YA Sharing

We have also pursued Innovative sharing agreements with the Veterans Administration. This program benefits both the VA and DOD beneficiary providIng a wider range of health care services. We now have more than 80 MTFS Involved with some form of sharing, ranging from computer supported diagnostic testing to Inpatient care. Our most ambitious effort to date has been our. Joint endeavor with the VA in Albuquerque, New Mexico. There instead of a costly hospital replacement project, the Air Force has moved into the new VA medical center. The estimated cost savings in construction costs alone is between $9 million and $10 million. We still continue to provide outpatient services from our existing facility. We have broken ground for a new ambulatory health care facility on the VA campus. We expect to occupy that new facility in the spring of next year. USAF Regional Hospital Minot is under It will have 5 designated VA beds with occupancy planned for

construction.

April 1988.

Another joint venture with the VA is under consideration with the USAF Regional Hospital Elmendorf, Alaska for a programmed FY 91 construction project. Other sites currently under study include: Nellis AFB, Las Vegas, Nevada; Davis-Monthan AFB, Arizona and Patrick AFB, Florida. Sharing with the VA at select locations can provide a greater range of services for our beneficiaries while reducing both government and beneficiary cost.

PRIMUS CLINICS

Both the Army and Navy have found their PRIMUS and NAVCARE clinics to be effective extensions of the direct care system for primary care. These contractor managed outpatient facilities have proven popular with patients

who 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. In FY 89, we plan another PRIMUS type clinic in the Tampa, Florida area, near MacDIII AFB.

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. We 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 authorizations. 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.

very pleased that over 201,000 Air Force families have elected to participate in the new dental Insurance program. 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 possibilities in this area. I would like to thank Congress for its support for this program.

Planning for the Future

Last year we developed AFMED 95 PLUS

It is

our concept for the future. a transitional plan that will take us beyond 1995. The plan highlights not only our traditional mission of service to the active duty force and familles 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 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 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 demonstration sites: 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

90-894 0 - 89 - 14

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 resources and the CHAMPUS funds attributable to the catchment area for all eligible beneficiaries. 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 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

Plan.

The Air Force proposes a concurrent and Independent evaluation of the demonstration sites with periodic progress reports to be submitted during the course of the project. These reports may provide sufficient documentation to support expansion of catchment area management prior to completion of the demonstration projects. We plan to begin these projects during FY 88 with fully operational plan at each site in FY 89. 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 porsion of the CHAMPUS budget. The current procedures established by DCD require ach Service to pay for its own beneficiaries. We hope to allocate funds on a catchment area basis during the catchment area demonstration test. We need

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 activities. 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 17 Air Force medical treatment facilities involved in 82 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.

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.

working toward four major goals:

Innovation exchange

The Center is

Innovation support (consisting of funds to assist in the initiation of

"Innovative" Ideas

Creative solutions (both Interim 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)

1