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Headquarters U.S. Air Force
Integrity - Service - Excellence




    Future Family Care Initiatives




                            Lt Gen C. Bruce Green
                       Air Force Surgeon General
                                      21 Nov 2011

                                              1
We’re All In!
                            AF Mission
                           The mission of the
                       United States Air Force is
                      to fly, fight and win#in air,
                        space and cyberspace


  AFMS Mission                                           AFMS Vision
Seamless Health Service                               World-Class Healthcare
 Support to USAF and                                   for Our Beneficiaries
Combatant Commanders                                    Anywhere, Anytime




        Through Global Vigilance, Reach, and Power!
                Integrity - Service - Excellence
VIDEO




Integrity - Service - Excellence           3
AFMS Framework Provides
                  Focus and Alignment,
                                     Strategies
 Overlapping
Mission Areas            Transform Deployable Capability
                      Rapid Response to Any Worldwide Contingency

     Fit
    Force                   Build Patient-Centered Care
                        Continuity & Prevention to Optimize Health


                     Invest in Education, Training & Research
                             Sustain Our Future Capabilities




    Strategy      Common Practice             Culture



            Integrity - Service - Excellence
In Pursuit of Lighter &
                            Leaner Medical Response
     Humanitarian Assistance              Health Response Team (HRT)
  Rapid Response Team (HARRT)

                                     Airlift Deployment Requirements:
 Earthquakes
 Indonesia                              < 24 HRS +
                                                                    C-17’s

                                        Rapid Response Medical Capabilities:
                                       Emergency, Resuscitative, & Surgical Care
 Earthquakes
     Chile                           Transition from Alaska Shelters to Utilis
                                     AK Shelter Compatible; Decreased Build Time
                                     Joint Program Testing w/ Collective Protection

                                     Developing “Portable” Functional Supply
 Earthquakes                        System (ER/OR/ICU/Peds/GYN/etc)
                                     Improved Storage/Shipping
      Haiti                          Secure/Weather Proof Versus Triwalls/Ropak
                                     Standardized Packing Portable Drawer Modules



MSC/Technician Role: Plans, Logistics, & Development
               Integrity - Service - Excellence
Future Based Agile Thinking for 2045
                                          Drivers Scope the Trajectory
Drivers are key factors that influence the future. FBAT researched
to fully define and characterize each driver, its polar description, its
constituent elements, and its current status and indicated trajectory
       Identify key                   Determine         Adjust           Maintain
                           Build
        drivers of                     strategic     Organization       Learning &
                         Scenarios
         change                      implications      Strategy          Monitor



Primary Drivers
- Knowledge: Science & Technology           AFMS Vector
                                             or String
- Geopolitics
- Culture
- Resources: Economic & Human

Coloring Drivers                                          2
                                                          0
- Environmental Change                                    1
                                                                    2
                                                                    0         2
- Human Factors                                           5         2         0      2
                                                                    7         3      0
                                                                              5      4
                                                                                     5


                      Integrity - Service - Excellence                                   6
AFMS Strategies – Medical Home
     Family Health Clinics Implemented – 61
                                              DATE        MAJCOM   MTF                Purpose
        Enrolled FH Population – 622,224                           Seymour
                                              01 Oct      ACC                         PCMH Sr Consultant visit
                                                                   Johnson
     Pediatric Clinics Implemented – 11       3-5 Oct     PACAF    Eielson            PCMH visit #2

        Enrolled Population – 26,531          4-6 Oct     AMC      Dover              PCMH Sr Consultant visit

                                              10-12 Oct   AETC     Vance              PCMH visit #1
     Total Population Enrolled – 648,755                           Altus
                                              12-13 Oct   AETC                        PCMH Sr Consultant visit
        57% of AFMS Enrollment                13-15 Oct   AFMC
                                                                   Tinker
                                                                                      PCMH Sr Consultant visit

            83% FH Enrollment                 18-20 Oct   AFGSC    Whiteman           PCMH Sr Consultant visit

            11% Pediatric Enrollment          24-26 Oct   USAFA    USAFA              PCMH visit #2

                                              26-Oct      ACC      -ellis             PCMH Sr Consultant Visit

                                              1- 5 -ov    PACAF    Anderson           PCMH visit #2

                                              1 -5 -ov    PACAF    Kadena             PCMH visit #2

                                              1-5 -ov     PACAF    Osan               PCMH visit #2

                                              2 -ov       AFSPC    Peterson           PCMH Sr Consultant visit

                                              2 -ov       ACC      Dyess              PCMH visit #1




11/29/2011         Integrity - Service - Excellence                           Data effective 1 Oct 11 from DSS
                                                                              enrollment numbers Sep 2011
                                                                                                                 7
Create The Setting
                                                                                                                             For “Right” Behaviors
                                                                      Percent of Patients Satisfied*                                                              Continuity of Care
                                                                                                                                                                                                                   Other Provider




                                                                                                                             $
                                                                   Family Health Providers at PCMH Sites                                                   MTF Primary Care Visit Distribution*
                                   100%                                                                                                                      Family Health / PCMH Patients
                                                                                                                                    100%
                                                                                                                                                                                         21471
                                       95%                                                                                           90%                                                                           PCMH Team
                                                                                                                                                        64954
                      % Satisfied




                                                                                                                                     80%                                                 42400
                                       90%                                                                           UP is           70%
                                                                                                                     Good            60%
                                                                                                                                                                                                                   PCMH PCM
                                       85%                                                                                           50%
                                                                                                                                                                                                      PCMH TEAM
                                                                                                                                     40%
                                       80%                                                                                           30%                123681                       121580           Continuity
                                                                                                                                     20%                                                                           Other Provider
                                       75%                                                                                           10%                                                                           (Family Health
                                             Jan-11       Mar-11       May-11     Jan-11       Mar-11     May-11                      0%                                                                           Clinic)
                                                                                                                                              Non-PCMH Sites (41/322163)    PCMH Sites (34/351952)                 PCM
                                                         PCMH Aggregate                     Non-PCMH Aggregate                                                                                                     (Non-PCMH
                                                                                                                                                                   Dec 2010 - May 2011                             Sites)




                                                  Satisfaction: Goal > 95%                                                                             Continuity: Goal > 90%


                                                                             $                                                                                                     $
                                                      Monthly Emergency Department and Urgent Care Utilization*                                             HEDIS Measures - Patients Enrolled to PCMH Clinics
                                                                      Per 100 PCMH Patients
            10                                                                                                                        40
Average Monthly Visit Rate (per 100)




                                  8                                                                                                   30
                                  6




                                                                                                                                  Score
                                                                                                                                      20
                                  4
                                                                                                                   DOWN               10                                                                            UP is
                                  2                                                                                  is                                                                                             Good




                                                                                                                             $
                                                                                                                   Good
                                  0                                                                                                       0
                                        Dec-10         Feb-11       Apr-11      Dec-10        Feb-11     Apr-11                               Dec-10    Feb-11     Apr-11       Dec-10           Feb-11   Apr-11
                                                      PCMH Aggregate                       Non PCMH Aggregate                                          PCMH Aggregate                      Non-PCMH Aggregate




                                       ED/Urgent Care Rate: Goal < 3/100                                                                         HEDIS Aggregate: Goal > 40

                                       Inspiring Trust & Confidence by Measuring and Rewarding Outcomes
                                                                                              Integrity - Service - Excellence                                                                                                  8
Leveraging Medical Informatics
 DATA        INFORMATION          KNOWLEDGE           WISDOM         CHANGE



                                                                 Better Care
TMDS                                      Clinical
                                                                  Through
                                          Practice
                                                               Evidence Based
                                         Guidelines
DEERS                                                              Practice

                     CarePoint           Medication              Better Health
PDTS       Health
                                           Alerts              Enhanced Patient
          Services   Registries
            Data                                                    Safety
$ / M2   Warehouse
                        User               Home                  Best Value
          (HSDW)
                     Interfaces           Sensors              Healthy Behavior
DMHRS
  i                                                              Better Care
                                         Expedited
 EHR                                    Test Results           Improved Patient
                                                                 Experience

Accelerating Information Exchange with Patient Activation
                Integrity - Service - Excellence
Activating Patients & Care Teams




 Health
 Team                                                                 Patient
Decision                          Patient                            Decision
Support                                                              Support
                                 Centered

PCMH Is The LynchpineTorBetter Decision Support ForlPatients & Health Teams
                Int g ity - Service - Excel ence
Investing In Education, Training,
                     Research, & Partnerships
Physician/Dentist Education (GME/DME)                             Research
  Stand alone programs                                              Diabetes
  Masters with civilian universities                                Telepathology
  Integrated/affiliated with Federal partners                       Teleradiology
  84 Advanced Education General Dentistry-1 slots/yr
  Dental Specialty certificate/Masters program opportunities

Nurse Education (Transition Program)
  Increasing to 241 enrolled students in FY10
  New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ




Education, Research, Partnerships – Absolutely Critical to
        Building & Sustaining Medical Services
                   Integrity - Service - Excellence                                 11
Patient-Centered Care
Ready: Reassure patient that you “know them”
Accessible: Be there when the patient needs you
Prepared: Respect patient and their time
Precise: Clarify all treatment and follow-up
Organized: Don’t ask patient what you should know or have
available in their medical record
Respectful: Always answer phones/resolve patient concerns
Thorough: Tell patient what to do if they feel worse




Patient-Centered Care Begins with Access to Earn Trust!
            Integrity - Service - Excellence                12
“TRUSTED CARE ANYWHERE”




13
Integrating New Technology

                              Hand-held,
                              Battery-powered,
                              Laser Cautery &
                              Ablation Tool




  From Force Health Protection To Logistics To Portable Surgical Tools
                Automated
Directed        Information
Energy             & Data
Sensors          Collection
                   (AIDC)                                   Future CCATT Mission -
                                    Current CCATT Mission
                                                                   Wireless


  Reaching Beyond with Evolutionary Advances and Concepts
                 Integrity - Service - Excellence                                    14

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Duke Grand Rounds Nov 2011

  • 1. Headquarters U.S. Air Force Integrity - Service - Excellence Future Family Care Initiatives Lt Gen C. Bruce Green Air Force Surgeon General 21 Nov 2011 1
  • 2. We’re All In! AF Mission The mission of the United States Air Force is to fly, fight and win#in air, space and cyberspace AFMS Mission AFMS Vision Seamless Health Service World-Class Healthcare Support to USAF and for Our Beneficiaries Combatant Commanders Anywhere, Anytime Through Global Vigilance, Reach, and Power! Integrity - Service - Excellence
  • 3. VIDEO Integrity - Service - Excellence 3
  • 4. AFMS Framework Provides Focus and Alignment, Strategies Overlapping Mission Areas Transform Deployable Capability Rapid Response to Any Worldwide Contingency Fit Force Build Patient-Centered Care Continuity & Prevention to Optimize Health Invest in Education, Training & Research Sustain Our Future Capabilities Strategy Common Practice Culture Integrity - Service - Excellence
  • 5. In Pursuit of Lighter & Leaner Medical Response Humanitarian Assistance Health Response Team (HRT) Rapid Response Team (HARRT) Airlift Deployment Requirements: Earthquakes Indonesia < 24 HRS + C-17’s Rapid Response Medical Capabilities: Emergency, Resuscitative, & Surgical Care Earthquakes Chile Transition from Alaska Shelters to Utilis AK Shelter Compatible; Decreased Build Time Joint Program Testing w/ Collective Protection Developing “Portable” Functional Supply Earthquakes System (ER/OR/ICU/Peds/GYN/etc) Improved Storage/Shipping Haiti Secure/Weather Proof Versus Triwalls/Ropak Standardized Packing Portable Drawer Modules MSC/Technician Role: Plans, Logistics, & Development Integrity - Service - Excellence
  • 6. Future Based Agile Thinking for 2045 Drivers Scope the Trajectory Drivers are key factors that influence the future. FBAT researched to fully define and characterize each driver, its polar description, its constituent elements, and its current status and indicated trajectory Identify key Determine Adjust Maintain Build drivers of strategic Organization Learning & Scenarios change implications Strategy Monitor Primary Drivers - Knowledge: Science & Technology AFMS Vector or String - Geopolitics - Culture - Resources: Economic & Human Coloring Drivers 2 0 - Environmental Change 1 2 0 2 - Human Factors 5 2 0 2 7 3 0 5 4 5 Integrity - Service - Excellence 6
  • 7. AFMS Strategies – Medical Home Family Health Clinics Implemented – 61 DATE MAJCOM MTF Purpose Enrolled FH Population – 622,224 Seymour 01 Oct ACC PCMH Sr Consultant visit Johnson Pediatric Clinics Implemented – 11 3-5 Oct PACAF Eielson PCMH visit #2 Enrolled Population – 26,531 4-6 Oct AMC Dover PCMH Sr Consultant visit 10-12 Oct AETC Vance PCMH visit #1 Total Population Enrolled – 648,755 Altus 12-13 Oct AETC PCMH Sr Consultant visit 57% of AFMS Enrollment 13-15 Oct AFMC Tinker PCMH Sr Consultant visit 83% FH Enrollment 18-20 Oct AFGSC Whiteman PCMH Sr Consultant visit 11% Pediatric Enrollment 24-26 Oct USAFA USAFA PCMH visit #2 26-Oct ACC -ellis PCMH Sr Consultant Visit 1- 5 -ov PACAF Anderson PCMH visit #2 1 -5 -ov PACAF Kadena PCMH visit #2 1-5 -ov PACAF Osan PCMH visit #2 2 -ov AFSPC Peterson PCMH Sr Consultant visit 2 -ov ACC Dyess PCMH visit #1 11/29/2011 Integrity - Service - Excellence Data effective 1 Oct 11 from DSS enrollment numbers Sep 2011 7
  • 8. Create The Setting For “Right” Behaviors Percent of Patients Satisfied* Continuity of Care Other Provider $ Family Health Providers at PCMH Sites MTF Primary Care Visit Distribution* 100% Family Health / PCMH Patients 100% 21471 95% 90% PCMH Team 64954 % Satisfied 80% 42400 90% UP is 70% Good 60% PCMH PCM 85% 50% PCMH TEAM 40% 80% 30% 123681 121580 Continuity 20% Other Provider 75% 10% (Family Health Jan-11 Mar-11 May-11 Jan-11 Mar-11 May-11 0% Clinic) Non-PCMH Sites (41/322163) PCMH Sites (34/351952) PCM PCMH Aggregate Non-PCMH Aggregate (Non-PCMH Dec 2010 - May 2011 Sites) Satisfaction: Goal > 95% Continuity: Goal > 90% $ $ Monthly Emergency Department and Urgent Care Utilization* HEDIS Measures - Patients Enrolled to PCMH Clinics Per 100 PCMH Patients 10 40 Average Monthly Visit Rate (per 100) 8 30 6 Score 20 4 DOWN 10 UP is 2 is Good $ Good 0 0 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 Dec-10 Feb-11 Apr-11 PCMH Aggregate Non PCMH Aggregate PCMH Aggregate Non-PCMH Aggregate ED/Urgent Care Rate: Goal < 3/100 HEDIS Aggregate: Goal > 40 Inspiring Trust & Confidence by Measuring and Rewarding Outcomes Integrity - Service - Excellence 8
  • 9. Leveraging Medical Informatics DATA INFORMATION KNOWLEDGE WISDOM CHANGE Better Care TMDS Clinical Through Practice Evidence Based Guidelines DEERS Practice CarePoint Medication Better Health PDTS Health Alerts Enhanced Patient Services Registries Data Safety $ / M2 Warehouse User Home Best Value (HSDW) Interfaces Sensors Healthy Behavior DMHRS i Better Care Expedited EHR Test Results Improved Patient Experience Accelerating Information Exchange with Patient Activation Integrity - Service - Excellence
  • 10. Activating Patients & Care Teams Health Team Patient Decision Patient Decision Support Support Centered PCMH Is The LynchpineTorBetter Decision Support ForlPatients & Health Teams Int g ity - Service - Excel ence
  • 11. Investing In Education, Training, Research, & Partnerships Physician/Dentist Education (GME/DME) Research Stand alone programs Diabetes Masters with civilian universities Telepathology Integrated/affiliated with Federal partners Teleradiology 84 Advanced Education General Dentistry-1 slots/yr Dental Specialty certificate/Masters program opportunities Nurse Education (Transition Program) Increasing to 241 enrolled students in FY10 New sites include: Cincinnati, OH & Scottsdale Healthcare, AZ Education, Research, Partnerships – Absolutely Critical to Building & Sustaining Medical Services Integrity - Service - Excellence 11
  • 12. Patient-Centered Care Ready: Reassure patient that you “know them” Accessible: Be there when the patient needs you Prepared: Respect patient and their time Precise: Clarify all treatment and follow-up Organized: Don’t ask patient what you should know or have available in their medical record Respectful: Always answer phones/resolve patient concerns Thorough: Tell patient what to do if they feel worse Patient-Centered Care Begins with Access to Earn Trust! Integrity - Service - Excellence 12
  • 14. Integrating New Technology Hand-held, Battery-powered, Laser Cautery & Ablation Tool From Force Health Protection To Logistics To Portable Surgical Tools Automated Directed Information Energy & Data Sensors Collection (AIDC) Future CCATT Mission - Current CCATT Mission Wireless Reaching Beyond with Evolutionary Advances and Concepts Integrity - Service - Excellence 14