Your Military Health System VADM (Dr) Rocky Bono Director, Defense Health Agency October 15, 2018

Secretary Mattis’ Priorities Restore Readiness and Lethality Strengthen Alliances Bring Business Reforms to DoD 2

Patient Outcomes & Experience of Care Enterprise Approach Patient Outcomes & Experience of Care Safety & Quality Improve Focused Improvement in critical patient safety measures avg. length of time between a referral order a specialist appointment Increase Unintended Retained Foreign Objects, Wrong Site Surgery, Hospital Infections patients satisfied with getting care when they need it ( 1 in 6 not satisfied) 4 New MHS measures focused on better health for 2019 Transparency of performance at MHS and MTF levels Readiness Efficiencies 6.3% Active Duty, Guard & Reserve Non Deployable ~1,900 MIL/CIV FTE HQ reductions $870M 75% Non-deployable conditions related to medical FY18 Savings Reprogrammed $648M Night vision goggles $210M DoD-wide Working Capital Fund > 80% CENTCOM MEDEVACs for Disease & Non-Battle Injuries Cybersecurity 7 87 Separate medical networks with different Cyber standards IT systems identified for decommissioning

Military Health System Consolidation 1 OCT 2018 1 OCT 2019 1 OCT 2020 1 OCT 2021 Previously transferred Transferring within phase 7% Facilities 13% MIL/CIV FTEs 12% Enrollees 17% Dispositions 52% Facilities 54% MIL/CIV FTEs 57% Enrollees 55% Dispositions 81% Facilities 93% MIL/CIV FTEs 89% Enrollees 88% Dispositions 100% MHS Enterprise Full Authority to Standardize Policies for all MTFs Health Plan, Pharmacy & Quadruple Aim Performance Plan (QPP) Functional Capabilities Facilities, MEDLOG & Acquisition Functional Capabilities Click 1 – Dates Click 2 – Phase 1 Click 3 – Phase 2 Click 4 – Phase 3 Click 5 – Phase 4, then first bar re. policies Click 6 – Health Plan, Rx and QPP FC Click 7 – Facilities, MedLog and Acq FC Click 8 – All other FCs All other Functional Capabilities

Military Health System Reforms Our Goals What Stays the Same Support to the Mission Patient-Centered Care What’s Changing Standardized Appointing & Referrals across System “Market” Orientation Reporting Relationships

Standardized Appointing & Referrals  MHS TARGET = 1 DAY Measure Description: The purpose of this measure is to monitor how well the MHS is able to book the patient’s initial specialty care referral appointment before leaving the MTF per the Defense Health Agency Interim Procedural Memorandum (DHA-IPM) 17-002 on specialty care referrals and appointing business rules. The measure displays the average number of days from when the referring provider submits the referral in CHCS/AHLTA to when the initial specialty care appointment was booked in CHCS.

Market Orientation Resources closest to health care delivery Local medical leaders with real authority to effectively move money and people to responsibly coordinate patient-centered care Data-driven

NCR Medical Directorate Reporting Relationships – Old Army Operational Units Navy MEDCOM Marine Air Force MAJCOMs CNO CMC BUMED CJCS Secretary of Defense Sec Army Sec Navy Sec CSAF CSA USD(P&R) ASD(HA) Defense Health Agency USUHS Combat Support Agency Responsibilities Policy & Oversight Army SG Navy SG Air Force SG NCR Medical Directorate MTFs

Military Health System – Before FY 2019 Reporting Relationships – New Secretary of Defense CJCS Sec Army Sec Navy Sec Air Force USD(P&R) ASD(HA) CSA CNO CMC CSAF USUHS Defense Health Agency Policy & Oversight Army SG Navy SG Air Force SG Combat Support Agency Responsibilities Air Force MAJCOMs Markets MTFs Army Operational Units Navy Operational Units Marine Operational Units Air Force Operational Units

TRICARE Changes in 2019: Introducing TRICARE Open Season 2nd week of NOV to 2nd week in DEC (12 NOV to 10 DEC in 2018) If you like your plan, you don’t need to do anything Starting in 2019 you’ll need to use open season to change plans (Prime and Select) For more information, go to TRICARE.mil/openseason Open season is an annual period when you can enroll in or change your health care coverage for the next year

TRICARE Changes in 2019: Introducing FEDVIP Open Season Federal Employee Dental and Vision Insurance Program (FEDVIP) Open Season – For RETIREES 2nd week of NOV to 2nd week in DEC (12 NOV to 10 DEC in 2018): Aligns with TRICARE open season New access to FEDVIP dental and vision plans! Must take action during 2018 open season to get coverage in 2019 To check eligibility and explore/compare plans go to TRICARE.Benefeds.com

TRICARE Changes in 2019: Representative FEDVIP Premiums 2018 TRICARE Retiree Dental Program Premiums METLIFE FEP GEHA Delta PPO AETNA PPO UCCI PPO 2019 FEDVIP Premiums for 6 Representative Plans METLIFE FEP GEHA Delta PPO AETNA PPO UCCI PPO Sources: http://www.moaa.org/uploadedFiles/Content/Publications_and_Media/News_Articles/2018_News_Articles/FEDVIP%20Booklet.pdf https://www.opm.gov/healthcare-insurance/dental-vision/plan-information/premiums/2018dentalpremium.pdf https://www.trdp.org/retirees/premiums.html

Humana Government Business Health Net Federal Services Managed Care Support Contractor (MCSC) Monthly Status: Oct 2018 (Aug data) Humana Government Business East Region Health Net Federal Services West Region Claims/TED: the #1 issue in the East. Numerous issues from beneficiaries & providers. CAP submitted 15 June, get-well date ~Dec 2018. Correspondence: addition of secure emails pushed metrics into the RED. Claims are also a large factor. Estimated Sep 2018 compliance. Provider Directory: HGB increased from 50% in Jul to 62% in Aug. Marked improvement due to LexisNexis. 1 Provider Directory Accuracy: #1 issue: 35.5% per interim audit results on 21 Sep 2018. Referral Management: Meeting timeliness standard. Accuracy issues continue. Call Centers: Metrics improved, but not completely stabilized. 1 2 2 3 3 2

Both contractors have Corrective Action Plans (CAPs) Key Performance Indicators (Aug 2018) 1 81% 81% 2 Both contractors have Corrective Action Plans (CAPs) HGB (East) - Claims Processing, Correspondence, Provider Directory Accuracy, Autism Care / ABA Therapy HNFS (West) - Provider Directory Accuracy, Customer Call Centers 3 3 1 2 3 GREEN - MEETS/EXCEEDS REQUIREMENTS / RED - DOESN’T MEET REQUIREMENTS ARROW: CHANGE IN COLOR FROM PREVIOUS MONTH

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