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‘Rethinking U.S. Military Health System’

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Arthur Kellermann, M.D.,  dean of the School of Medicine at the Uniformed Services University (USU) of the Health Sciences, has written a highly thoughtful piece for Health Affairs headlined “Rethinking the United States’ Military Health System”.

He discusses ways to make it work better. In  stripped-down form, here are some:

  1. “Make greater use of enlisted providers—Overseas and aboard ships, the Military Health System relies on its corpsmen, medics, and med techs to deliver routine care under supervision, as well as save lives in combat. However, the moment these skilled providers come home, they are relegated to minor clinical or clerical tasks because no comparable role exists in civilian health systems. If the Military Health System allowed them to function as “primary care technicians,” it could expand access to care, reduce use of emergency departments and urgent care centers, and strengthen readiness for future deployments.”
  2. “Consolidate treatment of complex cases—When a service member is wounded in combat, he or she is MEDEVACed to the nearest combat support hospital, then flown by Critical Care Air Transport to a stateside military hospital. Two decades ago, the Military Health System used a similar approach inside the United States to concentrate complex care to its top medical centers. If it reinstituted the practice, patients and taxpayers would benefit.”
  3. “Systematically improve practice—Many of the advances in trauma care in Iraq and Afghanistan came from the Joint Trauma System, which systematically analyzed casualty data to identify opportunities to improve. If the Military Health System employed a similar approach to assess delivery of high-risk care in stateside hospitals, it could ensure that beneficiaries get the right care at the right place for the right reason.”
  4. “Standardize to optimize—The U.S. armed forces have learned the value of training and fighting as a joint force. Military health care providers have learned the same lesson in combat zones but when they return home, they tend to revert to the old ways. Some variations in approach are inevitable, but the Military Health System should strive to standardize key workflows, equipment, and even the layout of its operating rooms and delivery suites.”
  5. “Keep patients healthy— In war zones, protecting the health of the force is a top priority. Taking an equally diligent approach to population health at home could produce substantial benefits. Redoubling efforts to boost rates of vaccination, discourage smoking and use of smokeless tobacco, prevent injuries, and treat hypertension and obesity could generate huge downstream savings.”
  6. “Treat selected civilians—In war zones, commanders have the latitude to treat ill and injured civilians if doing so will help win the support of the local population. Currently, most lack this authority in the United States. At present, only two military medical centers participate in their state’s trauma system. If more were allowed to do so, their medical staffs would benefit from the extra caseload, and the civilians they treat would benefit from the world-class trauma, burn, and rehab care available at these medical centers.”
  7. “Ensure clinical proficiency—Military surgeons are already partnering with the American College of Surgeons to devise objective ways to assess surgeons’ readiness to deploy. Recently, they devised a way to cross-walk Current Procedural Terminology codes used to track performance of surgical procedures to critical wartime surgical skills. Once this approach is refined, it will be extended to other wartime specialties such as emergency medicine, anesthesiology, and intensive care.”
  8. “Measure what matters—To ensure military providers address the ‘quadruple aim’—readiness, better health, better care, and lower per capita costs—the Military Health System has adopted 30 ‘Partnership for Improvement‘ measures. Adopting a smaller, high-yield set of ‘vital signs’ metrics devised by the National Academy of Medicine would allow Military Health System leaders to compare their system’s overall performance to other large health systems and satisfy Section 730 of the NDAA.”
  9. “Embrace Telehealth—In deployed settings, the Military Health System uses telehealth to support health care providers working in small forward operating bases and on ships at sea. Global teleconferencing allows trauma experts across 12 time zones to regularly meet, discuss complex cases, and identify opportunities to improve. Despite its success with telehealth overseas, the Military Health System was slow to adopt it at home due to stringent information security requirements and budgetary constraints.”

To read the whole article, please hit this link.

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