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. The 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.

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

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.

Increase to at least 95 percent the proportion of women aged 18 and older with uterine cervix who have ever received a Pap test, and to at least 85 percent those who received a Pap test within the preceding 1 to 3 years.

COMPOSITE HEALTH CARE SYSTEM

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The Composite Health Care System will provide the clinical and administrative information necessary for the military hospital commander to assess the effectiveness of resource use within his or her facility. Through this system, the commander can develop a local business improvement plan to increase the efficiency of the staff, assess the cost effectiveness of resource utilization, and manage based on outcome of therapeutic interventions. CHCS is on the leading edge of integrated, automated hospital information systems, and is the foundation for key data collecting for Coordinated Care.

At the May 1991 In Process Review, the Major Automated Information Systems Review Committee (MAISRC) approved a split Milestone III for CHCS. The Milestone IIIA decision meeting, next month, will evaluate most of the system for a deployment decision. In the 4th Quarter of FY 94, the Milestone IIIB decision meeting will evaluate the health care professional

FEDERAL HEALTH SHARING

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As the committee is aware, sharing between DoD and the Department of Veterans Affairs has occurred for many years. During FY 91, there were 3000 services shared involving over 200 military medical facility participants. Additionally, we have a variety of joint ventures in progress where we will share facilities. Just getting underway is a joint project with the DVA to define optimal care and rehabilitation utilization for patients with traumatic brain injury. A second recent collaborative initiative is to improve opportunities for care for all our beneficiaries who require major prosthetic devices. And, ongoing for several years, is the shared procurement program in which we participate with DVA and the Public Health Service.

Interagency committees from DoD and DVA exist to identify new opportunities for sharing, to facilitate cooperation and to oversee effective execution. And, as requested by this committee, we have begun preparatory work with DVA and the Department of Health and Human Services for conduct of a study to determine the potential for expanding our sharing arrangements with both the DVA and the Indian Health Service. DHHS has in place a contracting vehicle which could be used on a task order basis to accomplish the study.