Plan for unified medical care rejected

Air Force opposition has scuttled Army and Navy plans to merge the three services’ large medical bureaucracies, led now by three surgeons general, into a single Unified Medical Command.

Deputy Defense Secretary Gordon England decided this month not to endorse such a major streamlining of the military health care system given that Air Force leaders are so strongly against it.

Instead, England approved a more modest “new governance plan” for the health care system that directs joint oversight over four “key functional areas.” Dr. William Winkenwerder, assistant secretary of defense for health affairs, explained England’s “conceptual framework” in a phone interview last week.

Areas targeted for joint oversight are:

• Medical research. The Army Medical Research and Material Command, headquartered at Fort Detrick, Md., would oversee all military medical research. Winkenwerder said a process would be established “to ensure that the interests and equities of all three services are represented in setting priorities and ensuring that appropriate research gets done.”

• Medical education and training. The 2005 Base Realignment and Closure legislation already directs creation of a joint center for enlisted medical training at Fort Sam Houston in San Antonio. England embraces that change and wants more common training, standards and approaches. At the same time, said Winkenwerder, England recognizes that certain aspects of medical training will have to remain service unique.

• Health care delivery in major military markets. Starting with San Antonio and Washington D.C., the services are to shift toward a single service being in charge of care delivery in areas where there are large beneficiary populations and multiple hospitals.

• Shared support services. The services are to consolidate certain support services including information management and technology, facilities’ construction, contracting and procurement, and perhaps some logistical and financial functions.

Whatever entity is created to oversee shared support services it will report directly to his office, Winkenwerder said. But just as the Army will control medical research, a single service will be responsible for medical education and training, and for health care delivery in major markets.

The details are left to a transition team that soon will be named to review options and recommend steps to implement England’s concept. Winkenwerder said he doesn’t know yet who will be on that team. He predicts it will require a minimum of two years to implement the changes.

The TRICARE Management Activity will remain but will focus on health insurance, support contractor management and benefit delivery. TMA will lose other joint support responsibilities such as information technology. Those duties will shift to the new shared support services organization.

Though the course that England has set is less ambitious than a unified medical command, it still “needs to be planned and implemented in a very careful, detailed, thoughtful way,” said Winkenwerder.

Everyone recognizes, he added, that the military health care system delivers care anywhere in the world, achieves “incredible results” in saving lives and treating wounded and provides “a benefit highly prized by beneficiaries.” Therefore, “an underlying theme in all of this is we did not want to break anything that was working well.”