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Planning for the Future

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Last year we developed AFMED 95 PLUS - our concept for the future. a transitional plan that will take us beyond 1995. The plan highlights not only our traditional mission of sorvice to the active duty force and families but our commitment to the moral and ethical oollgation of providing or arrangIng quality health care to those who have served: the retired members and

their familles.

The direction of the plan is in concert with the Department of Defense Installation management policy of decentralized authority and increased flexibility 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 alled 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 us cost-effectively as possible.

We are looking ahead to implementing atatment are management at two

demonstration sites: Phoenix, Arizona (uko and will lomo Abs) and Las Vegas, Novada (Nellis NB). The medial treatment facility commander at each demonstration will be responsible for providing health care services for all

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olgible beneficiarios elther through the direct care system or by arranging she services through alternative sources as part of the Managed Health Care plan. Each commander will manage a budget comprised of the programmed direct are resources and the CWMPUS funds attributable to the caterment area for all eligible beneficiaries. The commander may enter into contracts and mot latod agreements for needed medical services.

Beneficiaries will be permitted to choose the existing system for obtainin medical care or become 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

The Air Force proposes a concurrent and independent evaluation of the demonstration sites with per lodic progress reports to be submitted during the qurse of the project. These reports may provide sufficient documentation to soport expansion of catchment area management prior to completion of the demonstration projects. We plan to begin these projects during FY 88 with a fully operational plan at each site in FY 89. They will operate for a minimum of a three-year period.

in FY s the Air Force has funding responsibility for the Air Force porsion of the ampus budget. The current procedures established by 000 require mon Service to pay for its am beneficlarla. We hope to allocate funds on a tement area basis during the catctment araa demonstration test. We need

Congressional support to allow CWMPUS 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 clvillan health care activities. The Partnership Program expands access to services for CMPUS 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 17 Air Force medical treatment facilities involved in 82 Partnership Agreements throughout the corus. Flexibility is needed to be able to co-mingle OMPUS and CRM funds in

order to achieve the significant cost savings envisioned under this program.

Innovation

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 conter is working toward four ma jor goals:

Innovation exchange

Inovation apport (consisting of funds to assist in the initiation of

"Imovative ideas

cutive wolutions (both Inter im and long-term for problems of nconas Ibility and productivity)

Professional development (educational seminars to stimulate creative

Already over 400 Innovative applications have been complled into a catalog. The range of inovative Ideas spans administrative service to sharing agreements with other health care organizations. The Imovators

atalog lists, proven time and money savers which have been Instituted in our : facilities. The Army, Navy and VA are interested in an "Innovation" crossfeed

as a result of our efforts.

Health Promotion

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 recolve a health risk appraisal to determine the health risks related to their lifestyle. A health promotion or wellness prescription will be tallored to the individual. This test began this month and will end in mid 1989. Data is being gathered on the eacper imental and control groups to determine what risk roductions can be made in the target population.

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As you know, the planning, programming, budgeting and responsibilities for construction of military treatment facilities were realigned from the military departments to the Defense Medical Facilities Office (Ouro) in 1986. Although medial facility construction is no longer under direct Air Force

control we romain committed to a strong construction program and are working diligently with the DMFO to correct long-standing construction deficiencies. within the DWFO's FY 89 Medical Construction Program are 12 Air Force projects for the Air Force with a total value of $101.7 million. Within the caves, there are three projects dedicated toward correcting compliance requirements. Lite safety upgrade projects are programmed for the hospitals at Dyess and Seymour Johnson NBs. An important seismic upgrade project has also been. programmed for our Regional Hospital at March AB. The FY 89 program emphasizes readiness and overseas requirements. During this year, we evaluated the overall effectiveness of our medical treatment facility Operations and Maintenance funded minor construction and repair and maintenance programs. This evaluation revealed we have been expending approximately $20 million on these programs each year ; however, the annual requirement to adequately maintain aur Inventory is estimated to be $32 mil

Ilon.

The shortfall in the funding level for the upkeep of aur Inventory is a result of a amulative process, not a sudden occurrence. For the past several years, we have necessarily delayed certain types of facility repair and at the wame time, changing technology and health care delivery techniques generated new facility construction requirements. To add to this growing maintenance Duck 109, the funding level of the Military construction Program (MOP) mes not kept proo with our needs. As a point of reference for this remark, we project that the current funding of the medial Nee nupporto a 60 year life cycle mich medical treatment facility will be fully upgraded or replaced onco each 80 years. We have projected that a facility 11fe cycle of 36 years is the

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