Christopher Meyer Center for Naval Analyses Sept 14, 2017 The National Academies of Sciences, Engineering, and Medicine Principles for Data-driven Decision Making Principle 2: Know your population and ask if the data matches Christopher Meyer Center for Naval Analyses Sept 14, 2017

Military Health Care Benefit Design Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost

Military Health Care Benefit Design Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost

Military Health Care Benefit Design Military medical facilities Inpatient Hospitals: 54 (41 in U.S.) Clinics: 377 (312 in U.S.) Dental Clinics: 250 (202 in U.S.) Veterinary Clinics: 251 (206 in U.S.)

Military Health Care Benefit Design Military medical facilities Inpatient Hospitals: 54 (41 in U.S.) Clinics: 377 (312 in U.S.) Dental Clinics: 250 (202 in U.S.) Veterinary Clinics: 251 (206 in U.S.)

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion The 9.4 million is broken into three categories Eligible (9.4) Enrollees (4.8) Users (7.9)

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion Prime is the Managed Care TRICARE option Just over of half Ret/FM <65 are enrolled in Prime

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion A user can be defined in many different ways.

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion How much health care does this buy?

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion Budget Categories: Most of the health care is delivered with O&M, MERHCF, and MILPERS funding

Military Health Care Benefit Design: Lower Cost Total eligible beneficiaries: 9.4 million FY 17 Funding: $52.55 Billion The cost of the health care delivered Where did the $17 B go?

Military Health Care Benefit Design: Lower Cost FY 17 Funding: $52.55 Billion: Where did the money ($17B) go?

Military Health Care Benefit Design: Lower Cost FY 17 Funding: $52.55 Billion: Where did the money ($17B) go?

Military Health Care Benefit Design: Lower Cost FY 17 Funding: $52.55 Billion: Where did the money ($17B) go?

Military Health Care Benefit Design: Increased Readiness Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost

Military Health Care Benefit Design: Increased Readiness Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost MHS leaders are evaluating a wide-ranging set of options to afford military medical personnel additional opportunities to maintain the clinical skills they will need in an operational environment. Convincing beneficiaries who are located within driving distance of an MTF to seek care there first is chief among those solutions.

Military Health Care Benefit Design: Increased Readiness Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost It will help provide military surgeons with an active clinical practice to sustain skills, and lowers costs for the entire system by more efficiently using military hospitals and clinics.

Military Health Care Benefit Design: Increased Readiness Volume of Readiness related care in the MTF The MHS has set a workload volume (RVU) goal of achieving volume equal to 40% of the Medical Group Management Association (MGMA) median. Source: MHS Modernization Study

Military Health Care Benefit Design: Increased Readiness Volume of Readiness related care in the MTF Source: MHS Modernization Study

Military Health Care Benefit Design: Increased Readiness Volume of Readiness related care in the MTF Source: MHS Modernization Study

Military Health Care Benefit Design: Increased Readiness 7,981 Annual RVUs 3,192 Annual RVUs 78% 22% Source: MHS Modernization Study

Military Health Care Benefit Design Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost Question 1: Does the current MHS construct meets the needs of the current military force and mission set?

Military Health Care Benefit Design Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost Question 2: Does the current MHS provide an affordable, agile, and evolving health care benefit to current AD family members, and eligible retirees and their families?

Military Health Care Benefit Design Military Health System (MHS) Quadruple Aim Increased Readiness Better Care Better Health Lower Cost Question 3: If we were building a military medical force and a personnel health care benefit, would we construct a system similar what we have today?

Contact information Christopher Meyer Director Health Research and Policy Meyerc@CNA.org 703-824-2784

Back Up/Discussion

Military Health Care Benefit Design: Lower Cost Inflation and risk-adjusted annualized costs for MTF and network enrollees were fairly stable over the three-year period. Total annualized costs rose by $711 for those who switched to MTF enrollment. MTF costs rose by $1,146; purchased care payments fell by $435. 14% increase in total cost

Survival – Casualty – Fatality Rates: Dates Mission and Dates1: Operation Enduring Freedom (OEF) 7 October 2001 – 28 December 2014 Operation Iraqi Freedom (OIF) 19 March 2003 – 31 August 2010 Operation New Dawn (OND) Iraq Transition Force 01 September – 15 December 2011 Operation Inherent Resolve (OIR) 15 October 2014 – Current New military operations in Iraq and Syria against the Islamic State of Iraq and the Levant Operation Freedom Sentinel (OFS) 01 January 2015 – Current (Follow-on Mission) Training, advising, and assisting Afghan security forces.

Data Driven Decisions: Use Data “The survival rate for the conflict in Afghanistan is 90.1%... The survival rate in WWII was about 70%; in Korea and Vietnam it rose to slightly more than 75%.”: 8 March 2012: US House Committee on Appropriations; Subcommittee on Defense “Our medical teams have achieved the highest combat survival rates in history. …all-time high survivability rate of 91% during Operations Enduring Freedom and Operations Iraqi Freedom despite more severe and complex wounds.”: 02 April 2014: US House Committee on Appropriations; Subcommittee on Defense

Data Driven Decisions: Interpret Data Survival Rate = WIA / (WIA + KIA + DOW) Vietnam: 153,303 WIA + 150,341 WIA, but not requiring hospitalization.3

Data Driven Decisions: Interpret Data Survival Rate = WIA / (WIA + KIA + DOW) Vietnam: 153,303 WIA 150,341 WIA, but not requiring hospitalization.3 Fallujah: 161 WIA 442 WIA But RTD.11

Data Driven Decisions: Need More Data PRT score category Sailors (%) Sailors who did not report to sea (%) Completed 180 days of sea duty (%) Failure 2 18 50 MS--satisfactory 21 12 64 MS--good 51 11 65 Exceeds standard 26 10 68   # of observations 574,046 4,119 33,364 Of the Sailors who left early, 26%* left for a medical reason 23% had an orthopedic diagnosis (lower back pain) 22% had a mental health diagnosis (including substance use/abuse) Need more predictive measures Source: CNA analyses of PRIMS and manpower data