Western Pacific Medical Alliance USNH Guam USNH Okinawa USNH Yokosuka TRICARE Pacific Conference October 22-24 2008 Seoul Korea.

Western Pacific Medical Alliance

USNH Guam

USNH Okinawa USNH Yokosuka

TRICARE Pacific Conference October 22-24 2008

Seoul Korea

Common Concerns

Distance from San Diego and CONUS

Common time zone (+/- 1 hour)

Support to operational commanders

Limited/Different local medical resources

USNH GuamUSNH Guam

USNH YokosukaUSNH Yokosuka

USNH OkinawaUSNH Okinawa

Okinawa to Honolulu4,644 miles

Norfolk to Honolulu4,895 miles

Where we are in the world

Fleet Commander’s Challenge

“If sailors’ families lose confidence in their overseas healthcare;

Sailors with families won’t take orders to FDNF,

7th Fleet cannot man its ships, U.S. Navy fails in its mission in this

AOR, U.S. fails in its commitment to the

government and people of Japan”

VADM Doug CrowderCommander, 7th Fleet

“United by a common time zone, by locations in the Western Pacific

substantially distant from other NMW facilities, and by similar challenges in meeting their operational support missions and line commanders’ expectations, the leaders of the U.S. Navy’s three medical treatment facilities (MTFs) in WESTPAC will collaboratively plan to achieve economies of scale, cost-efficient sharing of resources, and effective employment of personnel.”

The Concept of Operations

Origins of the Alliance

Jan 07: NMW Commander’s guidance

May 07: three COs propose “Alliance” idea

Jun 07: Guam summit meeting of senior leaders from three commands

Jul 07: charter and CONOPS approved

Purpose of the Alliance

The purpose for creating the WESTPAC Medical Alliance is to work collaboratively to identify

efficient, patient-centered solutions for operational healthcare support.

Initial Project Teams

1. Improve perinatal care across the AOR

2. Establish specialty consultation

capability

3. Standardize overseas screening

procedures

4. Establish robust medical evacuation

system in WESTPAC

Perinatal Resource Sharing

Problem: The three OCONUS WESTPAC Navy MTF’s have access to different perinatal services leading to difficulties maintaining equivalent levels of care across the region.

Approach: Tri-command team created to identify and remove barriers to equivalent level of care.

Accomplishments

Bi-monthly MFM Site visits commenced 6/07

Bi-annual NICU Site visits commenced 8/07

Nursery enhancement project at USNH Yokosuka Referral and NICU cost data

collection initiated Moving toward a uniform standard of

risk acceptance/mitigation

Specialty Resource Sharing

Problem No standard means of

communicating among WESTPAC MTF providers for specialty consultation.

No consistent level of specialty consultative care across all three Navy WESTPAC MTFs.

No significant virtual consultation/telemedicine available among the 3 WESTPAC MTFs.

Accomplishments

Established clear lines of communication with the Emergency Department as the key liaison at each MTF

Circuit-rider commenced for: MFM, Pulmonary / Critical Care, Developmental Peds,

Podiatry Circuit-rider plan established for numerous

other specialties Literature review to assess safety,

efficacy, and cost effectiveness of virtual consultation

Sharing of providers for gapped billets in pharmacy, Industrial Hygiene etc.

Overseas Screening Process

Problem: Beneficiaries that arrive in WESTPAC region after ineffective overseas screening require medical care that exceeds resources available at WESTPAC MTFs

This results in increased medico-legal risk, added costs of referral or medevacs, and lost man-hours to Line units

Actions taken

1. Matrix team of joint services using LSS tools to identify and correct process problems.

2. Joint “future state” process map created (Navy, USMC, Army, AF)

3. Joint Medical/Dental OSS Forms created.4. Joint instruction for proposal currently in

draft.

Actions taken

5. Joint OSS Website established for WPMA (see next slide)

6. Point paper to MHS Surgeon Generals recommending Joint MHS OSS process

7. Pilot study between April – June 2008 revealed that the cost of care for treating pts with OSS disqualifying conditions was > $147K

OSS Web Portal

Aeromedical Evacuation

Problem: The aerovac system for routine patients is inefficient and leads to: Wasted time for referring providers and

case managers Delay in patient care Increased time away from work or

families for patients and accompanying staff

Cost to sponsor’s command

Solutions

ROFR established for USNH Okinawa 9/08

Started WESTPAC subspecialty circuit riding to decrease overall need for patients to travel to other MTFs

Explored options for using military airlift between BMC Iwakuni and USNH Okinawa

Other accomplishments

This project addressed the need for creating an information portal to share data and information among the three WESTPAC Medical Alliance MTF’s to allow for transparency in decision making.

Other Benefits of the WESTPAC Medical Alliance

True Collaboration at every level Improved communication across the

WESTPAC Region Real Team work with customer focus Synergy of ideas across the

commands

What we have learned

Working together, we can better meet the needs of our beneficiaries throughout our Western Pacific Area of Operation.

Together, we can ensure the right expertise is at the right place at the right time, to deliver quality and safe patient care to our patients.

Lean & Six Sigma tools can help us address complex healthcare issues.

Questions?