Patients in the military health system should see a standardized system for making appointments, navigating between primary and specialty care and interacting with Tricare contract managers in the coming year or two, the Defense Health Agency’s top officer said Monday.

DHA plans to create a uniform system of quality medical care that patients will find familiar regardless of duty station, DHA director Army Lt. Gen. Ronald Place told attendees during a forum for families at the Association of the United States Army annual meeting in Washington.

Place likened the current system, in which the Army, Navy and Air Force are responsible for managing and staffing their individual hospitals and clinics, to the “fog of war.”

“The No. 1 challenge, complaint, issue, that I hear in terms of our military health system is, ‘You guys don’t have a system. Because when I go to make an appointment at one location, it’s different than when I try to do it at another location — Is it better to do it online? Is it better to call the central line, to call the clinic?… What about a referral? … How does that work?’ We don’t have a system,” Place said.

The planned changes are part of the managerial transfer of all military hospitals and clinics to the Defense Health Agency and systemic transformation of the divided military health care system into a uniform system of direct, managed care.

On Oct. 1, DHA assumed management and administration of all military health facilities in the continental United States. The Army, Navy and Air Force medical departments will continue to provide care and administrative functions within those facilities during the transition, but eventually, the facilities will become more standardized and streamlined, DHA officials said.

According to Place, the current setup developed because each facility created their own approaches to solving problems at the local level. While well-meaning, Place said, this created significant differences for patients who move frequently between installations.

With the DHA managed hospitals and clinics, patients should not see gaps or shifts in care. But they should have an easier time navigating through appointments and treatment, Place said.

“It starts with standardization, like, when it comes to going to the pharmacy, shouldn’t it be the same methodology. Right now it’s, ‘Should I go to the window? Do I need to go to the window? Do I need to get a ticket, two tickets? Why two tickets?’” Place asked, describing the maddening lengthy process for filling prescriptions at a military treatment facility.

“Most important is how do we set up a system that supports you? We are part of the problem,” he said.

In addition to assuming management of the military health care facilities, DHA in the next two years will coalesce facility management into “markets,” or geographic areas of centralized management, support and administration, and will establish defense health regions overseas to prepare for the transfer of 74 facilities to DHA.

Also coming to the military health system is a reduction of 17,000 medical billets across the military services. Place’s predecessor, Vice Adm. Raquel Bono, said earlier this year that DHA is currently reviewing need and demand and determining whether some positions should be eliminated, positions filled or outsourced.

The Defense Department also is rolling out its new electronic heath record system, MHS Genesis, across the health system and will negotiate the next generation of Tricare contracts in the next two years.

Known as T-5, the contracts could be worth more than $15 billion per year. Currently, Health Net Federal Services LLC manages the contract for Tricare West Region and Human Military Healthcare Services holds the Tricare East contract. Humana’s contract ends in 2022 while Health Net contract is up in 2023.

The new contracts, Place said, should improve medical care received in the civilian sector by military families by ensuring that there are enough physicians available to handle the patient load and fixing known problems, such as delays in receiving lab results at overseas facilities.

“I’m not here to tell you that the military health system is perfect. We know that it is not, but iteratively, it gets better every day, every week, every month, every year,” he said.

On Tuesday at AUSA, the Army’s top leadership, including Army Secretary Ryan McCarthy, Army Chief of Staff James McConville and Sergeant Major of the Army Michael Grinston will address family issues, including medical care, in a town hall style event.

Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.

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