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This year also has seen extensive work on the managed care plan for the Uniform Services Treatment Facilities. This plan is nearing completion and we project an early 1993 date for the start of services under the managed care plan.

The Request for Proposals for implementing coordinated care in Washington and Oregon is scheduled for release this summer. The model for this project will be the CHAMPUS reform initiative successor contract for California and Hawaii.

Also this fiscal year, we will begin development of a similar contract solicitation for Florida. Because of contractual commitments to an already existing managed care project in the Southeast Region, the schedule is for release of an RFP in FY 1993 with delivery of services to begin in 1995.

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The Base Realignment and Closure Act has generated considerable concern among many beneficiaries living in proximity to a hospital scheduled for closure. For the Coordinated Care Program, I have established a joint service task force to analyze strategies for possible initiatives in non-catchment areas, those areas not served by a military hospital yet having sizable beneficiary populations.

This task force will work with the

military services as they develop transition plans for the

delivery of health care to eligible beneficiaries remaining in areas affected by closure actions.

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This year we have implemented, or continued implementation of, several new benefits for our beneficiaries as well as some less visible management improvements to the CHAMPUS program.

*We implemented the CHAMPUS benefit authorizing payment for mammograms and pap smears. We are expanding further preventive care services as part of the Coordinated Care Program.

*Coverage was established under CHAMPUS for lung and

heart-lung transplants.

*Case management of high cost or catastrophically ill beneficiaries was continued. We will be expanding this as part of our Coordinated Care Program.

When

*Physician payment reform regulations were promulgated. fully implemented in May of this year, payment equity will be increased, payments for overpriced procedures will be reduced, and payments for primary care services will be increased. *Comprehensive mental health regulations were published, improving our utilization management of this CHAMPUS benefit. *We now are in the process of implementing a new mental health partial hospitalization benefit.

THE HEALTH BENEFIT

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The military health benefit is a substantial one; one many of our beneficiaries identify as a top priority. On occasion, it is a prudent practice to consider that health benefit in the context of history as well as in contrast to the health benefits in the general population. The military health benefit today is a very good one, and the Department is continually challenged to ensure that it retains its value. As recently directed by Congress, the Department has begun an evaluation of this benefit. evaluation promises to be comprehensive, examining in addition to the benefit, delivery mechanisms, utilization, costs, quality, beneficiary knowledge of and access to care available, and more.

The

Important for our beneficiaries is that they have access to a benefit that is as consistent and uniform as possible, irrespective of their geographic location. That is one of the fundamental principles of coordinated care. It was applied in the development of the current RFP for California and Hawaii.

QUALITY ASSURANCE AND UTILIZATION MANAGEMENT

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The attention paid to health care today derives largely from the spiralling growth in costs, and certainly that is an issue for the Department as well as a concern of this committee. Nevertheless, as the individual responsible for the effective execution of our medical mission, I am equally concerned that the health benefit offered to our beneficiaries is of the highest quality.

This year, we have developed a Comprehensive Quality . Management Plan addressing quality issues for care received both within our hospitals and through CHAMPUS. We are initiating development of a quality assurance program for mental health and have continued our national program of mental health utilization management. We are close to awarding four regional utilization management and quality assurance contracts for all of the continental United States, except the demonstration states of California and Hawaii and the southeast region. Finally, we have refined our external peer review program to identify

opportunities for improving health care delivery.,

HEALTH PROMOTION AND DISEASE PREVENTION

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A

A key component of the Coordinated Care Program is a scientifically based, quantifiable health promotion and disease prevention program. The central challenge of Healthy People 2000, National Health Promotion and Disease Prevention Objectives, published by the Department of Health and Human Services in September 1990, is the implementation of what is already known about promoting health and preventing disease. panel of DoD experts reviewed the 383 DHHS objectives, and of these, they determined 181 to be of initial primary concern to the Department of Defense. These 181 objectives have been incorporated into Promoting Health 2000, the DoD implementation of the DHHS objectives. Some specific examples of our highest priorities include:

* Reduce cigarette smoking to a prevalence of no more than 15 percent among people aged 20 and older.

Increase hepatitis B immunization levels to 90 percent

among occupationally exposed workers.

⭑ Expand coverage for immunizations recommended by the U.S. Clinical Preventive Services Task Force to all beneficiaries, both children and adults.

Increase to at least 80 percent the proportion of women aged 40 and older who have ever received a clinical breast examination and a mammogram, and to at least 60 percent those aged 50 and older who have received them within the preceding 1 to 2 years.