1. Navy Medicine Strategic Plan Executive Medical Department Enlisted Course 05 February 2014
Karen L. M. Sayers, MSOD
Office of Strategy Management/M5
U.S. Navy Bureau of Medicine & Surgery

2. Overview of Strategic Planning Process
Learning Objectives
Overview of Strategic Planning Process
Navy Medicine’s Strategic Plan
Cascading the Plan
Executing & Reviewing Progress
Operational improvement continues alongside strategic work:
There are many critical improvement initiatives which must be continued, but that don’t represent a change and therefore are operational rather than strategic in nature. E.g.,
Establish quality guidelines and health care policy
Monitor MTF performance metrics
Prepare for Navy Medicine audit
Establish research priorities and set guidance for conducting research

3. Open Systems Change Model
& Baldrige Criteria
& PDCA Do
Human Resource Focus
Leadership
Strategy
Structures
Systems
Processes
Outputs
Outcomes
Feedback
Check
Plan
Business
Results
Customer
Focus
Leadership
Strategic
Planning
Process
Management
Operational improvement continues alongside strategic work:
There are many critical improvement initiatives which must be continued, but that don’t represent a change and therefore are operational rather than strategic in nature. E.g.,
Establish quality guidelines and health care policy
Monitor MTF performance metrics
Prepare for Navy Medicine audit
Establish research priorities and set guidance for conducting research
Act
Measurement
Analysis &
Knowledge
Management
Key phases of strategic planning adapted from Bryson(2011), Allison & Kaye(2005), and Wheelen & Hunger(2006)

4. Strategy is a Design for Change
Strategy is change: What’s being added, dropped or done differently in order to create organizational value faster than business as usual?
Strategic Vision
Value
Continuous Improvement
Strategic Plan
Strategic
Change
Core
Operations
Core Business
Readiness
Jointness
Our strategic plan focuses efforts on 3 specific areas in order to significantly increase the overall value/worth we provide to the people we serve.
Navy Medicine’s Strategy targets:
Readiness
Value
Jointness
Our day-to-day core operations provide the foundation for this strategic plan and require continuing incremental improvements to support it.
Operational improvement continues alongside strategic work:
There are many critical improvement initiatives which must be continued, but that don’t represent a change and therefore are operational rather than strategic in nature. E.g.,
Establish quality guidelines and health care policy
Monitor MTF performance metrics
Prepare for Navy Medicine audit
Establish research priorities and set guidance for conducting research
Time

5. READINESS - VALUE - JOINTNESS
Navy Medicine
No Change
Mission
We enable readiness, wellness, and health care to Sailors, Marines, their families, and all others entrusted to us worldwide, be it on land or at sea.
Vision
Navy Medicine is the pinnacle of excellence - answering the call across any dynamic - from kinetic operations to global engagement. Our health care is patient-centered and provides best value, preserves health, and maintains readiness. Agility, professionalism, an ethos of care, and the ability to deploy to any environment or sea state are our hallmarks.
Guiding Principles
Ship - Shipmate - Self
Strategic Priorities
READINESS - VALUE - JOINTNESS

6. Navy Medicine Guiding Principles
No Change
Ship – Shipmate - Self
Ship ➢ Take care of the ship. The ship is the mission, the environment or command we operate in, our patients, and those we serve who seek care. It could be the Marines we are serving alongside or the vaccine we are trying to create. We must all consistently ask ourselves where we fit into the overall mission and priorities of not just our commands, but of the entire Navy Medicine enterprise. We must honor our proud heritage and perform the mission without fail.
Shipmate ➢ Take care of each other. Be vigilant to the needs and actions of your shipmates and watch out for one another. We must maintain an optimum level of professionalism at all times. We must remain on a path that supports our core values of honor, courage and commitment. When someone starts to veer off that course or starts to show signs of trouble, step between your shipmate and trouble and help them course correct. We all need one another to succeed. Leave no shipmate behind.
Self ➢ Take care of yourself. You cannot care for others if you are not caring for yourself. Asking for help is a sign of strength. We are all in this together. You must constantly reflect on your own needs and those of your family. Speak up so we can better equip you to meet the challenges you are facing. Self-reflection and awareness is also an important part of leadership and success.

7. Navy Medicine’s Strategic Goals
No Change
We provide agile, adaptable, and scalable capabilities prepared to engage globally across the range of military operations within maritime and other domains in support of the national defense strategy.
Readiness
We will provide exceptional value to those we serve by ensuring highest quality care through best health care practices, full and efficient utilization of our services, and lower care costs.
Value
We lead Navy Medicine to jointness and improved interoperability by pursuing the most effective ways of mission accomplishment.
Jointness
Strategic enabling objectives will help Navy Medicine achieve its mission and accomplish our Goals and Objectives.
STRATEGIC ENABLING OBJECTIVES

8. Navy Medicine FY14 Strategy
Changes noted in italics and brown font color
Military Leaders: “I can call upon the Navy and Marine Corps at any moment and they will be medically ready to deploy and optimally medically supported in action.”
Warfighter: “My family and I are in the best possible medical hands while on Active Duty and when I retire.”
U.S. Public: “Our interests are being well-protected by our Navy and Marine Corps and resources are being appropriately utilized to that end.”
Readiness
Value
Value = (Quality X Capability) / Cost
Jointness
R1. Deliver ready capabilities to the operational commander
V1. Decrease enrollee network cost/Increase recapture of Purchased Care
J1. Leverage joint initiatives to optimize performance of Navy Medicine’s mission
R2. Deliver relevant capability and capacity for Theater Security Engagement operations
V2. Realize full benefit from Medical Home Ports and Neighborhoods
J2. Improve Navy Medicine interoperability
Strategic Enabling Objectives
R3. Optimize use of medical informatics, technology, and telehealth
V3. Standardize clinical, non-clinical, and business processes
J3. Improve communications and alignment

9. Navy Medicine Strategy Objective Definitions
Changes noted in italics and brown font color
Readiness
Value
Value = (Quality X Capability) / Cost
Jointness
J1 Leverage joint initiatives to optimize performance of Navy Medicine’s mission
Definition: Inventory Navy Medicine’s capabilities and assess each for importance and interoperability within the Joint and interagency environment. For those capabilities that are not vital but that are, or can become, interoperable and where it makes sense from a value perspective, Navy Medicine will lead both sister Services and interagency to develop joint solutions.
R1 Deliver ready capabilities to the operational commander
Definition: To maximize alignment between requirements, capabilities, and capacities we will transition our health service support into interoperable adaptive force packages by aligning Navy Medicine's manning, training, and equipping.
V1 Decrease enrollee network cost/Increase recapture of Purchased Care
Definition: Navy Medicine will decrease network spending, maximize training experience of our staff and optimize resource utilization. We will meet training/currency targets while managing referrals in order to provide Prime Service Area enrollees the best care at the best value.
R2 Deliver relevant capability and capacity for Theater Security Engagement operations
Definition: To support the Operational Commander’s Theater Campaign Plans, we will partner with the Joint, Inter-Agency, international community, and host nation capabilities by providing integrated and focused medical forces to conduct maritime health engagement operations. We will proactively build relationships that mitigate human suffering as the vanguard of interagency and multinational efforts by providing appropriate medical capability in support of whole-of-government responses and priorities.
V2 Realize full benefit from Medical Home Ports and Neighborhoods
Definition: Navy Medicine will realize full benefit from our MHP and Neighborhoods. We will attain better health for our patients, and when they do need care, we will provide the best care possible in a patient-centered care environment.
J2 Improve Navy Medicine interoperability
Definition: In order to optimize our ability to work synergistically with other military services, we will develop and implement processes and programs that enhance interdependence. Particular focus will be placed on training and career management to prepare Navy Medicine personnel to successfully lead in a joint and interagency environment and that our operational constructs consider this interoperability as a way to sustain mission capability.

10. Navy Medicine Strategy Objective Definitions
Strategic Enabling Objectives
R3: Optimize use of medical informatics, technology, and telehealth
Definition: We will leverage informatics, technology, and telehealth with standardized interoperable tools and processes throughout the enterprise. Quality metrics and data will then be used to optimize our clinical and business decision making, workflows, and outcomes within the Operational, Joint, and Interagency environment.
V3: Standardize clinical, non-clinical, and business processes
Definition: Through appropriate standardization and consistency in our processes, we will improve delivery of Navy Medicine capabilities and services, clinical outcomes, care quality, and overall efficiency while reducing costs and resource utilization.
J3: Improve Communications and Alignment
Definition: Navy Medicine will drive strategic alignment using communication capabilities and a clear governance structure, holding each level of Navy Medicine accountable for strategic execution. Alignment and communication will ensure that the Navy Medicine’s intent and strategic plan is understood by all stakeholders and provide two-way communication.

11. Cascading Approach Passive Role (Holding Company)
Active Role (Operating Company)
TATA Family Group
Hotel Chain
Financial Services Company
Private Equity Firm
General
Electric
McDonalds
Exxon Mobil
Navy
Medicine
Home Depot
Global Manufacturing Company
Consumer Bank Branches
New
Contributory
Identical
Dominant Technique

12. Cascading the Strategy Works backward from the strategic vision.
Translates the future state into concrete tactical steps that we can take today.
Strategic Plan
Breaking apart the challenge:
STRATEGIC
Strategic Vision
Disaggregate high-level vision into specific tactics
Move from long-term results to short-term indicators
Everyone understands what they can directly impact
Value
Strategically-focused activity
How will we achieve it?
Stakeholders
Readiness, Value, Jointness
How will we achieve it?
FY14 Strategy Map
Enabling Objectives
How will we achieve it?
TACTICAL
TODAY
FUTURE
Time

13. Value = (Quality X Capability) / Cost
Navy Medicine Strategy Map
Military Leaders: “I can call upon the Navy and Marine Corps at any moment and they will be medically ready to deploy and optimally medically supported in action.”
Warfighter: “My family and I are in the best possible medical hands while on Active Duty and when I retire.”
U.S. Public: “Our interests are being well-protected by our Navy and Marine Corps and resources are being appropriately utilized to that end.”
Readiness
Value
Value = (Quality X Capability) / Cost
Jointness
R1. Deliver ready capabilities to the operational commander
V1. Decrease enrollee network cost/Increase recapture of Purchased Care
J1. Leverage joint initiatives to optimize performance of Navy Medicine’s mission
R2. Deliver relevant capability and capacity for Theater Security Engagement operations
V2. Realize full benefit from Medical Home Ports and Neighborhoods
J2. Improve Navy Medicine interoperability
Regions can add 1 objective (either linked to a specific goal or an enabling objective)
Strategic Enabling Objectives
EO1. Optimize use of medical informatics, technology, and telehealth
EO2. Standardize clinical, non-clinical, and business processes
EO3. Improve communications and alignment

14. Value = (Quality X Capability) / Cost
Navy Medicine Strategy Map
Military Leaders: “I can call upon the Navy and Marine Corps at any moment and they will be medically ready to deploy and optimally medically supported in action.”
Warfighter: “My family and I are in the best possible medical hands while on Active Duty and when I retire.”
U.S. Public: “Our interests are being well-protected by our Navy and Marine Corps and resources are being appropriately utilized to that end.”
Readiness
Value
Value = (Quality X Capability) / Cost
Jointness
R1. Deliver ready capabilities to the operational commander
V1. Decrease enrollee network cost/Increase recapture of Purchased Care
J1. Leverage joint initiatives to optimize performance of Navy Medicine’s mission
Only if applicable
(Region decides)
V2. Realize full benefit from Medical Home Ports and Neighborhoods
Strategic Enabling Objectives
V2. Standardize clinical, non-clinical, and business processes
J3. Improve communications and alignment

15. Navy Medicine Strategy Map Value = (Quality X Capability) / Cost
Military Leaders: “I can call upon the Navy and Marine Corps at any moment and they will be medically ready to deploy and optimally medically supported in action.”
Warfighter: “My family and I are in the best possible medical hands while on Active Duty and when I retire.”
U.S. Public: “Our interests are being well-protected by our Navy and Marine Corps and resources are being appropriately utilized to that end.”
Readiness
Value
Value = (Quality X Capability) / Cost
Jointness
* BUMED Codes & Echelon 3 specialized commands will not have all objectives but just those they directly support
* Some leeway here to develop new contributory objectives in support of the three goals
R1. Deliver ready capabilities to the operational commander
V1. Decrease enrollee network cost/Increase recapture of Purchased Care
J1. Leverage joint initiatives to optimize performance of Navy Medicine’s mission
R2. Deliver relevant capability and capacity for Theater Security Engagement operations
V2. Realize full benefit from Medical Home Ports and Neighborhoods
J2. Improve Navy Medicine interoperability
Strategic Enabling Objectives
EO1. Optimize use of medical informatics, technology, and telehealth
EO2. Standardize clinical, non-clinical, and business processes
EO3. Improve communications and alignment

16. Cascading Initiatives & Measures
SG ‘s Metrics
Regional Dashboard Metrics
Bumed Code Metrics
MTF/Command Dashboard Metrics
Directorate/Department Metrics
As the Plan cascades, different levels may develop new initiatives to support the given objectives
These new initiatives & measures will be designed to support the higher level goals, objectives & measures
Subordinate Levels may also develop expanded metrics/measures

17. Senior Strategy Board Review Cycle
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Planning
Environmental Scan
Draft Strategic Plan
Strategic
Planning Offsite
Value Goal Group
Execution
Jointness Goal Group
Readiness Goal Group
NME Review
NMW Review
NME Review
NMW Review
NMW Review
NME Review
NMW Review
NME Review
Monitoring
Value Goal Brief
Readiness Goal Brief
Jointness Goal Brief
Value Goal Brief
Readiness Goal Brief
Jointness Goal Brief
Value Goal Brief
Readiness Goal Brief
Jointness Goal Brief
Value Goal Brief
Readiness Goal Brief
Jointness Goal Brief

18. CPO Mess Can fix Admin Status
Readiness Goal
R1 Objective Objective Lead: CAPT Zinder Action Officer: CDR Givens
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Deliver ready capabilities to the operational commander
RM1: Adaptive Force Packaging,
Readiness Status
AFPR
Status in DRRS-N Via
EMPARTS
DMLSS
RCRP
EMPARTS P=29%
T=19%
A=35%
R=24% DMLSS EMFs R=99%
FDPMU R:
2=95%\96%
2=74%
RM2: Risk-adjusted Wholeness measure
TBD
N/A
RM3: Warfighter / leadership
assessment survey
Stable or improving rating on Likert scale.
Tool in complete
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI11
CD&I Standup (in process)
“Front End Assessment (FEA)” of Navy Medicine readiness reporting.
DRRS-N reporting of NAVMED Sponsored & Supported Platforms
Develop & deploy tool to assess operational Commanders’ satisfaction with Navy Medicine’s readiness during all phases of deployment.
CD&I
Pending
FTE Estimation
CPO Mess Can fix Admin Status
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2 J

19. Value Goal
V1 Objective
Objective Lead: RDML Gillingham Action Officer: CAPT Jenkins
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Decrease enrollee network cost/Increase Recapture of Purchased Care
VM1
Purchased care cost per MTF prime enrollee per month
$99.06
FY13
$102.88
Slide 7
VM2
Average Workload Market Share: Total Prime Direct Care Vs. Total Prime Care within a Prime Service Area
FY12
47%
50%
Slide 8
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
VI1
Evaluate top MDCs by utilization and associated costs
LCDR Coker No
Redesigning Regional Purchased Care (REPO) meeting structure to focus on top MDCs by utilization and costs vice a generic product line review
Standing-by for similar eMSM initiatives in development by DHA Analytics
VI2
Evaluate implementation of productivity/currency measures across enterprise in alignment with MHS M3
Benchmarks completed for Skill Type 1 & 2 providers and will be utilized in FY15 performance planning cycle
Services will be responsible for monitoring
VI3
CONUS Hospital CPLAN
CAPT Beilman
CDR Ringer
MTF site visits completed

20. Improve Communications and Alignment
Jointness Goal
J3 Objective Objective Lead: RDML Coe Action Officer: CAPT Smith
On Target
At Risk
Off Target
In Development
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Improve Communications and Alignment
J3M1a. % Navy Commands with annual plan aligned with the Navy Medicine Strategic Plan
100% 
N/A
J3M1b. % initiatives aligned with NM strategic plan
J3M2. % Survey participants who can successfully identify strategic plan
90%
45%
See survey results
J3M3. Regional metrics
80% of SG dashboard metrics at or above selected threshold
2nd cycle complete
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
J3I1
Develop and Communicate a Focused Message No
Strategic Plan Cascade
Gayle Goff (OSM)
Rollout to BUMED, Regions, MTFs, and E3s
Strategic Communications Plan
Gayle Goff (OSM) & CAPT Lockwood (PAO)
Develop and implement communication plan (focus: deckplate)
J3I2
Accountability Initiative
Metrics Governing Board
Continue to refine metrics; improve automation
Regional Performance Review
COS
Refreshed review reflects FY14 strategic changes; NME will undergo review in January
J3I3
BUMED Reinvention
CAPT Hall
None at this time
Single digits continue to define BUMED mission; ADCs will take vision and develop organizational constructs
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2

21. Questions? Ms. Karen L. M .Sayers, MSOD
Office of Strategy Management/M5
Bureau of Medicine & Surgery
7700 Arlington Blvd
Falls Church, VA
Com:
DSN:
BB:

22. Senior Strategy Board Readiness Goal Brief
We provide agile, adaptable, and scalable capabilities prepared to engage globally across the range of military operations within maritime and other domains in support of the national defense strategy..
November 14, 2013
Goal Lead: RDML Stephen Pachuta
Vice Goal Lead: RDML Brian Pecha

23. Readiness Goal
R1 Objective Objective Lead: CAPT Zinder Action Officer: CDR Givens
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Deliver ready capabilities to the operational commander
RM1: Adaptive Force Packaging,
Readiness Status
AFPR
Status in DRRS-N Via
EMPARTS
DMLSS
RCRP
EMPARTS P=29%
T=19%
A=35%
R=24% DMLSS EMFs R=99%
FDPMU R:
2=95%\96%
2=74%
RM2: Risk-adjusted Wholeness measure
TBD
N/A
RM3: Warfighter / leadership
assessment survey
Stable or improving rating on Likert scale.
Tool in complete
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI11
CD&I Standup (in process)
“Front End Assessment (FEA)” of Navy Medicine readiness reporting.
DRRS-N reporting of NAVMED Sponsored & Supported Platforms
Develop & deploy tool to assess operational Commanders’ satisfaction with Navy Medicine’s readiness during all phases of deployment.
CD&I
Pending
FTE Estimation
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2 J

24. On Target
At Risk
Off Target
Readiness Goal
R1 Objective Objective Lead: CAPT Zinder Action Officer: CDR Givens
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI12
F2F: Train wartime specialties
Ensure use of EMPARTS to report Total Force (AC & RC) personnel and training readiness.
CD&I/M1/M7
Yes
A-Status
Working in coordination with BUMED M1/M7 to develop the F2F concept.
RI13
Create wholeness equation
for Readiness
CD&I No
Continue efforts to align with Navy’s capabilities-based readiness reporting system (DRRS-N)
RI14
Develop NTSPs for every platform (BSO-18)
Developing a process to facilitate operational training requirements that support execution of all Navy Medicine deployable capabilities
RI15
Formalize unit training / certification requirements
CD&I/USFFC/HQMC
Working in coordination with USFFC, HQMC and BUMED M3 to define platform certification requirements and to formalize unit training.

25. Readiness Goal
R2 Objective Objective Lead: RDML Chinn Action Officer: CAPT Diehl
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Deliver relevant capability and capacity for Theater Security Engagement operations
RM4: Percent of Global Health Engagement (GHE) professionals, identified by AQD, assigned to key billets within the joint, Inter-Agency and International Community
27% of GHE key billets within Joint, IA and international community filled
Presenting billet and AQD requirements
RM5: Warfighter demand for Navy Medical Theater Security Engagement capabilities as measured by OPTEMPO
Stable or increasing demand (OPTEMPO) for all Navy Medical Theater Security Engagement capabilities
Establishing Baseline, no measure currently
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI21
Establish a GHE Additional Qualifying Designator; Identify qualified personnel.
CAPT Diehl/CDR Currie
Sub-objective
leads are identifying
any issues with their
Teams. No
On 11/7, Deputy Corps Chiefs approved briefing seeking approval of GHE AQD COA to go to Corps Chiefs.
RI22
Identify/establish key GHE billets within the Joint, IA and international community.
CAPT Diehl/LCDR Jette
Same as above
Analyzing additional billets that could be coded with GHE AQD but should wait on AQD approval.
RI23
Identify/establish Navy Medical Theater Security Engagement capabilities by UTC.
CAPT Diehl/CDR Coleman
Working in coordination with USFFC and BUMED M5/M3 to define GHE Adaptive Force Packages.
RI24
Establish an algorithm for measuring and comparing historical OPTEMPO to current year OPTEMPO.
CAPT Diehl/LCDR Wicker
Same as above.
Developing collection process to establish baseline for OPTEMPO algorithm. Establishing contact and Fellow(LNO ) at Defense Security Cooperation Agency (DSCA).
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2

26. On Target
At Risk
Off Target
Readiness Goal
R3 Objective Objective Lead: CDR Thornton Action Officers: CAPT Beilman
Mr. Bill Frank
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Optimize use of medical informatics, technology, and telehealth
RM6 Speed to decision
Clearly define IT business processes to facilitate good analysis with the goal of reducing the cycle time average from 180 days to 90 days
In the current Governance process baselines have been established by which to track pages that take 90 days or less in “Block-2” of the enterprise governance process
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI31
Continue efforts to automate the governance process
Bill Frank
N/A No
Determine transition steps required to maintain the effort while simultaneously transitioning these efforts to the DHA
RI32
Train functional and portfolio managers on their “mission”
Until the existing governance process is fully absorbed by the DHQ, training functional and portfolio managers on their “mission” will be crucial to the process of fielding IT solutions throughout the BSO-18 enterprise.
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2

27. Readiness Goal
R3 Objective Objective Lead: CDR Thornton Action Officers: CAPT Beilman
Mr. Bill Frank
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Optimize use of medical informatics, technology, and telehealth
RM7 Improved EHR Performance
50% increase in use of standard inpatient content
Improve AHLTA speed and reliability
Utilization of Standard content major modules will be 100% complete in FY14
Baseline statistics have been collected from 5 pilot sites
RM8 Increase in Virtual Visits
Increase virtual visits by 20%
FY13 initiatives in place to start increase
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
RI34
Implementation of TriService standardized content (will inform new EHR)
CAPT Beilman
N/A No
Help inform the standard data dictionary
Push quality reports (value)
Standardize ICU , Newborn, Pediatric content
RI35
Spotlight on AHLTA speed and reliability
Baseline established, piloting reports at 5 sites, working on automated report using E2E tool.
RI36
Increase Use of TH Modality
CAPT Mitton
Communicate strategic direction to Regions ; Seat on MHS Telehealth IPT; ID initial service lines for Navy

28. R1 Objective Decision Required
Synopsis of Decision
Add Administrative Status (A-Status) as measured in EMPARTS to the Regional Review.
Area of Impact
Reporting/reviewing A-Status as part of the Regional Review will provide an important indicator in progress towards achieving Readiness Measure One (RM1).
COAs
Pros
Cons 1
Add A-Status to Regional Review.
Important indicator in achieving RM1
Perform to measure.
Administrative requirements 2
Status Quo – no change
No administrative burden.
Provides no feedback on A-Status
No ownership of readiness.
COA #1: Approved
Recommended COA

29. Navy Medicine Strategic Goal: Value Informational Brief
In executing Navy Medicine’s mission, we will provide exceptional value to those we serve by ensuring full and efficient utilization of our services, highest quality care through best healthcare practices, and lower care costs.
Informational Brief
RDML Terry J. Moulton, MSC, USN
RDML Kenneth J. Iverson, MC, USN
23 January 2014

30. Value Goal
V1 Objective
Objective Lead: RDML Gillingham Action Officer: CAPT Jenkins
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Decrease enrollee network cost/Increase Recapture of Purchased Care
VM1
Purchased care cost per MTF prime enrollee per month
$99.06
FY13
$102.88
Slide 7
VM2
Average Workload Market Share: Total Prime Direct Care Vs. Total Prime Care within a Prime Service Area
FY12
47%
50%
Slide 8
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
VI1
Evaluate top MDCs by utilization and associated costs
LCDR Coker No
Redesigning Regional Purchased Care (REPO) meeting structure to focus on top MDCs by utilization and costs vice a generic product line review
Standing-by for similar eMSM initiatives in development by DHA Analytics
VI2
Evaluate implementation of productivity/currency measures across enterprise in alignment with MHS M3
Benchmarks completed for Skill Type 1 & 2 providers and will be utilized in FY15 performance planning cycle
Services will be responsible for monitoring
VI3
CONUS Hospital CPLAN
CAPT Beilman
CDR Ringer
MTF site visits completed

31. Value Goal
V2 Objective
Objective Lead: RDML Iverson Action Officer: CDR Manning
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Realize full benefit of our Medical Home Ports and
Neighborhoods
VM3
PCM Continuity (% appts with PCM) Source: TOC
>65%
64%
Slide 10
VM4
ED Utilization (# visits/100 enrollees/month) Source: M2
<2.5
3.3
Slide 11
VM5
Patient enrollment and staffing (Enrollment/ assigned FTE) Source: M2
1,100 – 1,300
863
Slide 12
VM6
3rd Next Available Acute Appointment Source: TMA
<0.5
1.1
Slide 13
VM7
Secure Messaging (Total Connected / Total Enrolled)
40%
27%
Slide 14
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
VI4
Tri-Service PCMH Standardization
CDR Manning No
Coordinate with the PCMH AB to develop and implement standardized strategic, operational and tactical metrics and Primary Care business and clinical processes
VI5
Sustainment and expansion of MHP and Neighborhood
Lead sustainment through NCQA recognition, CMC facilitation, site visits, and metric reviews
Expansion through implementation of MHP to OPFOR
Optimize relationship between MHP, specialty care, and ancillary services focusing on comprehensive care integrated across disciplines
VI6
Utilization outliers medical management initiative
Provided actionable utilization outlier reports to Regions and MTFs using Tri-Service agreed upon collection methods
VI7
Effective implementation of Nurse Advice line
Successfully implement NAL by April, 2014

32. Value Goal
V3 Objective
Objective Lead: RDML McCormick-Boyle/RDML Alvarado
Action Officer: CDR Palarca
On Target
At Risk
Off Target
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Standardize clinical, non-clinical, and business practices
VM8
SOP compliance in support of financial audit readiness effort
95%
86%
Slide 15, 16
VM9
OR utilization
75%
Portsmouth 72%
San Diego 57%
Slide 17
VM10
Post Traumatic Stress Disorder Direct Care CPG Compliance
>90%
88%
Slide 18
VM11
Pregnancy Direct Care CPG Compliance
100%
98%
Slide 19
VM12
Low Back Pain CPG Compliance
TBD
77%
Slide 20
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
VI7
Continue to monitor SOP compliance in support of financial audit readiness effort
Mr. Steven Sninsky (M8) No
Second quarter assessment schedule pending confirmation
VI8
Utilize standardized dashboard to measure Navy operating rooms efficiency and incorporate standardized Tri-Service methodology for standardization
CAPT Ferrara (CSB)
Partner with Army Surgical Services
Implement dashboard at NH Camp Lejeune and NH Jacksonville
Align strategic sourcing efforts
VI9
Improve clinical outcomes by minimizing practice variation through adherence to evidence-based care
CAPT Ferrara
Obtain baseline data for Opioid Therapy for Chronic Pain and Major Depressive Disorder CPGs
Finalize targets and outcome measures for PTSD, Pregnancy and Low Back Pain CPGs
Execute CPG Communications Plan

33. Senior Strategy Board Decision Brief
Jointness
We lead Navy Medicine to jointness and improved interoperability by pursuing the most effective ways of mission accomplishment.
Goal Lead: RDML Raquel Bono, MC, USN
Vice Goal Lead: RADM Bruce Doll, DC, USN
December 18, 2013

34. Analysis of current JCS JCIDS efforts for gaps and solutions.
Jointness Goal
J1 Objective Objective Lead: RDML Bono Action Officer: CAPT Duncan
On Target
At Risk
Off Target
In Development
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Leverage joint initiatives to optimize performance of Navy Medicine’s mission
J1M1
TBD 
J1M2 
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
J1I1
Capability Assessment No
Analysis of current JCS JCIDS efforts for gaps and solutions.
J1I2
Jointness/CD&I Integration
Reconstituting group with additional skill sets. Focus on CD&I team integration
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2

35. Jointness Goal
J2 Objective Objective Lead: Mr. Oliveria Action Officer: TBD
On Target
At Risk
Off Target
In Development
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Improve Navy Medicine interoperability
J2M1:
% Officers self-reporting to E-JDAL
% Officers with JPME I
% Officers with JPME II
% Officers with Joint Qualified certification
% respondents who are aware of JQO
% of staff promoted with joint experience
90%
15%
10% 5%
60%
TBD
Unknown
<10%
<6%
<1% 
N/A
J2M2:
Identify # of coded MHS joint billets
Identify # of Navy coded joint billets
Identify # Navy non-coded joint experiences 3
~200
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
J2I1
Inventory Current Tri-service & Joint Billets Occupied by Navy Medicine
M-1
2 FTEs
Yes
Compare Joint billet list among BUPERS and BUMED/M1 based on AQD and joint experience/opportunities.
J2I2
Determine Desired Joint Billets to Fill
M-00C
1 FTE
Determine level of interest in pursuing Joint billets.
Identify a Navy LNO to cooperate with Army/AF/DHA about Joint billets.
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2

36. Improve Communications and Alignment
Jointness Goal
J3 Objective Objective Lead: RDML Coe Action Officer: CAPT Smith
On Target
At Risk
Off Target
In Development
OBJECTIVE
& Status Color
MEASURE
TARGET
CURRENT
DESIRED TREND
TREND
TREND GRAPH
Improve Communications and Alignment
J3M1a. % Navy Commands with annual plan aligned with the Navy Medicine Strategic Plan
100% 
N/A
J3M1b. % initiatives aligned with NM strategic plan
J3M2. % Survey participants who can successfully identify strategic plan
90%
45%
See survey results
J3M3. Regional metrics
80% of SG dashboard metrics at or above selected threshold
2nd cycle complete
INITIATIVE
OWNER
RESOURCE NEEDS?
DECISION NEEDED?
ID NEXT STEPS
J3I1
Develop and Communicate a Focused Message No
Strategic Plan Cascade
Gayle Goff (OSM)
Rollout to BUMED, Regions, MTFs, and E3s
Strategic Communications Plan
Gayle Goff (OSM) & CAPT Lockwood (PAO)
Develop and implement communication plan (focus: deckplate)
J3I2
Accountability Initiative
Metrics Governing Board
Continue to refine metrics; improve automation
Regional Performance Review
COS
Refreshed review reflects FY14 strategic changes; NME will undergo review in January
J3I3
BUMED Reinvention
CAPT Hall
None at this time
Single digits continue to define BUMED mission; ADCs will take vision and develop organizational constructs
Average Purchased Care per enrollee per month (PMPM) - Average Purchased Care costs per enrollee per month
Metric target is TBD:
Recommendation #1 Keep the target reductions from larger purchased care goals (4.6%) to offset inflation and give 1-2% reduction in overall costs.
E.g. FY12 average was $106.65/enrollee new target would be $ /enrollee
Recommendation #2 Set target on the expected (or predicted) decrease in utilization associated with increased use of Medical homes
Metric focus is on Bag 2 spending
Compliments our push to shift Bag 2 to Bag 1 strategically
Workload Market Share (PRIME only)
Compares the amount of inpatient and outpatient care provided by Navy Medicine Direct Care to the total amount of care given in a PSA to Prime Patients
Addresses the need to take greater responsibility for the management of care of all PRIME Within a PSA to reduce cost
Changes:
Move to 2 metrics vice 3:
Eliminated total purchased care costs: with goal of dramatically increasing enrollment we expect PC Costs to increase this year. However, we also expect the overall cost to decrease as our management of the patients with in the DC system are less expensive (utilization rates) than the PC system.
Focus is to look at:
The effective cost management of the Prime population (Metric #1)
The shift from Purchased Care to Direct care (Bag 2 to Bag 1) shown in metric #2