COMNAVSURFLANT FORCE MEDICAL BRIEF (UNCLAS)

1. COMNAVSURFLANTFORCE MEDICAL BRIEF(UNCLAS)

2. Force Medical Staff

3. Medical ISICs NNSY Portsmouth, VA COMSG TWO • 116 Ships • 32 Shore based commands with MDRs • 57 Medical Officers • 158 Independent Duty Corpsmen • 56,000 Operationally Assigned ADSMs NS Norfolk, VA WSU COMLOGGRU TWO NAB Little Creek, VA COMPHIBGRU TWO COMEODGRU TWO NS Mayport, FL WSU NS Pascagoula, MS COMDESRON SIX NS Ingleside, TX COMINEWARCOM

4. COMNAVSURFLANT MISSION Inspect Man Equip Train & Maintain

5. Manning • Ensure care for 56K operationally assigned Active Duty Service members (ADSMs) • Validate Medical Manning requirements • Manage unplanned losses • Coordinate professional training & transition

6. Equipping • SERP - Shipboard Equipment Replacement Program • NAVSEA Funds - phased replacement - > $5K • TOB – Technical Operating Budget Funds • AMMAL & ADAL Changes • OPTAR Advances & Augments • Unfunded & Mission requirements • Fleet Prime Vendor Contract • FISC Medical Representative

7. Training • SWMOIC - Surface Warfare Medical Officer Indoc. Course • IDC REFTRA -Independent Duty Corpsman Refresher Training Course • Medical Augmentation Personnel (MAP) Training Course • PCO/PXO Course -Prospective Commanding Officer / Executive Officer Brief

8. Force ReadinessDirectives • Shipboard Medical Procedures Manual COMNAVSURFORINST 6000.1 • Medical Officer & Independent Duty Corpsman Process Assessment Improvement Reviews COMNAVSURFORINST 6320.1B • Medical Readiness Inspections CINCLANTFLT/CINCPACFLT INST 6000.1

9. Readiness Dashboard • IMR • Immunization reporting • Click on “red” light • Current status click on green light • AMMAL • Percentages • Click on “yellow” • Readiness Status • Click on “yellow”

10. Access Quality Cost Healthcare Integration / Systems Management

11. Operational Forces Enrollment:Control of Cost, Quality & Access Uniform benefit is not provided to the operationally assigned ADSM: • No policy/standardized process for enrollment • No assignment of responsibility for primary care. • No mechanism to ensure direct care system control of primary and referral/specialty care • Operational Unit Senior Medical Department Rep is not recognized as Primary Care Provider (PCP) • There is no mechanism to ensure patient encounter information is fed back to Operational PCP

12. Access: EMD Usage ADSM Navy ADFM

13. 5000 4500 4000 3500 3000 2500 2000 1500 1000 500 0 Access: EMD Acuity 0001-0359 0400-0759 0800-1159 1200-1559 1600-1959 2000-2359 EMERGENCY NON-URGENT URGENT

14. Access: Enrollment Sample OP UIC Enrollment BMC Visits FY01 Air Force Army Enrolled to the wrong DMIS NOT ENROLLED 33% Navy/ TRNG CTRS Marines 7% ENROLLED GLOBALLY Not Enrolled LOCAL TPC & 17% MTFs 15% BMC 28%

15. COST: Readiness Impact - Personnel Admissions at Critical Intervals 300 250 200 150 100 Dispositions: 40% LIMDU/PEB 28% Conleave 32% Returned to Duty AVG Time Away: Days Admission 3.22 Returned to Duty N/A Conleave 24.24 LIMDU/PEB PermLoss 50 0 OCT 2001 JAN 2002 APR 2002 JUL 2002 OCT 2002 JAN 2003 APR 2003 JUL 2003

16. Quality • PCP Patient Population Management – No continuity of care & no return information on patient encounters • Specialty Care and Referral Management – Redundant processes/ poorly coordinated referral • Case Management - Complicated or cross regional cases are difficult to coordinate and resolve

17. Magnitude The gap: ~250,000 Naval Operational Forces not properly enrolled: • Access is often provided at the most expensive level of care • A uniform benefit is not provided, i.e. benefit information, billing, and PCP Training & Ed. • At present, limited integration of the Operational and Direct Care System • Optimization of primary and specialty care provided to ADSM has not been achieved

18. Access Quality Cost How does this relate to Readiness, Integration & Optimization? • Readiness - lost man-hours & permanent personnel losses at critical points in deployment cycles • Integration – Two separately funded healthcare sub-systems • No mandate for the coordination & control of care between the direct care system and the operational force PCP • Optimization - Direct Care System is unable to program resources to support an unknown cost of readiness • Healthcare system is inefficient - uncontrolled access, affecting the TRICARE MCSC

19. Business Practices or Processes Impacted • System Integration & Readiness • MTF enrollment practices for Operational Forces • Specialty/Referral Care • Operation Force Liaison Programs • System Optimization • MTF Case Management • CHCS - Workload capture of support provided to operational forces • Health Plan cost accounting/expenses for operational forces.

20. Short Term Objectives: Endorsement of Policy Letter: • Change in the enrollment process to an automated system transparent to the member • Validation of the operational unit senior medical department representatives as Primary Care Providers equivalent to their MTF PCM counterparts

21. Midterm Objectives: • BUPERS mandate DEERS validation is a personnel function at check-in • Approval of OPNAV Enrollment & Assignment Instruction for Operational Forces • Revise Operation Force Department/Fleet Liaison Instruction to include more detailed training regarding the Enrollment process & the TRICARE benefit

22. Long Term Objectives: • Seamless, transparent integration of two previously parallel medical systems • Uniform benefit for all beneficiaries

23. Health care on the waterfront is a “Total Force Concept” Force medical is the catalyst for integration, and an advocate for sailors, their families & shipboard medical departments. Branch Medical Clinics Naval Hospitals Force Medical Force Medical Medical ISICs Force Medical FLEET FORCES COMMAND SURFOR NAVMEDLOGCOM BUMED OPNAV 931 BUPERS NEHC/NEPMU