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

2. Common Concerns Distance from San Diego and CONUS Common time zone (+/- 1 hour) Support to operational commanders Limited/Different local medical resources USNH Guam USNH Yokosuka USNH Okinawa

3. Okinawa to Honolulu 4,644 miles Norfolk to Honolulu 4,895 miles Where we are in the world

4. Fleet Commander’s Challenge “If sailors’ families lose confidence in their overseas healthcare; “If sailors’ families lose confidence in their overseas healthcare; Sailors with families won’t take orders to FDNF, Sailors with families won’t take orders to FDNF, 7 th Fleet cannot man its ships, 7 th Fleet cannot man its ships, U.S. Navy fails in its mission in this AOR, U.S. Navy fails in its mission in this AOR, U.S. fails in its commitment to the government and people of Japan” U.S. fails in its commitment to the government and people of Japan” VADM Doug Crowder Commander, 7 th Fleet

5. “ United by a common time zone, “ 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.” 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

6. Origins of the Alliance Jan 07: NMW Commander’s guidance Jan 07: NMW Commander’s guidance May 07: three COs propose “Alliance” idea May 07: three COs propose “Alliance” idea Jun 07: Guam summit meeting of senior leaders from three commands Jun 07: Guam summit meeting of senior leaders from three commands Jul 07: charter and CONOPS approved Jul 07: charter and CONOPS approved

7. 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.

8. 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

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

10. Accomplishments Bi-monthly MFM Site visits commenced 6/07 Bi-monthly MFM Site visits commenced 6/07 Bi-annual NICU Site visits commenced 8/07 Bi-annual NICU Site visits commenced 8/07 Nursery enhancement project at USNH Nursery enhancement project at USNH Yokosuka Referral and NICU cost data collection initiated Yokosuka Referral and NICU cost data collection initiated Moving toward a uniform standard of risk acceptance/mitigation Moving toward a uniform standard of risk acceptance/mitigation

11. Specialty Resource Sharing Problem Problem No standard means of communicating among WESTPAC MTF providers for specialty consultation. 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 consistent level of specialty consultative care across all three Navy WESTPAC MTFs. No significant virtual consultation/telemedicine available among the 3 WESTPAC MTFs. No significant virtual consultation/telemedicine available among the 3 WESTPAC MTFs.

12. Accomplishments Established clear lines of communication with the Emergency Department as the key liaison at each MTF Established clear lines of communication with the Emergency Department as the key liaison at each MTF Circuit-rider commenced for: Circuit-rider commenced for: MFM, Pulmonary / Critical Care, Developmental Peds, Podiatry MFM, Pulmonary / Critical Care, Developmental Peds, Podiatry Circuit-rider plan established for numerous other specialties Circuit-rider plan established for numerous other specialties Literature review to assess safety, efficacy, and cost effectiveness of virtual consultation Literature review to assess safety, efficacy, and cost effectiveness of virtual consultation Sharing of providers for gapped billets in pharmacy, Industrial Hygiene etc. Sharing of providers for gapped billets in pharmacy, Industrial Hygiene etc.

13. Overseas Screening Process Problem: Beneficiaries that arrive in WESTPAC region after ineffective overseas screening require medical care that exceeds resources available at WESTPAC MTFs 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 This results in increased medico-legal risk, added costs of referral or medevacs, and lost man-hours to Line units

14. 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.

15. 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

16. OSS Web Portal

17. Aeromedical Evacuation Problem: The aerovac system for routine patients is inefficient and leads to: Problem: The aerovac system for routine patients is inefficient and leads to: Wasted time for referring providers and case managers Wasted time for referring providers and case managers Delay in patient care Delay in patient care Increased time away from work or families for patients and accompanying staff Increased time away from work or families for patients and accompanying staff Cost to sponsor’s command Cost to sponsor’s command

18. Solutions ROFR established for USNH Okinawa 9/08 ROFR established for USNH Okinawa 9/08 Started WESTPAC subspecialty circuit riding to decrease overall need for patients to travel to other MTFs 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 Explored options for using military airlift between BMC Iwakuni and USNH Okinawa

19. 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. 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.

20. Other Benefits of the WESTPAC Medical Alliance True Collaboration at every level True Collaboration at every level Improved communication across the WESTPAC Region Improved communication across the WESTPAC Region Real Team work with customer focus Real Team work with customer focus Synergy of ideas across the commands Synergy of ideas across the commands

21. What we have learned Working together, we can better meet the needs of our beneficiaries throughout our Western Pacific Area of Operation. 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. 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. Lean & Six Sigma tools can help us address complex healthcare issues.

22. Questions?