1. Optimizing Health: Standing up the US Army Public Health Command
USPHS Scientific and Training Symposium
Optimizing Health: Standing up the US Army Public Health Command
BG Timothy K. Adams
CG, USAPHC (Prov)
21 June 2011
UNCLASSIFIED
UNCLASSIFIED

2. BRIEFING OUTLINE
PURPOSE: To provide an overview on the US Army Public Health Command to USPHS Scientific and Training Symposium attendees.
Army Medical Command (MEDCOM) Overview
MEDCOM Reorganization: 5 Lines of Effort
Public Health Command Background
Mission
Structure
Transition timeline
Integration Opportunities
Public Health Support to Operations in Japan
Questions
UNCLASSIFIED
UNCLASSIFIED

3. OneStaff The Department of the Army TSG & CG
Office of The Surgeon General
(OTSG) Pentagon/Falls Church, VA
An Army Staff Element
Policy and Regulation
Represents the Army
US Army Medical Command
(MEDCOM) Fort Sam Houston, TX
Direct Reporting Unit (DRU)
Fixed Facility Healthcare
Doctrine
Training
Leader Development
Organizations
Materiel
Personnel
Facilities
Regional
Medical
Commands
(5)
Warrior Transition
Command
Research &
AMEDD Center
& School
Dental
The Department of the Army
OneStaff
TSG & CG
USAMEDCOM
DoD Executive Agencies
Armed Forces Institute of Pathology
DoD Veterinary Services Activity
Armed Service Blood Program Office
Military Vaccine Program/Vaccine Hlth Care Netwk
Armed Forces Health Surveillance Center
Medical Research for Prevention, Mitigation
and Treatment of Blast Injuries
Investigational New Drugs Force Health Protection
Military Entrance Processing Command – (MEDICAL)
ARSTAF
Principal
Public Health
(Provisional)
Development, Policy Direction, Organization, and Overall Management of an Integrated Army-wide Health Service System
The Surgeon General is dual hatted as the CG MEDCOM. What has emerged as the template for DRU organization under the Army Campaign Plan has been in place in MEDCOM since The Surgeon General has executive agency of a number of critical joint organizations as noted on the lower right of the slide. Within MEDCOM there are 11 major subordinate command including, the AMEDD Center and School-the largest school in the Army school system; the Medical Research and Material Command-which conducts over 80% of all DoD Medical research and development; the Center for Health Promotion and Preventive Medicine, Veterinary command, Dental Command, and 6 geographical Regional Medical Commands.
WTC Components:
WTU BDE – 2
WTU BN – 13
WTU CO – 17
CBWTU - 9
COL
UNCLASSIFIED

4. Major Subordinate Commands
MEDICAL RESEARCH & MATERIEL COMMAND
Ft. Detrick
WESTERN RMC
NORTHERN RMC
JBLM
MAMC
APG
PUBLIC HEALTH COMMAND
Ft. Belvoir
WARRIOR TRANSITION COMMAND
Crystal City
WAMC
SOUTHERN RMC
Readiness Division
WBAMC
CRDAMC
DDEAMC
Readiness Division
Readiness Division
FSH
BAMC
EUROPE RMC
PACIFIC RMC
Japan
Korea
AMEDDC&S
TAMC
FSH
Readiness Division
DENCOM
Readiness Division
FSH
COL
UNCLASSIFIED 4

5. OTSG/MEDCOM Personnel
AMEDD AT A GLANCE
AMEDD Personnel
World Wide
OTSG/MEDCOM Personnel
Beneficiaries
24,631 Total AC Military
40,189 Civilians
8,429 Contractors
2,326 Total NG/RC Military
75, Total
4,397 Medical Corps Officers
904 Dental Corps Officers
8,381 Other Officers
35,792 Enlisted
49,474 Total AC
8,429 Contractors
45,883 Civilian
50,301 Total NG/RC
154, Total
Active/Reserve
10 / Combat Spt Hosp (CSH)
16 / FWD Surg Tm (FSTs)
100 / Other Active Units
0 / Other Army NG Units
0 / Other Army AR Units
126/52/167 AC/NG/AR
Deployable Units
(345 Total)
546K Active Duty (AD)
814K Family Members (FM) (AD)
214K Dependent Survivor
180K Eligible NG/R
264K Family Members of NG/R
714K Retired
825K FM Retired
145K Other
3,702K Total
TOE Units
MEDCOM
Installations
Walter Reed
Fort Detrick
TDA Facilities
U.S. Army Medical Center (MEDCEN): MEDCENs are large hospitals organized, staffed and equipped to provide preventive, primary, and specialized (tertiary) care, as well as related dental, medical, and social support services. MEDCENS also provide comprehensive pharmacy services (inpatient, outpatient, clinical, oncology, nuclear), as well as comprehensive laboratory and radiology services. When designated, MEDCENs conduct post graduate medical, dental and allied health education.
Bliss, Bragg, Gordon, Hood, Landstuhl, Lewis, Sam Houston, Tripler, Walter Reed
U.S. Army Community Hospital: Smaller in scale and scope than MEDCENs, ACHs are hospitals organized, staffed and equipped to provide preventive, primary, and specialized (secondary) care, as well as related dental, medical, pharmacy, lab, radiology and social support services.
Knox, Belvoir, Sill, Carson, Polk, Riley, Leonard Wood, Irwin, Wainwright, Jackson, West Point, Campbell, Stewart, Benning, Korea
U.S. Army Health Center (AHCE): A MTF that is organized, staffed and equipped to provide preventive, primary, and specialty outpatient services. Also, AHCEs may provide ambulatory services, such as same day surgery, as well as urgent care/emergency services. Although AHCEs may have up to 25 observation beds for care not to exceed 72 hours, unlike MEDCENs and ACHs they are not staffed and equipped to provide inpatient services. Also provides full range of ambulatory (outpatient) pharmacy services and limited laboratory and radiology services.
Eustis, Lee, Meade, Leavenworth, Huachuca, Heidelberg, Vicenza
U.S. Army Health Clinic (AHC): A MTF that is organized, staffed and equipped to provide preventive, primary, and some specialty outpatient services to eligible personnel. Generally, basic laboratory, radiology, and pharmacy services are offered on-site. Also, AHCL’s may have up to 25 observation beds for care not to exceed 72 hours.
Supporting an Installation: Redstone, Rucker, Myer, Drum, Monmouth, Aberdeen, Carlisle, Zama, Dugway (Schofield / Richardson?)
U.S. Army Troop Medical Clinic (TMC): A MTF that is organized, staffed and equipped to provide sick call, immunizations, medical examinations, physical profiling, and limited pharmacy and treatment services to eligible personnel. Patients needing additional care may be referred to larger MTFs.
U.S. Army Occupational Health Clinic (OHC): A MTF that is organized, staffed and equipped to coordinate and implement the Army’s Occupational Health Program for both military and Federal Government civilian employees. They are equipped to treat occupational illness and injury and provide emergency treatment of non-occupational illness and injury. Also, they provide preventive health services, such as, hearing conservation, occupational vision and industrial hygiene services. Patients needing additional care may be referred to other MTFs or private physicians and dentists.
U.S. Army Dental Clinics: We are using 147 as the number of clinics because we are counting stand alone dental clinics and combined medical/dental clinics (111) plus hospital dental clinics (24), as well as SRP/Reception Station/Inprocessing center with DTRs (12) because we actually use all of these facilities to accomplish our mission. If you count only Cat 500 buildings which will include dental clinics in hospitals, the number will be 135.
FY10 Execution: Includes DHP O&M, RDTE, MILPERs, BRAC, OMA
9 Medical Centers
17 Army Community Hospitals
7 Army Health Centers
9 Army Health Clinics (supporting an installation)
128 Army Health Clinics
47 Army Troop Medical Clinics
18 Army Occupational Health Clinics
147 Dental Clinics
96 Veterinary Clinics
31 Research and Development Laboratories
32 Prevention Facilities
Total
Daily Expenditures
(All appropriations)
$35.13M Total
COL
UNCLASSIFIED

6. Average Day in Direct-Care MEDCOM
Outpatient Care
Inpatient Care
1,214 Beds Occupied
374 Patients Admitted
41,986 Clinic visits
Dental Services
26,620 Procedures
64 Births
Veterinary Services
1,961 Veterinary Outpatient Visits
and 418 food safety visits
50,420 Laboratory Procedures
Clinic Visits, Births, Inpatient Care, Dental, and Veterinary Services data are all from Oct 08 - Jun 09
Laboratory Procedures, Outpatient Pharmancy, Radiology Procedures and Immunizations are all FY08 data
54, 048 Outpatient Pharmacy Prescriptions
Medical Logistics Services
150,000 Supply Transactions
1561 Medical Maintenance WOs
12,494 Radiology Procedures
Deployments
1,232 Soldiers Deployed
5,879 Immunizations
COL
UNCLASSIFIED

7. MEDCOM Reorganization - 5 Lines of Effort
MISSION: USAMEDCOM provisionally realigns and reorganizes the CONUS RMCs NLT 1 OCT 2009 IOT improve span of control, while enhancing support to Soldiers, beneficiaries, Army readiness and transformation; on order executes permanent realignment NLT 1 OCT 2010.
ENDSTATE 1
Realign RMCs
RMC boundaries are realigned ICW TRO boundaries; the respective levels of command and staff leadership are reorganized to provide the proper span of control; the requisite C2 leaders and structures are in place and projected accordingly; As the MEDCOM improves support to Soldiers, beneficiaries, Army Readiness, and transformation. 2
Staff REORG
Command Plan
Public Health Command 3
DENCOM Realign 4 5
WTU / AMAP REORG
UNCLASSIFIED 7
* Colors group similar / like actions
UNCLASSIFIED

8. Public Health Command Transition
US Army Public Health Command (Provisional)
UNCLASSIFIED

9. In the beginning….
Idea: merge VETCOM and CHPPM capabilities, optimize public health support to Army
Similar, overlapping missions of mutual interest
Inconsistent public health services across the force
Feasibility Study conducted by Public Health Command working group, September 2008
Course of Action chosen by TSG, effective 17 July 2009
Integrate select missions of CHPPM and VETCOM
Select Level I and II veterinary services (from VETCOM) and preventive medicine missions re-aligned to MTF
Initial Operational Capability – 1 October 2010
Full Operational Capability – 1 October 2011
CIP Submitted to MEDCOM
US Army Public Health Command (Provisional)
UNCLASSIFIED
UNCLASSIFIED

10. Commander’s Intent
MEDCOM will reorganize its public health capabilities to:
Enhance the health and wellness of Soldiers and military retirees, their Families, and DA Civilian employees
Create a single point of accountability and responsibility for public health within the MEDCOM
Optimize public health support to the Army
Improve the planning and use of Army public health assets across the full spectrum of installations and activities
Execute effective Veterinary Service programs across the DoD
End State
A unified Army public health team that enhances and protects the health, fitness, and well-being of Soldiers, their Families, DA Civilian employees, and military retirees; and executes effective veterinary service programs across the DoD
US Army Public Health Command (Provisional)
UNCLASSIFIED
UNCLASSIFIED

11. US Army Center for Health Promotion & Preventive Medicine (CHPPM)
What We Do:
Public Health and Wellness consultants for the Army
Expertise in field preventive medicine, environmental and occupational health, health promotion and wellness, epidemiology and disease surveillance, toxicology, laboratory sciences, hazardous and medical waste, drinking water, entomological vectors, radiation sources and health Risk Communication
Specialized Facilities:
Analytical Chemistry Laboratories
Radiochemistry Laboratory
Entomology Laboratories
Soils Laboratory
Molecular Biology Laboratory
Serum Repository
Toxicology Laboratory
Public Health Information Systems
Just to give you a brief glimpse of my organization, we are the main public health unit in the Army. CHPPM has the laboratories and the experts to provide any necessary consultative support throughout the world. We are also provide the main links to civilian public health organizations, like CDC, and now, the Homeland Security Agency.
Talk to CHPPM about their missions, e.g. Health Promotion Coordinators, etc.
US Army Public Health Command (Provisional)
UNCLASSIFIED

12. US Army Veterinary Command (VETCOM)
Food Safety/ Defense
Sanitation Audits/ Approved Sources
Special Events Food Defense Teams
Operational Rations/ DFACS/DeCA/AAFES
Food and Water Vulnerability Assessments
Food and Water Risk Assessments
Animal Medicine
Military Working Dogs
Other Government Owned Animals
Privately Owned Animals
Human-animal bond program support
One Health – One Medicine
Public Health Team
Zoonotic Disease Surveillance/Prevention
Trained Soldiers
OIF/OEF/ND/HOA/OCO
Humanitarian Assistance/Civil Affairs
Special Taskers-Department of State, Secret Service, USDA, COCOMS
ALFOODACTS/DSCP ALERTS/VENDOR RECALLS
Support over 250 Commissaries worldwide
Support over 2000 Dining Facilities worldwide
$5.3 Billion Subsistence Inspected
Over 2300 MWDs
Over 300 Other Government-Owned Animals
Over 450,000 Military Family Pets
Animal Bite Program
US Army Public Health Command (Provisional)
UNCLASSIFIED

13. PHC Transition Team: A3 Working Groups
US Army Public Health Command (Provisional)
UNCLASSIFIED

14. PHC CONOPS MEDCOM RMCs RPHC AIPH Regions MTF District PHC Installation
CHPPM and VETCOM integrate into the PHC
RVCs and CHPPM Subordinate Commands integrate into PHC Regions under the C2 of the PHC
RMCs have C2 of installation PVNTMED missions
PHC has oversight of level I-III PVNTMED missions through RMCs
RMCs will have enterprise oversight and monitoring authority of the level I-II VETSVC
Oversight authority infers a level of monitoring, advising, coordination and collaboration needed to execute oversight
This slide depicts
functional areas
MEDCOM
RMCs
PHC
RPHC
Regions
MTF
District
Installation
PVNTMED
VETSVCS
AIPH
Oversight (PH Missions)
RMCs oversee I-II VETSVCs;
PHC oversees I-III PVNTMED
Coordinate / Collaborate
(PH Missions)
Monitor (PH Missions)
Color Legend – Level of PH Services
Major Sub Command Level (V)
Strategic Level (V)
Regional or Area Level (III and IV)
Installation Level (I and II)
Red
Lt Blue
Gold
Green
UNCLASSIFIED
US Army Public Health Command (Provisional)

15. APHC Strategy Map Alignment to AMEDD BSC September 2010
Vision
World-Class Provider of Public Health Services across DA and DoD.
Promote health and prevent disease, injury, and disability of Soldiers and military retirees, their Families, and DA Civilian employees; assure effective execution of full spectrum veterinary service for Army and DoD Veterinary missions.
Mission
Strategic
Themes
Synchronize Public Health
Maximize Value in Health Services
Build the Team
Balance Innovation with Standardization
Optimize Communication and Knowledge Management
ENDS
SUSTAIN PREPARE RESET TRANSFORM
Patient/Customer/
Stakeholder
CS 1.0
Minimized Diseases & Injuries of Military Significance
CS 2.0
Enhanced Health & Well-Being
CS 3.0
Optimized Public Health Programs and Practices
CS 4.0
Optimized Animal Care
CS 1.0, 2.0, 3.0
CS 1.0, 3.0
CS 1.0, 2.0, 3.0, 5.0
CS 4.0
IP 5.0 Finalize Public Health Command
Transition Process
IP 6.0 Ensure Effective
Public Health Oversight
IP 7.0 Ensure Safe DoD
Food and Water
IP 8.0 Improve Disease & Injury Surveillance and Control
Internal Process
IP 7.0, 11.0, IP IP 7.0, IP 7.0, 10.0
IP 9.0 Integrate Delivery of Health Promotion and Wellness Services
IP Minimize Risk from Occupational & Environmental Health Hazards
IP Enhance Characterization and Analysis of Health Status and Threats
WAYS
Feedback Adjusts Resourcing Decisions
IP IP 7.0, IP 7.0
IP Ensure High Quality Veterinary Clinical Services
IP Develop and Enhance Relationships with Key Partners
Alignment to AMEDD Strategic Objectives shown in red
IP 8.0, CS 6.0 , IP 13.0, 14.0
Learning
and
Growth
LG Maximize & Sustain Workforce Competencies
LG Standardize & Document Command Business Practices
LG Improve Knowledge Management
MEANS
LG 17.0, LG 19.0, LG 20.0
Resource
R Maximize Human Capital
R Optimize Facilities and Infrastructure
R Forecast Requirements and Secure Enduring Resources
R R R 21.0
AMEDD Objectives not aligned to PHC objectives are: IP15.0 Leverage Research, Development and Acqusition and IP 16.0 Synchronize Army Medicine to Support Army Stationing & BRAC 15 15 15

16. PHC Structure, Roles & Responsibilities
PHC Headquarters
Aberdeen Proving Ground, MD
Provide C2 for PHCRs, PHCDs, AIPH, and MWD Center.
Provide PH oversight, policy, and promulgation.
PHC HQ
Public Health Command – Regions
Provide C2 of PH Districts.
Execute specialized core PH services within AOR.
Monitor training, mentoring, and credentialing.
Monitor installation level PH mission execution.
Senior VCO serve as Veterinary Services Advisor to RMC.
NOTE: DoD MWD (VS) Center and Food, Analysis & Diagnostic Laboratory aligned under PHCR-South
RPHC
PHC
Regions
PHC
AIPH
Army Institute of Public Health
Aberdeen Proving Ground, MD
Provide unique operational and
strategic services & expertise.
Develop Public Health programs.
Provide technical supervision /
consultation.
Oversee quality assurance /
process improvement.
Public Health Command -Districts
Execute general core PH services.
Environmental Health
Field Preventive Medicine
Veterinary Public Health
Provide training and mentoring.
Monitor installation level EH, FPM, and Vet mission execution.
Provide C2 of installation veterinary missions at CONUS and OCONUS locations.
PHC
Districts
Color Legend: Level of Public Health Services
Major Sub Command Level (V)
Strategic Level (V)
Regional or Area Level (III and IV)
Lt Blue
Gold
Red
Vet
Branches
& Sections
US Army Public Health Command (Provisional)
UNCLASSIFIED

17. PHC Organizational Structure
IOC
CONCEPT
Align by technical function (AR 40-5; 40-3)
Implement standard PHC organizational structure
Regional and District personnel execute operational missions along the functional portfolios.
Army Institute of Public Health (IPH) senior managers serve as Portfolio Directors overseeing portfolios for MEDCOM Public Health
Develop and analyze PH programs and policy
Execute unique low-density PH services
Color Legend
Major Sub Command Level (HQ)
Strategic Level (V)
Strategic Portfolio Managers
Unique Services
Regional or Area Level (III and IV)
District Level (III)
Lt Blue
Green
Red
Gold
Violet
Yellow
US Army Public Health Command (Provisional)
UNCLASSIFIED

18. PHC Organizational Structure
Color Legend
Major Sub Command Level (HQ)
Strategic Level (V)
Strategic Portfolio
Shared Services
Regional or Area Level (III and IV)
District Level (III)
Lt Blue
Green
Red
Gold
Violet
Yellow
PHC Organizational Structure
FOC
CONCEPT
Align by technical function (AR 40-5; 40-3)
Implement standard PHC organizational structure
Regional and District personnel execute operational missions along the functional portfolios.
Army Institute of Public Health (IPH) senior managers serve as Portfolio Directors overseeing portfolios for MEDCOM Public Health
Develop and analyze PH programs and policy
Execute unique low-density PH services
US Army Public Health Command (Provisional)
UNCLASSIFIED

19. Personnel Strength as of 1 Mar 2011 3,051
Legacy CHPPM (1,190)
Legacy VETCOM (1,861)
UNCLASSIFIED
US Army Public Health Command (Provisional)

20. Formal Steps to FOC Command Implementation Plan (CIP) Permanent Order
Formal documentation to establish PHC
Approved by HQDA, dated 23 May 11
Permanent Order
Official documentation of the creation of the USAPHC
In staffing
Re-designate/Inactivate VETCOM
US Army Public Health Command (Provisional)
UNCLASSIFIED

21. PHC Transition TimelineFY
2011+
Phase I (Provisional)
Phase II (IOC)
1 OCT 11 – PHC FOC
WRMC/SRMC Enterprise Rapid Experiment, Phase II (Monitor)
July 11 – Re-designate / Inactivation Ceremonies
June 11 – Anticipated Permanent Order
May 11 – HQDA Approval of CIP FY
2011
1 Feb 11 – ATTACH CONUS RVCs to PHCRs
19 Jan 11 – PHC OPORD (PHC Reorganization) published
1 Jan 11 - DVCs aligned to RVCs along target CONUS regions
1 DEC 10 – MEDCOM approves CIP
1 OCT 10 – PHC IOC;
WRMC Enterprise Rapid Experiment, Phase I (Coordinate/Collaborate)
1 AUG 10 – OPCON OCONUS RVCs to PHCRs;
OPCON Installation PM assets to MEDDAC-Japan FY
2010
1 MAR 10 – BG Adams briefed on CONPLAN
1 APR 10 –OPCON VETCOM and VETCOM-EUR to PHC (P)
26 FEB 10 – TSG approves CONOPS
19 JAN 10– MEDCOM CofS IPR
1 OCT 09 – Establish PHC(Provisional) per OPORD (MEDCOM REORG) FY
2009
28 AUG 09 – PHC TT Project Charter Approved
17 JUL 09 – WARNO (Establishment of USAPHC)
3 JUN 09 – TSG selects PHC COA 3a.1
U.S. Army Public Health Command (Provisional)
UNCLASSIFIED 21

22. USAPHC Integration Opportunities
Preventive Medicine
Veterinary Health Services
Disease prevention and control
Field preventive medicine
Environmental health
Health surveillance and epidemiology
Laboratory services
Health risk assessment
Integration Opportunities
Emerging Programs
Army Wellness Centers
NAF Central Fund
First Year Graduate Veterinary Education (FYGVE)
Community Health Promotion Councils
(AR 40-3, AR , AR , AR )
Veterinary Medical care for Government- Owned Animals
Zoonotic disease surveillance and control
Food safety and food defense quality assurance programs
Veterinary Medical care for Privately-Owned Animals
(AR 40-5)
Occupational health
Health surveillance and epidemiology
Soldier, family, community health, and health promotion
Toxicology
Laboratory Services
Health Risk Communication
Zoonotic disease surveillance and control
Food safety and food defense quality assurance programs
US Army Public Health Command (Provisional)
UNCLASSIFIED
UNCLASSIFIED

23. The New Public Health Paradigm
Laboratory Animal Veterinarian
Sanitary Engineer
Veterinary Pathologist
Nuclear Medical Science Officer
Occupational Health Nurse
Health Physicist
Geologist
Chemist
Safety and Occupational Health Specialist
Animal Care Specialist
Audiologist
Chaplain
Medical Laboratory Specialist
Meteorologist
Psychologist
Ergonomist
Fire Protection Engineer
Entomologist
Physicist
Dietitian
Acoustical Engineer
Safety Engineer
Wildlife Biologist
Medical Officer
Dental Officer
Social Worker
Veterinarian
Agronomist
Optometrist
Toxicologist
Epidemiologist
Electrical Engineer
Marine Biologist
Mechanical Engineer
Physical Therapist
Environmental Engineer
Community Health Nurse
Industrial Hygienist
Environmental Law Attorney
Clinical Medicine Veterinarian
Comparative Medicine Veterinarian
Environmental Scientist
Preventive Medicine Physician
Veterinary Food Inspection Specialist
Veterinary Services Food Safety Officer
Environmental Protection Specialist
U.S. Army Public Health Command (Provisional)
UNCLASSIFIED

24. Ambient Radiation Monitoring Air Water Soil Food/Bottled Water Testing
Public Health Support to Operations in Japan
Ambient Radiation Monitoring
Air
Water
Soil
Food/Bottled Water Testing
Support personnel evacuations
Veterinary clinical support to Search and Rescue Dogs
Support to JSF-J and PACOM
US Army Public Health Command (Provisional)
UNCLASSIFIED

25. Questions UNCLASSIFIED U.S. Army Public Health Command (Provisional)