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find the walk-in clinics convenient with no out-of-pocket expense for the user.
We plan to open four of these clinics in FY 88:
in the Riverside and Sacramento
California areas, the Omaha, Nebraska area and the Tucson, Arizona area.
89, we plan another PRIMUS type clinic
the Tampa, Florida area, near MacDill
In an effort to provide better service to our beneficiaries, we have
extended clinic hours in some locations and opened satellite clinics and
pharmacies away from the main hospital.
These initiatives have eased long
waiting times and crowded conditions in our medical treatment facilities.
have tapped the retiree talent base through a variety of volunteer programs.
This has resulted in 200,000 man-hours in volunteer time by more than 2, 100
retirees during FY 87.
This provides the equivalent suport of 487 manpower
author i zations.
We expect this program to continue to grow and expand services
available to our patients, such as satellite pharmacy services already
established through support from these volunteers.
This program has improved
the flow of information between the MTF and retiree population.
I am very pleased that over 201,000 Air Force families have elected to
participate in the new dental
The plan's basic dental
benefits package provides an excellent beginning toward a full range program.
We are working with the other Uniformed Services and DOD to explore
our traditional mission of service to the active duty force and families but our
commitment to the moral and ethical obligation of providing or arranging quality
health care to those who have served:
the retired members and their families.
The direction of the plan is in concert with the Department of Defense
installation management policy of decentralized authority and increased flex
ibility for local commanders.
The concept of locally managed health care looks
beyond the base and the direct care system.
The on-site medical treatment
facility commander will be responsible and have increased authority to integrate
the base and local community health care options through a system called
catchment area management. Those options include arranging care within the
federal and private health care sector.
Commanders will be able to enter into
contractual or negotiated agreements with community providers to deliver health
care services within the catchment area.
We expect this new approach to improve
accessibility, quality and convenience while using available resources as cost
effectively as possible.
We are looking ahead to implementing catchment area management at two
Phoenix, Arizona (Luke and Williams AFBs) and Las Vegas,
Nevada (Nellis AFB).
The medical treatment facility commander at each
demonstration will be responsible for providing health care services for all
eligible beneficiaries either through the direct care system or by arranging the
services through alternative sources as part of the Managed Health Care Plan.
Each commander will manage a budget comprised of the programmed direct care
resources and the CHAMPUS funds attributable to the catchment area for all
The commander may enter into contracts and negotiated
agreements for needed medical services.
Beneficiaries will be permitted to choose the existing system for obtaining
medical care or became a member of the plan.
We believe the features offered in
the Plan (e.g. reduced cost sharing, improved accessibility, virtual elimination
of claim forms) will provide sufficient incentive to choose the Plan.
The Air Force proposes a concurrent and independent evaluation of the
demonstration sites with periodic progress reports to be submitted during the
These reports may provide sufficient documentation to
course of the project.
support expansion of catchment area management prior to completion of the
We are beginning the logistics support for these
projects during FY 88 with a fully operational plan at each site beginning in FY
They will operate for a minimum of a three-year per lod.
In FY 88 the Air Force has funding responsibility for the Air Force portion
of the CHAMPUS budget.
The current procedures established by DOD require each
Service to pay for its own beneficiar ies.
We hope to allocate funds on a
catchment area basis during the catchment area demonstration test.
Congressional support to allow CHAMPUS funds to be used at the local level at
other selected locations where demonstrated potential exists to save money
through locally negotiated agreements.
The Partnership Program, an expansion of the Joint Health Benefits Delivery
Program, encourages increased sharing between military and civilian health care
The Partnership Program expands access to services for CHAMPUS
beneficiaries and has cost savings potential to the government where competitive
rates can be negotiated and where medical treatment facility resources can be
more fully utilized.
We have 18
Force medical treatment facilities involved
in 83 Partnership Agreements throughout the conus. Flexibility is needed to be
able to co-mingle CHAMPUS and O&M funds in order to achieve the significant cost
savings envisioned under this program.
I have recently created a new Center for Health Care Innovation which is
working to establish joint venture agreements with the other Armed Services, the
Public Health Service, and the Veterans Administration. The Center is working
toward four major goals:
Innovation support (consisting of funds to assist in the initiation of
Creative solutions (both inter im and long-term for problems of
accessibility and productivity)
Professional development (educational seminars to stimulate creative
thinking, improve the leadership base and discuss health care trends)
Already over 400 innovative applications have been compiled into a catalog.
The range of innovative Ideas spans administrative service to sharing agreements
with other health care organizations.
The Innovators Catalog lists, proven time
and money savers which have been instituted in our facilities.
The Army, Nary
and VA are interested in an "innovation" crossfeed as a result of our efforts.
To achieve the best state of health and readiness possible for our active
duty members, we are implementing an important test of a Prototype Health
Promotion Clinic at Carswell AFB.
We are shifting modest acute care resources
to staff and operate a clinic that will focus on reducing the risks of premature
death and attaining optimum health.
Five hundred individuals will receive a
health risk appraisal to determine the health risks related to their lifestyle.
A health promotion or wellness prescription will be tailored to the individual.
This test began last month and will end in mid 1989.
Data is being gathered on
the experimental and control groups to determine what risk reductions can be
made in the target population.
As you know, the responsibility for planning, programming, and budgeting
for construction of military medical treatment facilities was realigned from the
military departments to the Defense Medical Facilities Office (OMFO) in 1986.
Although medical facility construction is no longer under direct Air Force
control, we remain committed to a strong construction program and are working
diligently with the OMFO to correct long-standing construction deficiencies.
Within the OMFO'S FY 89 Medical construction Program are included 12 Air Force
projects for the Air Force having a total value of $101.7 million. · Within the
CONUS, there are three projects dedicated toward correcting compliance
Two life safety upgrade projects are programmed for the hospitals Additional proposed construction in the FY 89 program for Europe,
at Dyess and Seymour Johnson AFBs, and the third is an important seismic upgrade
project for our Regional Hospital at March AFB.
supporting both peacet ime and wart ime missions, includes:
alteration composite medical facility projects for Hahn Air Base, Germany, and
United Kingdom; and a replacement clinic project for Rhein-Main,
Biological/chemmical agent and blast protective features will be
incorporated into the design of these projects to support second echelon mission
needs of these medical facilities.
in the funding level for the upkeep of our inventory is a
result of a cumulative process, not a sudden occurrence.
For the past several
years, we have necessarily delayed certain types of facility repair and at the
same time, changing technology and health care delivery techniques generated new
facility construction requirements.
To add to this growing maintenance backlog,
the funding level of the Military Construction Program (MCP) has not kept pace
with our needs. · As a point of reference for this remark, we project that the
current funding of the medical MCP supports a 50 year life cycle
treatment facility will be fully upgraded or replaced once each 50 years.
have projected that a facility life cycle of 35 years is the max imum cycle in
which building systems, technological support and functional capabilities can be
As a result, a greater investment in facility maintenance is
One of the most serious facility problems we are faced with is the cor
rection of life safety deficiencies.
in 1985, we engaged the Department of
Health and Human Services to evaluate the extent to which Life Safety Code
deficiencies exist in 47 of our OONUS hospitals.
They determined that more than
$11 million of Life Safety Code deficiencies exist and they also identified
another $59 million of related facility upgrade requirements. While we have given the correction of these deficiencies a high priority, constraining funding
levels do not allow correction of these problems in as timely a manner as we
This year, we instituted several management actions to improve the overall
per formance of our facility O&M program; however, these actions will still fall