expanding IA missions • Surge in Afghanistan • AFRICOM (Djibouti) • Anti-piracy • Marine Corps Growth • Grow the Force • MARSOC • OSCAR – current plan creates teams at the Reg Level. • ACMC states that MH assets to be embedded at Bn Level • Wounded Warrior • Mental Health • Traumatic Brain Injury/Neurotrauma • Audiology/Occupational Therapy • Rehabilitation/Occ Therapy • Shift in utilization paradigm for certain MSC specialties • Social Worker/Occupational Therapy • Humanitarian Missions • EDIS • CONUS/ICONUS/OCONUS • USMC (Autism)

21. Input from Specialty Leaders Regional/MTF Commanders Fleet/FMF Medical leadership Total growth requirement in these 10 specialties = 539 Estimated growth in FMF/Fleet=202. Will require validation by BSO leadership USMC=137* Fleet=45 SPECWAR=20* BUMED (BSO18) growth=337 BUMED vs Other BSO Requirements * Does not include emerging requirements for MARSOC and revised OSCAR projections

22. Compensation to Address Growth * Mil2Civ and Adaptive Core are already in the billet file ** 588 issue pending N1/HA/Congressional support

23. CIVPERS DISCUSSION Mr. Jerry LaCamera

24. Major Initiatives – Civilian Workforce Central Recruiting - Philadelphia Successful implementation of NSPS Partner on DoD-level Initiatives Captain James A. Lovell Federal Health Care Center, North Chicago, IL Established pilot intern program at BUMED HQ with 13 interns

25. BSO-18 Civilian Workforce Growth FY 01- FY 09 On-board -- Federal Civilians Reflects loss of 129 in FY 2008 for USUHS transfer

26. Selected Healthcare Occupation Growth FY 01- FY 09

27. NMLC Contract FTEs 2003 - 2009

28. Workforce Planning ComparisonMilitary vs. Federal Civilian & Contractors Military Forecasting Needs Program Requirements/ Authorizations Centralized Recruiting Career Track with Associated Training and Education Guidance Centralized Detailing Centralized Promotion Decisions Retirement Federal Civilian & Contractors Predominantly driven locally Retirement What is the right approach on Civilian Workforce Shaping and Forecasting for projected needs of workload demand?

29. BSO 18 BUSINESS PLAN BENEFICIARY POPULATION DRIVEN PERSONNEL TRAINING CNRC N13 RETENTION INCENTIVES / SPECIAL PAYS ACCESSIONS “A” SCHOOL IN-HOUSE SKILLS N15 POM / PR BSO 27 RECRUITMENT & STRENGHT PLAN BSO 18 BILLETS BSO 60/70 OPERATIONAL SCHOOLS CME WORKLOAD DEMAND SIGNALS PERSONNEL POLICY DIRECT CARE “C” SCHOOL SPECIALTY SCHOOLS TIFMMS EPA DATA SYS. PRIMARY CARE MANPOWER OPA RESIDENCY PROGRAMS SEAT PRIVATE SECTOR DUINS GDE SPECIALTY CARE OPERATIONAL DEPLOYMENTS MTF MANNING NMP FTOS GME TOMP EDUCATION FLEET OPERATION & USMC/FMF FORCES HEALTH CARE DELIVERY READINESS MISSION BENEFITS MISSION PATIENT & FAMILY CENTERED CARE

30. MANPOWER REQUIREMENT/BILLET DISCUSSION Mr. Kevin Magnusson

31. The Force Development Process Identify the Mission, Function, Task Determine the requirements (Military, Civilian and Contract) Program Billet (BSO 18) Authorize Billets Personnel Assets to the Fleet Feedback Demand Signal Recruiting Training Promotion Retention Distribution Inventory

32. IT’S ALL ABOUT THE DATA AMD DMHRSi All Requirement EMPARTS Assignments AC, RC, DH, CN Readiness Assignments Operational Sourcing Decisions Time Entry Billet Titles Mission Assignments Training Civ Org Codes Deployable Status Facility Staffing Decisions CA Function Codes Personnel Assets to the Fleet Feedback Demand Signal Recruiting Training Promotion Retention Distribution Inventory

33. Total Force Management FLTMPS (Training Data) NES (enlisted personnel Data) TFMMS (AMD) (Staff Requirements) OPINS (Officer Personnel Data) DCPDS (Civilian Personnel Data) EMPARTS (Medical Readiness Data)

34. Surge Daily Operational Support Force Sustainment OSA + + = Training Navy/USMC Organic Fleet/MARFOR TPPH, Net Rotation Base OCONUS MTF Hospital Ship Isolated CONUS MTF Exped. Med. Facilities R&D, HQ, Trainers OCONUS MTF Defining the Military EssentialDemand Signal Meeting Operational Capability Operational Support Algorithm (Tri-Service/OSD Validated Methodology) Military Manpower Determined by Capabilities Required by Enterprise

35. Defining Right Supply to Meet Demand • Desired Effects • Provide prepared forces • Provide quality care efficiently Labor Demand Signals Operational Support Algorithm Business Planning Production Targets Military Essential Federal Civilian In-house Contract TRICARE Network No No No Yes Yes Yes • Daily operational support • Operational surge capability • Sustainment training, TPPH, Net rotation base • Federal civilians/Contracts not available, affordable, or executable • Meets IGCA requirements? • Inherently governmental? • Organic resources are available with appropriate skills? • Availability, affordability, ability to hire? • Already performed by a contractor? • Work is short in duration? • Total contract costs less than Federal civilian? • Require service to be in direct care system? Guiding Principles and Necessary Outcomes Operationally focused Flexible in complex environments Dual use providing the health benefit Managed and defined career path Production at the right cost Diversity throughout

36. Naval Medical Manpower Study Briefing to Navy Medicine Flag/SES Conference, Mr. Steve Richter, JHU/APL 06 October 09 Status, Progress and Way Ahead Unclassified

37. Agenda Where we have been Where we are Where we are going

38. Where We Have BeenInitial task – August 07 to July 08 Task Objective Develop a process that determines the uniformed requirement for Navy Medicine, and Is based upon operational requirements Is automatable and adaptable to changing assumptions or policies Permits sensitivity analysis and excursions • Task Output • Process tested in evaluation of mental health cadre, family practice physicians and surgical specialties • Briefed in July 08

39. Where We AreFollow-on task – August 08 to July 09 • Task Objectives • Mature the process that determines the uniformed requirement for Navy Medicine, and • Is based upon operational requirements • Is automatable and adaptable to changing assumptions or policies • Permits sensitivity analysis and excursions • Identifies structure that may be candidate for sourcing through Reserve component, civilian or contractor • Begin process automation • Task Output • Refined strategy • Development and approval of methodologies for calculating MTF staffing requirements • Began incorporation of Wikimetrics to determine MTF workload-driven requirement • Incorporated capability to consider emerging operational constructs (EMF and tailored packages) • Software development plan and roadmap • Completed prototype tool for analysis of officer specialties • Briefed to M1 and key staff in July 09

40. ProcessWhere We Are There are two components comprising the total force requirement Calculating the operational requirement and “tail” required to sustain Status – complete for 102 officer specialties Working on developing analytic methodology for enlisted requirement MTF workload driven requirement Status– working with BUMED and NAVMED West to develop data that will initially support use of six methodologies This piece is key to ensuring total force nature of the tool Notes There are several specialties that do not have significant operational requirements Determining the requirement for these specialties truly depends on determining and applying MTF driven workload Key assumptions and variables can have significant impact on results Rotation policy, OCONUS policy, GME faculty mix, composition and employment of surge packages

41. Where We Are GoingFollow-on task – August 09 to August 10 • Task Objectives • Refine staffing methodologies and integrate beneficiary healthcare demand • Develop tool module to provide analysis of enlisted requirement • Provide initial capability demonstration/begin socialization • Develop/execute verification and validation plan • Deliver validated tool and documentation Initial Progress – Developed/vetted key definitions – Modified analyst – tool interface structure in response to feedback – Developed preliminary analytic methodology for enlisted – Began enlisted billet analysis – Began analysis of enlisted training requirements and pipeline

42. Where We Are Going Task Timeline - August 09 to August 10 Collaborative Sessions Demo/ socialization Enlisted methodology review Metrics review and discussion GUI demonstration and feedback Final Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Adjust analyst interface nomenclature Complete and vet definitions Refine analyst interface and algorithm Obtain and incorporate updated list of deployment platforms and capabilities Oct Nov Dec Jan Feb Mar Apr May Jun Jul Model Demonstration and project status brief - M1 scheduled for 08 October - M1/M3/M8 scheduled for 13 October - N931 not yet scheduled, anticipate happening after post-brief adjustments Nov Dec Jan Feb Mar Apr May Jun Jul Metric development and analysis Present V&V plan and execute Nov Dec Jan Feb Mar Apr May Jun Jul Deliver V&V report Deliver tool Ongoing Tool refinement Development/integration of enlisted manpower analysis methodology

43. Naval Medical Manpower Study Briefing to Navy Medicine Flag/SES Conference, Mr. Steve Richter, JHU/APL 06 October 09 Status, Progress and Way Ahead Unclassified

44. Proposed FY10-15 Updates to PEOPLE Goal DRAFT – June 2009

45. Navy Medicine Total Force Project Group Steering Group: M1 – chair M3/5 M8 Corps Chiefs CDR NMSC Manpower Work Grp M12/NMSC Ed&Trng Work Grp M15/NMMPTE RQMTs TRNG ED Personnel Work Grp M13/OCM Billets Clinical GME Operational APL/WF Models Mil Civ GDE METC A&C Sch BSO18 POM/PR NSPS Fleet DUINS Platform (UTC) Access SEAT FMF Retain Joint CME COCOM compensation DOD/VA Ldrshp Dev Promotion In-sourcing PCO/PXO Compentency FLT Surgeons DOD/VA AMDOC Wk Force Dev

46. Training & Education Strategy Goal: Develop, establish, and implement a comprehensive training and education strategy for Navy Medicine Chartered Strategy Workgroup: Co-Chairs: CAPT B. Welbourn/CAPT J. Mead FFC – CAPT D. McNally N931 – CAPT B. Feril TMO – CDR F. Kass / TECOM – LCDR S. Parks Office of MC – CAPT J. Pierce Office of DC – CAPT Rinaudo Office of NC – CAPT R. Mercado Office of MSC – CAT S. Hite Office of FORCEM – HMCM Menke, HMCS Hickey BUMED – Mr. D. Howell, Mr. V. Vaccaro, Ms. R. Coughenour, Ms. De los Reyes NMSC – CAPT K. Summers MPT&E – CAPT T. Nathan, NOMI – CAPT L. Cornforth Major Objectives/Issues: • Form an Echelon 2 authoritative body to align medical department T & E strategy responsive to identified & future health service support mission essential tasks • Develop a comprehensive Navy Medicine T &E strategy • Develop implementation plan – 1, 3, & 5 year goals ** Include elements of Humanitarian Assistance Disaster Response T & E Subcommittee of the HA/DR Workgroup POA&M: Initial meeting 6 - 7 Oct 2009 • Define requirements transit to T & E execution • initial assessment of gaps/needs/delta • form sub-workgroups/comm plan to draft strategy structure/framework • Final strategy with full implementation plan – July 2010

48. Total Force Strategic Considerations • Given differences in military and Civilian/Contractor workforce planning, what processes are needed to inform and optimize resources to workload? • Enterprise / Region / MTF / OpForces • Strategic communications on MSC and MH growth will be key • Engage OpForces/N1 • With evolution to the UTC/EMF construct • Roles/missions for Reserves? • Operational Requirements • Global Sourcing/IA • Should total force capacity assessment be the determinant in assessing the “redlines”? DATA INTEGRITY IS CRITICAL TO GETTING STRATEGIC DECISIONS RIGHT

49. Back-UP

50. Training & Education Goal: Expand number of cont ed & in-service programs between VHA & DoD with direct cost avoidance to both Departments Deploy a cont ed program to improve efficiency in a joint sharing environment Health Executive Council (HEC) on Continuing Ed Co-Chairs: CAPT J. Luke -USUHS & Ms. Louise Van Diepen - VHA Deputy Chief Employee Education Service Officer Navy members: CAPT J. Mead, CAPT J. Hansen, CAPT F. Wahle, Dr. K. Natkin Robust participation: VHA, Army, Air Force & Health Care Interservice Training Office Major Objectives/Issues: • increase volume of shared training offered at the facility level • increase support to a common DoD Knowledge portal (MHS Learn) • reduce the overlap in mandatory training for VHA & DoD personnel who serve in both DEPTs • deploy a common in-service and cont ed curriculum for the Federal Health Care Centers and expanded joint venture sites POA&M: • Continue initiative - Total value of FY 09 VHA/DoD shared training $12,775,116 • Campaign for common DoD health service knowledge portal • Developed & published FY 2010 - 2012 Joint Strategic Plan • Draft Executive Decision Memo regarding Mandatory Training Reduction