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UBO Keynote Presentation Speaker: Rachel Foster

UBO Keynote Presentation Speaker: Rachel Foster. Date: 25 March 2010 Time: 0805 – 0845. Defense Health Program Overview. Military Health System: Who We Are. 9.6 million beneficiaries 3.5 million TRICARE Prime enrollees (direct care system)

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UBO Keynote Presentation Speaker: Rachel Foster

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  1. UBO Keynote PresentationSpeaker: Rachel Foster Date: 25 March 2010 Time: 0805 – 0845

  2. Defense Health Program Overview

  3. Military Health System: Who We Are • 9.6 million beneficiaries • 3.5 million TRICARE Prime enrollees (direct care system) • 1.5 million TRICARE Prime enrollees (contractor networks) • Remainder • TRICARE Standard/Extra • TRICARE for Life • TRICARE Plus • TRICARE Reserve Select • Military Treatment Facilities (MTFs) • 59 Hospitals & Medical Centers • 364 Health Clinics • Network providers • 347,673 individual providers 3

  4. Priorities & Challenges FY 2011 • Traumatic Brain Injury and Psychological Health • Wounded Warrior Care and Transition Support • World Class Healthcare Facilities • Medical MILCON • Facility Sustainment, Restoration and Modernization • BRAC Implementation • Electronic Health Record • Quadruple Aim – Establishing the Direct Care System as System of choice • Accessible World Class Patient Care • Increased Active Duty population over authorized levels • Cumulative effect of war-related workload • Minimizing effect of Medical Deployments • Controlling Healthcare Costs • Increased intensity and number of visits per user • Increased users • Leveraging Investment in Facilities to establish the Direct Care System as System of Choice 4

  5. Rising Costs for the MHS +14.3 +2.6 +4.5 +7.6 +14.9 48%: New Benefits 29%: Per Visit Cost Growth ($B) 10%: New Users 13%: Utilization • Source: Congressional Budget Office To limit its impact on the DoD budget, the MHS must find innovative ways to slow the cost curve 5

  6. Readiness Pre- and Post-deployment Family Health Behavioral Health Professional Competency/Currency Population Health Healthy service members, families, and retirees Quality health care outcomes A Positive Patient Experience Patient and Family centered Care, Access, Satisfaction Cost Responsibly Managed Experience of Care Population Health Readiness Per Capita Cost Our Ultimate Goal: The Quadruple Aim 7

  7. Aligning Strategy and Budget • Individual Medical Readiness • Psychological Health • Engaging Patients and Healthy Behaviors • Evidence-based Care • Wounded Warrior Care • 24/7 Access to Your Team • Personal Relationship with Your Doctor • Value-based Incentives and Reimbursements • Functional EHR • Using Research to Improve Performance • Fully Capable MHS Workforce Planning Planning Programming Text Execution Execution Budgeting 8

  8. Financial Processes 9

  9. New Financial Processes • Intended Results Shared Fate • “Shared Vision” “Shared Fate” • Financial processes support strategic direction • Better understanding and control over program baseline Shared Vision 10

  10. Third Party Billing Way Ahead

  11. 10 USC 1095 _____________________________________________________________________________________________________________________________________________________________________________________________ Problem Statement The Services are not able to fulfill the Third Party Collection Program (TPCP) mandate to the best of their ability “…the United States shall have the right to collect from a third-party payer reasonable charges for health care services incurred by the United States on behalf of such person through a facility of the uniformed services…”

  12. Background • CFO disapproved DBT certification in June 2007 for an Enterprise-wide Charge Master Based Billing (CMBB) System • Proposed CMBB System didn’t meet full requirements (e.g. electronic Pharmacy billing was not included) • Costs for full functionality unknown, along with return on investment (ROI) • One Service did not require billing function • Raised question whether Enterprise system needed • At the time, known that each Service building separate ERPs • Unclear how CMBB would interface with ERPs

  13. Way Ahead • HA/TMA will provide data that Services need to bill • Services decide how they are going to bill • Contract out selected functions within the revenue cycle • Purchase own billing product, connected to own ERP • Take ownership of TPOCS and maintain it (I thought Rachel wanted this statement removed)

  14. Enterprise Activity • What constitutes an Enterprise Activity? • Need to share information across Enterprise • Information not available elsewhere • Required Enterprise Activity Example: AHLTA • Information shared across for continuity of care • Information shared up and down for reporting and surveillance • Optional Enterprise Activity Example: Billing and Collections • No need to share individual billing transactions among Services • No need to share individual billing transactions with TMA

  15. Proposed Schedule of Events March 2009 HA/TMA identifydata and method tomake it available forthe Services to bill December 2009 CONOPS Released June 2007 CMBB Canceled May 2009 BPMB recommendwhat/if changes tobe made to TPOCS July 2011 CBER Phase 1 TBD (NLT Oct 2013) Sunset TPOCS  16

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