Colonel Christopher Priest Director, Reserve Medical Programs Force Health Protection and Readiness Office of the Assistant Secretary of Defense for Health Affairs DEPLOYMENT HEALTH ASSESSMENT 2012 USAR LEADERSHIP CONFERENCE SEPTEMBER 21, 2012

Purpose Provide an overview of the Department of Defense policy guidance, reported data trends and observations of program management concerns 2

Agenda Why do we need a Post Deployment Health Assessment/Reassessment? Integrating the Health Assessment Cycle Current policy and statutory requirements Health Affairs Quality Assurance Program –Observations on compliance –Referral Management –QA follow-up Conclusion 3

PDHRA – Good for the Army Critical Commander tool for promoting wellness and enhancing unit readiness Drives early identification of health issues post-deployment Prioritizes treatment of potentially serious conditions that result from deployment Promotes post-deployment reintegration 4

PDHRA – Good for the Soldier Enhances the deployment-related continuum of care Provides screening and opportunity for Soldier education Identifies resources; facilitates access to care Can serve as a tool to guide restoration of health and functioning after deployment 5

PDHRA – A Collaborative Effort Health Affairs – Establishes DoD policy, develops the tool, monitors adherence Army G-1 – Leads the effort; ensures Army policy consistency, develops procedures for implementation Human Resources – Oversees the program; ensures timelines are met Medical Community – Ensures proper screening and follow-up care if needed Line Leadership – Involvement and support are crucial to success The Soldier – It’s always about the Soldier and their Families…keep the main thing the main thing 6

Health Assessment Cycle Retirement/ Separation & Beyond Post-Deployment Re-assessment Pre-Deployment Deployment In Garrison Accession Baseline Health Assessment Secondary Prevention Tertiary Prevention Periodic Health Assessment Post-Deployment Primary Prevention Operations Mental Health Assessments 7

Review of Current Policy DoDI is the principal DoD policy guidance –Assessments required for: Readiness to deploy Negative effects of deployment on health Requires pre- and post-deployment health assessments, and; PDHRA conducted days following return from deployment Enhanced in late 2007 –Added coverage for TBI, alcohol abuse, impact of physical or emotional problems on work, relationships, etc. –Standardized questions in the PDHA wherever possible –Re-certified in September, 2011 –Pertinent Army Regulations: 40-66, Revising Assessments –All deployment assessments are being revised –Goal: Make as science-based and user-friendly as possible 8

Changes to DD 2900 (PDHRA) Incorporate Mental Health Assessment per NDAA12 Question sequence Comment space for Soldier responses Alcohol audit-C questions – raise cut off Deleting TBI questions Additional guidance for provider Modify demographic information Additional comment space for clinician Soldier unsure response options deleted Exposure open ended question Modify force protection questions Deleting Major/Minor Concerns 9

Review of Current Policy: 2012 NDAA Section 702 Mental Health Assessment mandate –Updates requirements mandated in NDAA10, Sec 708: Conducted in a private setting Administered by qualified clinicians Results recorded in medical record; –Change in scheduling Pre-deployment: beginning 120 days before deployment Post-deployment: days after redeployment; months after redeployment PDHRA form revised to incorporate mental health assessment RCs lack electronic means to conduct MH assessments and upload to MEDPRO –Manual System; form storage and retrieval issues? –Case Management? 10

TRICARE and the VA TRICARE Eligibility and Access ‾Transition Assistance Management Program (6 mos) post - deployment is an invaluable tool for Soldier Reintegration Full TRICARE benefit at no-cost to the Soldier Resolved the concurrent benefit issue for those Soldiers retained on Active Duty for medical care ‾Services authority to retain or return to Active Duty those Soldiers who meet the criteria for Medical Retention Processing ‾Care authorized by the Medical Management Support Office (MMSO) for documented LOD conditions resulting from the period of active duty This is a Hot Topic issue with TMA and the Services Documentation is the key 11

TRICARE and the VA Veterans Affairs ‾Is an invaluable partner to provide continuity of care ‾Provides up to five years of care post-mobilization DD214 Provides full access to the VHA as a category 6 beneficiary ‾Military Health Record data (AHLTA) is available to the VA ‾VA record data is not readily available to the RC… you have to ask for it ‾Bi-directional data feeds is a key topic in the DoD-VA working groups Other challenges ‾Difficulty in integrating personal health insurance utilization ‾Referred care conducted by means other than the Federal programs is difficult to coordinate 12

Force Health Quality Assurance Pertinent findings from 2011/12 QA Visits : –PDHRAs are being administered, however : PDHRAs are not getting into AFHSC’s Defense Medical Surveillance System (Service data feed, not a compliance issue) Compliance with meeting the day timeline has improved! There's little evidence Service Members are getting help for identified issues, especially within the Guard and Reserve –Disconnects between Personnel and Medical –Lack of a referral tracking tool –Lack tracking of referral recommendations, limited case management – Follow-up largely unknown after initial screening except for encounter data from the Military Health System –A lot of focus on pre-deployment and post-mobilization medical issue identification, but not enough focus on PDHRA medical issue tracking and follow-up 13

14 Deployment Health Assessment Process Navy, Marine, Coast Guard members initiate health assessment Army members initiate health assessment Air Force members initiate health assessment Assessment printed and put in Service Member’s record Assessment sent to AFHSC (electronic) Assessment stored in Service system (electronic) Assessment stored in DMSS Electronic Health Record (AHLTA) Sent to VA Data available for analysis Does not meet AFHSC business rules (a non- valid SSN or a non- valid form date (including future dates)) Services notified of assessment forms requiring adjudication Available to Providers who have ability to assess Service System DHIMS Meets AFHSC business rules Completed by Provider

Completion of PDHRA (DD2900) based on CTS Roster Data Source: DMSS Prepared by: Armed Forces Health Surveillance Center (AFHSC) FHP&R Proponent: Col Butel Data Source: DMSS (AFHSC) Related Policy: DoDI RC data reflects completion as of certification date, and removal of those deployed to unknown deployment location This metric reflects the proportion of those returning from deployment who have completed the DD2900 health assessment within 60 days prior and up to 210 days post deployment end based on the “Provider Certification Date” Deployment dates are based on DMDC rosters and includes deployments lasting longer than 30 days Excludes those without a deployment end date and those with an unknown deployment location 15

Deployment Health Assessments, Feb - Jul 2012 % Active Duty Army – Top % Army Reserve/National Guard – Lower General Health Good to Excellent Medical or Dental Problems Reported Medical Referral Indicated Pre-deploy (DD 2795) 96% 99% 13% 9% 6% 3% Post-deploy (DD 2796) 89% 88% 32% 39% 23% 26% 10% are Emergency or Immediate care referrals Post-deploy Reassessment (DD 2900) 83% 81% 29% 45% (Depression 9%; PTSD 128%; TBI 6%, Alc 33%) 18% 26% 16

TBI Recommended Referrals and Types of MHS Encounters (60 days) - PDHA 17 This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2796 health assessment within 60 days prior and up to 60 days post deployment return based on the “Provider Certification Date” Follow-up encounters include those encounters that occurred following a TBI referral within 60 days of the provider certification date on the DD2796 Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS *Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard FHP&R Proponent: Ms. Elizabeth Fudge Related Policy: 10744f of Title 10 US Code of Public Law Data Source: DMSS data compiled and summarized by AFHSC

Mental Health Recommended Referrals and Types of MHS Encounters (60 days) - PDHRA 18 This metric reflects the proportion of those returning from deployment as indicated in the CTS Roster who have completed the DD2900 health assessment within 90 days to 180 days post deployment return based on the “Provider Certification Date” Follow-up encounters include those encounters that occurred following a positive MH Referral within 60 days of the provider certification date on the DD2900 Includes only deployments to OEF or OIF greater than 30 days in duration and only civilians that seek care within the MHS *Other refers to Civilians not associated with Army, Navy, Air Force, Marine Corps, & Coast Guard FHP&R Proponent: Lt Col Lawson Related Policy: NDAA 2012, Section 702; 10744f of Title 10 US Code of Public Law Data Source: DMSS data compiled and summarized by AFHSC

The Challenge… Essential to track PDHRA referrals and document Line of Duty requirements USAR must shift into a case management mentality It is not enough to simply comply with the PDHRA requirements. There are tools to ensure Soldiers get follow-on care but the clock is ticking Stratify the effort, what do you care about most? Impacts on a fit and healthy operational force, capable of sustained operations 19

The Way Ahead Avoid assessment fatigue –Command must emphasize importance of assessments –Provide help for identified concerns to show value –Make assessments easy and efficient for personnel and providers Enhance efficiencies and increase Soldier compliance –Work to synchronize timing of all deployment-related required assessments to reduce soldier burden, reduce time away from training and for RC, time away from civilian employment PDHRA timeliness is critically important –Health issues tend to worsen if not addressed –180-day TAMP eligibility facilitates seeking care Follow-up is key –Failure to act negatively impacts everyone – Soldiers/civilians, their families, and the Army –Track the referrals to conclusion –The Gold Standard: Integrated delivery of health care 20

You Are Critical to Success The Army and Line Leaders –Leadership and support Positively affects Soldier attitude Maximizes operational readiness –Day-to-day program execution Human Resources – Oversees the program –Ensures timelines are met Medical Community –Identifies concerns –Provides early treatment and intervention Conference Organizers –Conveys program importance –Increases program effectiveness 21

Conclusion Thank You! 22