Update On The DHA Transition - AMSUS
Update on the DHA TransitionBarclay P. Butler, Ph.D., MBAAssistant Director for ManagementDecember 5, 2019
Disclosures Dr. Butler has no relevant financial or non-financial intereststo disclose. Disclosure will be made when a product is discussed for anunapproved use. This continuing education activity is managed and accreditedby AffinityCE in collaboration with AMSUS. AffinityCE andAMSUS staff as well as Planners and Reviewers, have norelevant financial or non-financial interests to disclose. Commercial Support was not received for this activity2
Learning OutcomesAt the conclusion of this activity, participants will be able to:1. Recognize the status of the execution of the MarketConstruct: Markets, Small Markets and Stand-alone MTFOrganization, and Defense Health Regions.2. Define the evolution of the DHA headquarters to include thestatus of the functional capabilities.3. Summarize the plan to complete the transition of the MHS.4. Interpret how DHA is baselining performance and monitoringthe execution of the plan.5. Define how DHA will optimize readiness and performancethrough the Market construct.3
AgendaEstablishing the Market ConstructTransition Execution UpdateNext StepsOutcomes4
ESTABLISHING THE MARKETCONSTRUCT5
What is a Market?A Market is a group of MTFs working together in one geographic area. Marketsoperate as a system lead by a Market Office to support the sharing of patients, staff,budget, and many other functions across facilities to optimize readiness and thedelivery and coordination of health services.6
Fundamental Units of Organization7
MHS Market Structure8
Small and Stand-Alone MTF Organization9
Defense Health Regions10
Improving the MHS through the MarketConstruct11
Core Market Benefits12
Comparing DHA HQ to Market OfficeAuthoritiesDHA HQ is responsible for coordinating withASD(HA), the MILDEPs, and the COCOMS toidentify the MHS strategic goals in support of theQPP (improved readiness, better care, betterhealth, and lower costs).DHA HQ establishes requirements for healthcare delivery at MTFs across the enterprise.Market Offices are DHA management andexecution bodies that support MTFs to ensurecompliance with DHA requirements. MarketOffices drive execution of the Quadruple AimPerformance Process business plan to optimizeMTF performance across the Market.The Market Office tailors these requirements toits individual Market based on patientpopulation and hospital performance.13
Military Health System Transformation14
TRANSITION EXECUTION UPDATE15
Overview of Market Establishment ApproachDHA HQ Builds Capability and CapacityDHA FCs Build IOCDHA FCs Build FOCEnd StateObjective 1DHA Builds Initial HQCapability and CapacityMILDEP MedicalDepartment HQs andIMOs Provide DirectSupport to DHA Objective 2Stand Up DirectReporting Markets (21)Objective 3Establish the SmallMarket & Stand-AloneMTF Office (1)RHC-Atlantic (Army)RHC-Central (Army)RHC-Pacific (Army)RHC-Europe (Army)Navy Direct Support CellAFMRA (Air Force)Objective 4Establish theOCONUS DefenseHealth Regions (2)1) DHA HQ at FOC,functions andresourcestransferred, orcovered by MOAwith POAM2) MILDEPReadinessCommands atFOC3) 20 DirectReportingMarkets4) 1 SSO5) 2 OCONUSDefense HealthRegionsMILDEP Readiness TransitionADC / IOCFOC16
Implementation Timeline1 MAY 2019 - 31 DEC 20191 JAN 2020 – 30 SEP 20201 JAN 2020 – 30 SEP 20201 JAN 2020 – 30 SEP 2021Objective 1Objective 2Objective 3Objective 4Establish CapabilityStand-Up MarketsForm SSOForm DHRs100%80%60%40%20%0%7% Facilities13% MIL/CIV FTEs12% Enrollees17% Dispositions57% Facilities75% MIL/CIV FTEs64% Enrollees86% Dispositions100%80%60%40%20%0%86% Facilities100% MHS Enterprise97% MIL/CIV FTEs91% Enrollees93% DispositionsGraph KeyPreviously TransferredTransferring in Phase DHA ADC of CONUS MTFs ADC executed through relationshipwith Direct Support elements DHA assumes responsibility of tIMOMarkets and certifies 17 additionalMarkets DHA certifies SSO and assumesresponsibility of SSO Service IMOs divest OCONUS MTFsand realign personnel to DHRs Build DHA capability and capacity Service IMOs divest CONUS SSs andrealign personnel to SSO DHA certifies DHR-E and DHR-IP tIMO certifies 4 markets from 5 3 Build DHA capability and capacity tosupport 4 initial markets Service IMOs divest CONUS Markets RHC-A/C end Direct Support SSs remain with Service IMOs Overseas support continues DHA HQ and FCs reach fulloperational capability and capacity Strategic pause in Market standup toallow DHA HQ to mature Overseas support continues Service IMOs end Direct Support OCONUS support continuesNote: Data is specific to transitioning facilities by objective, DHA HQ and Market overhead are not included.Areas supported by MarketsAreas supported by Small MarketsAreas supported by Stand-Alone MTFsAs of 11 OCT 2019 - * Dates are Conditions BasedAreas supported by Defense Health Regions17
MHS Market Structure18
Direct Support (DS) Intermediate ManagementOrganizations (IMOs) and Market Communication*This communication structure refers to formal communication including: formalrequest for support form Services, formal tasking to Services, formal distribution of19
Overall UpdateRecent AccomplishmentsDirect Support (DS) MOAs SignedBegan DS Relationship while DHA assumedADC (DSD Memo Signed)Identified and Notified New Market DirectorsSuccessful Market Workshop and MarketWalkthrough20
Transition Program Management OfficeThese elements are significantlyfocused on the establishment ofDHA HQ until the conditions havebeen met to begin Marketestablishment in FY20.Dr. Barclay ButlerTST ResponsibilitiesDHA Assistant Director forManagement COL Christian MekoTransition Support TeamComms, Schedule, Risk, ProgramMgmt, Data AnalyticstIMOMarket Transition Office (MTO)DirectorSupport the development of DHA transition andprogram management productsMonitor and report transition progress for FCsand DHA HQMTO Responsibilities: Coordinate overall Market implementation effort Facilitate Market Leadership and Transition Officertraining Develop and maintain Market deliverables Prepare Certification materials for leadershipFC Responsibilities:MTO Deputy Director:Market EstablishmentDHA FunctionalCapabilitiesAdmin, Ops, LogisticsMTO Deputy Director:SSO and DHR EstablishmentAdmin, Ops, Logistics Define scope of functions within FC Develop transition plans in partnership withMILDEP SMEs Execution of plan & monitoring of sub-tasksdelegated to MILDEPs Report transition status, barriers and risks to DHALeadership; develop mitigation proposalsMIST Responsibilities:COL Sang PakMIST #1Capt SamuelVanGordonSchedule, Risk,Comms, Tech,Program MgmtMIST #2MIST #3MIST #4Schedule, Risk,Comms, Tech,Program MgmtSchedule, Risk,Comms, Tech,Program MgmtSchedule, Risk,Comms, Tech,Program Mgmt Support individual Market establishment Coordinate between DHA HQ, FCs, and Markets Facilitate on-site market kickoffs, market plandevelopment, execution, and reporting Advise Market Transition Teams on POAMs Standup 3 months prior to establishment of Market(Estimated DEC 19 MIST #1&2, FEB 20 MIST #3&4)21
Maturing the Headquarters67% of total weighted conditions* completed.*Conditions were weighted on the probability they will not occur and impact if they do not occur within the IOC target timeline, to better assess the difficulty in completion related to developing DHA HQ capability and capacity.As of: 11/14/201922
Conditions Based ApproachThe DHA’s Market certification process has shifted from a time-based process to aconditions-based certificationTime-Based ApproachConditions-BasedApproachScheduled dates for Market Markets are certified oncecertificationthey’ve met conditions laidout in the implementationtoolsLinear approach withminimal flexibilityEnables DHA to focus onmaturing the Headquartersin support of the Markets23
Training and EventsMarket Workshop and Outbrief Internal Workshop and Joint outbrief with DHA and theServices to review the transfer of authorities and/orresponsibilities from each of the Services and tIMO to theDHA with the establishment of a Market.CPX Scenario-driven exercise of functional capabilities within DHAHQ and the authority, direction, and control responsibilitiesnecessary for Initial Operating Capabilities.24
Modified Critical Tasks and DecisionsAS OF: 10/28/1912Functional CapabilitiesManpower & Staffing3Resources4StructureAs Of: 10/29/19Decision PointMilestoneMissed MilestoneAt RiskIssueCritical Plan 3 Milestone25
NEXT STEPS26
Transition of MTFs into a MarketThe Market transition process is a shared responsibility between the DHA and Market Office Leadership toensure the Market is ready and DHA has the capability and capacity to support each Market.InputMarket Certification Market meets Certification criteria and is certified as aMarket by DHA1DHA HQ IOC Conditions have been met by all FCs DHA has the capability and capacity to take on thespecific MarketSMMAC and sTLT BriefingDHA Director briefs Market Certification and DHA HQ abilityto support the Market to each bodyDHA Director Signs Memo2 DHA Director signs memo setting the date for MTF(s)transfer from the Services to the Market3Required Coordination*External stakeholders include: Congress, Secretary of Defense,Deputy Secretary of Defense, Personnel and Readiness, HealthAffairs, Surgeons General, MTF Commanders, MTF Staff, SeniorMission Commanders, beneficiaries, unions, local leadership, andothers as appropriateOutput External stakeholders* notified of certification Update local media stakeholders* on MTF Transfer4MTF(s) Transfer to DHA on D-Day MTF(s) officially transfer to Market527
D-Day Process: MTF(s) Transfer to DHAThe below process outlines how the MTFs will be transferred into Markets, after the point of Market OfficeCertification and confirmation the DHA has the capability and capacity to support the incoming Market.Required CoordinationMarket and DHA HQ Market Office certified DHA HQ has capability andcapacity to support theMarket Notification of Market Certification to the following stakeholder: Congress, Secretary of Defense, Deputy Secretary of Defense, Personnel and Readiness, Health Affairs,and the Surgeons General, DHA HQ Staff, MTF Commanders, MTF Staff, Unions, Senior MissionCommanders, Beneficiaries, Local Leadership, and others as appropriate Revalidate Service DS elements and DHA authorities prior to MTF(s) transfer Update local media organizations with MTF(s) transfer 2D-11D-10D-9D-8D-7D-6D-5D-4D-3D-2D-1D-0D 1Market Established SMMAC briefedMTF Transfer Process Decision Point DHA Director determines if the MTF Transfer can occur once preceding actions complete sTLT briefed*Disclaimer: This timeline is flexible andwill be adjusted as neededDirector’s Memo DHA Director signs Director’s Memo, which: Identifies date on which MTFs() will transfer into the Market Identifies MTF(s) that will comprise the Market Identifies authorities, responsibilities, and processes transferring from the Service DS elements to DHA Identifies authorities, responsibilities, and processes remaining with the Service DS elements DHA Director memo sent to Secretary of Defense, Deputy Secretary of Defense, Personnel and Readiness,28Health Affairs, and Surgeon Generals
Standardization BenefitsBenefitsDHA PrioritiesCost savings with increased value: thestandardization of administrative services allowsfor greater cost savings and enhanced efficienciesenabling increased buying power and a broaderchoice of service providers and greater access toquality careGreat OutcomesStreamlining authorities: enables efficiencies andconsistency in messaging, processes, training,patient care, and personnel managementReady Medical ForceConsistency creates confidence: standardizedprocesses and expectations creates anenvironment that allows employees to feelconfident in the execution of the missionStaff FulfillmentPatient Experience: consistency in care andstandardized processes and systems improvespatient satisfaction and experiencePatient SatisfactionIn the private sector, this has been done successfully at: Virginia Mason ProductionSystem, Intermountain Health, and the Institute for Healthcare Improvement29
Aligning DHA’s Acquisition Processes with theFuture State of the MHS30
Operationalizing Strategic Sourcing InitiativesOne of the ways we’re operationalizing strategic sourcing throughout DHA is with the new MHS Request Submissions Portal.Identify Problem, Gap, or Review and ValidateNeedQualityCheckRequestSubmittedThe MHS Request Submissions Portal, in addition to the QPP priorities and other priority factors make up thedecision making architecture that supports one MTF-to-Market and DHA HQ Portfolio of Initiatives. Thisstreamlined acquisition process enables DHA to employ enterprise-wide solutions and focus resources on thehighest priority projects.31
OUTCOMES32
Patient Centered ApproachGreat outcomes, a ready medical force, patients satisfied –all flow directly from a patient-centered approach thatinforms our daily actions and decisions.33
What Success Looks Like34
What Must We Accomplish?DHA Establish the functions and management structures at DHA headquarters, as well as in the subordinateorganizations we will use to operate the MTFs. Identify civilian personnel who are transferring to the DHA and positions that must be hired to successfullyoperate the headquarters, support functions and markets. Meet all the conditions required to stand up each of the functional areas required to operate the MTFs,assuming those day-to-day support and management functions from the military departments. Meet our responsibilities as a combat support agency.Markets Establish and certify the 21 markets and associated support functions. Establish the Small-Market and Stand-Alone Office to support facilities not located in a market region. Establish the Defense Health Regions to support OCONUS facilities35
QUESTIONS?36
How to Claim CE CreditIf you would like to receive continuing education credit for thisactivity, please visit:amsus.cds.pesgce.com37
The Market transition process is a shared responsibility between the DHA and Market Office Leadership to ensure the Market is ready and DHA has the capability and capacity to support each Market. *External stakeholders include: Congress, Secretary of Defense,
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