Western Regional Medical Command A Collaborative Approach To Changing The Landscape Of Military Medicine In The Puget Sound Area January 8, 2014 BG John M. Cho Commanding General, Western Regional Medical Command Senior Market Executive, Puget Sound Enhanced Multi-Service Market

Western Regional Medical Command BG John Cho CSM Marshall Huffman Established Headquarters In July 2009 11 Medical Treatment Facilities covering 20 Western States Over 18,000 employees & $1.6B Annual Operating Budget Our MISSION is to provide comprehensive health services in order to optimize Force Readiness and the Health and Well-being of our Military, Family, and Retiree population. Our VISION is to be an integrated and synchronized "Team of Teams" delivering quality, trusted, and responsive healthcare.

Western Regional Medical Command Ft. Wainwright WESTERN RMC JBER MEDICAL RESEARCH & MATERIEL COMMAND JBLM NORTHERN RMC Ft. Belvoir Ft. Detrick APG PUBLIC HEALTH COMMAND Ft. Leavenworth Ft. Carson Ft. Riley POM WARRIOR TRANSITION COMMAND Ft. Irwin White Sands Missile Range Ft Leonard Wood WAMC Crystal City SOUTHERN RMC Ft. Huachuca CRDAMC Ft. Bliss DDEAMC EUROPE RMC FSH BAMC PACIFIC RMC MEDCOM Japan Korea SRMC FSH FSH TAMC AMEDDC&S FSH Power Projection Platforms DENCOM FSH

Military Health System Governance Structure eMSM NCR Tidewater San Antonio Colorado Springs Puget Sound Hawaii Secretary of Defense/ Dep. Secretary of Defense Under Secretary of Defense (Personnel and Readiness) Military Health System Executive Review Policy Action Council Assistant Secretary of Defense (Health Affairs) Senior Military Medical Action Council = eMSM = Single Service Medical Deputies Action Group The Eight Largest Markets (and Service/Department Leads) The MHSER (Military Health System Executive Review) is the Service Vice Chief’s forum for DoD leadership input into the strategic transitional and emerging issues facing the MHS, the DHP, and the DoD. The ASD(HA) has overall responsibility for eMSM Governance. Senior Military Medical Advisory Council (SMMAC) Executive Group would champion the eMSM construct. The eMSM Governing Council comprised of Service DSGs and the DHA Deputy Director. The Council would: provide oversight, guidance and dispute resolution for the eMSMs; hold eMSM Managers accountable for successful implementation of 5-year Performance Plans; and set eMSM objectives in accordance with guidance from SMMAC to achieve alignment with MHS strategic goals. (Improved Readiness, Better Health, Better Care, and Reduced Cost). Funds flow from the Services would be based upon agreed and Council-approved 5-year Performance Plans The eMSM Manager would be accountable to the eMSM Governing Council for Performance Plan execution. And as previously stated, the MTFs would be accountable to the eMSM Manager and Services to support eMSM performance plans. Enhanced Multi-Service Market Leadership Group Army Army AF DHA Army Navy Army AF 4

Puget Sound Enhanced Multi-Service Market Naval Hospital Bremerton VA Puget Sound Healthcare System 62d Medical Squadron JBLM – McChord Field Naval Hospital Oak Harbor Madigan Army Medical Center The TRICARE Puget Sound Executive Council (TEC) is established as the governing body for the delivery and management of health care services in the Puget Sound Market 92d Medical Group Fairchild AFB Washington National Guard Health Safety & Work-Life Support Activity (USCG)

Puget Sound Enhanced Multi-Service Market Services: Army, Air Force, Navy Population Served: Approx. 290,000 Enrolled Population: 180,000 Military Treatment Facilities Army Madigan Army Medical Center Madigan – Puyallup Medical Home Madigan – South Sound Medical Home Okubo Family Practice Clinic OMAMC - JB Lewis-McChord Winder Family Medical Clinic Navy Navy Hospital Oak Harbor Navy Hospital Bremerton NBC Everett NBHC Bangor NBHC Puget Sound Air Force 62nd Medical Squad JB Lewis-McChord 

Puget Sound Enhanced Multi-Service Market Strategy Map Vision Lines of Effort Outcomes Endstate Army, Navy, USAF Unity of Effort to achieve the Quadruple Aim 1. Increase Inpatient Capability and Utilization Productivity Policy Leading Practices Leverage Technology Partnerships Medical Diplomacy Strategic enabler that fully leverages the Direct Care system Objective 1-1 Internal Medicine PCMH Model Objective 1-2 Synchronize efforts with Providers & Specialty Leaders Objective 1-3 A Rapid and Efficient Referral and Patient Transport System Objective 1-4 UMV Support to Seamless System Interface 2. Support / Maintain / Grow GME Experience Production and Business Policy Organizational Development Standardization/Centralization Staff Development Robust GME programs providing a readiness platform while delivering best value care to beneficiaries Objective 2-1 Accept all Cases/Maximize Capacity Objective 2-2 Leverage Market Multiple Sites of Care to Meet Patient Demand Objective 2-3 Redesign Model to improve training quality & Patient Experience Deliver the highest quality, cost effective and integrated health services in the Puget Sound Market in support of current and former Service Members and their families. An eMSM fully optimized, with highest value, highest quality primary care, specialty care and GME programs resulting in the Patient’s Preferred system of choice while transforming from a healthcare system to a System for Health. A System for Health that Maintains, Restores and Improves the health of the population as their Health System of Choice. 3. Maximize Benefits of the PCMH Model Health Infrastructure Talent Management Productivity Policy PCMH Models Leverage Technology/Resources Full enrollment in PCMH will deliver highest quality, best value care Objective 3-1 Maximize Enrollment Objective 3-2 Leverage Wellness Centers as extensions of PCMH Objective 3-3 Maintain, Restore, Improve Health of the Population Objective 3-4 Enhance the Patient Experience 4. Strategic Engagement and Alignment Our Successes will transfer Lessons Learned to best meet future needs Targeted Communication Patient and Staff Engagement Partnerships Leading Practices Objective 4-1 Tell Our Story of Success Objective 4-2 Identify Future Opportunities for Patient Engagement Objective 4-3 Strengthen Partnerships with VA, UW, Network Facilities Objective 4-4 360 Strategic Communication Objective 4-5 Exceed Leadership Expectations Objective 4-6 Create Spirit of Entrepreneurialism to Grow Successful Practices

A collaborative approach to healthcare in the enhanced Multi-Service Puget Sound Market