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'Defense Health Agency' Unveiled
New Agency Eyed to Oversee Medical Training, Research
A Department of Defense plan to put the Army in charge of all military medical training and research could be pulled soon in favor of establishing a new Defense Health Agency to handle these responsibilities and more, senior officials have told the DoD Task Force on the Future of Military Health Care.
The Defense Health Agency, or DHA, would assume oversight of all medical training and research as well as management of TRICARE and responsibility for some “shared” medical activities across the services.
The TRICARE Management Activity would form the foundation of the new agency with additional staff drawn from service medical departments. But the Army, Navy and Air Force would continue to run separate medical departments and retain control of their medical personnel and most facilities.
The DHA concept, seen as only an incremental step toward the dramatic streamlining and greater efficiencies projected from creating a unified medical command, has been endorsed by senior medical leaders. It awaits final approval of Deputy Defense Secretary Gordon England.
Dr. Stephen L. Jones, principal deputy secretary of defense for health affairs, said England still might decide to stick with an alternative “governance plan” for the military health system that he endorsed last year.
But that plan, which would give the Army responsibility for all medical training and research, has raised worries over “preserving service equities,” Dr. Michael P. Dinneen, director of strategy management for the military health system, told the task force at a Sept. 5 hearing in Washington D.C..
The DHA, Dinneen said, would be “a neutral party” for delivering “support functions…in an equitable manner across the three services.”
Unveiling of the Defense Health Agency concept surprised several task force members, in part because they had just listened to presentations by think tank economists on the merits, potential cost-savings and challenges for the department of creating a unified medical command.
“I hope I wasn’t asleep and missed it but I was expecting a briefing on the joint medical command,” retired Army Maj. Gen. Nancy Adams, former commander of Tripler Army Medical Center in Hawaii, told Jones. She asked him explain why DoD officials had abandoned plans for a joint command.
The Army, Navy and Joint Staff had backed a unified medical command, saying it would make medical care more effective and save several hundred million dollars a year. The Air Force opposed the idea, citing clash of cultures that could weaken medical support of operational missions.
Jones ignored these disagreements in answering Adams.
“DoD leadership, when presented with the unified medical command, kind of saw that as moving all the way,” Jones told her. “And, of course, within the system, there are pros and cons for doing that.”
The “conservative” alternative England embraced last year would move to selective joint oversight. It would put the Army Medical Research and Materiel Command at Fort Detrick, Md., in charge of all military medical research. It would use the 2005 Base Realignment and Closure (BRAC) Commission’s call for a joint center of enlisted medical training at Fort Sam Houston in San Antonio to give Army responsibility for all medical training.
England’s plan also called for a single service to control healthcare delivery in major “markets,” starting with San Antonio and the Washington D.C. area. Finally, he wanted the service consolidation of certain support functions including information management, contracting, facilities’ construction and financial management.
The prospect of rolling so many of these responsibilities under the Army was a topic of many discussions among department medical leaders since December. What has evolved instead, Jones said, is the Defense Health Agency. DHA would be a “step in the direction” of a unified command “if future leadership within the department would like to go” that way, he said. “So, rather than a whole loaf, we’ve kind of cut the bread in half.”
On a follow-up question from Adams, Jones conceded that DHA would oversee delivery of medical care in the San Antonio and Washington, D.C. areas, but not in other major medical markets including San Diego, Tacoma, Wash., Norfolk, Va., and Hawaii. Oversight of these large markets would fall to whatever service has the dominant medical presence.
In interview after the hearing, Adams said the DHA offers less “predictability” than would a unified or joint medical command.
“I’m trying to sort out logically what the benefit is of this, which is a kind of a kluging together of disparate parts, as opposed to saying, ‘Okay, we’re going to unify health care under a joint command structure.’ We all know what that means. It’s defined by doctrine.”
She noted that the DHA would be led by a three-star officer, the same rank held by Army, Navy and Air Force surgeons general.
“It’s kind of like we’ve created a hybrid that is worse than the hybrid we’re living with,” Adams said.
Jones laughed off the criticism, saying more bureaucracy isn’t the goal.
“What we tried to do is make it more streamlined, more transparent, but yet respect the execution [responsibility] of the services” in delivering medical care, he said.
Hours before Jones unveiled the DHA concept, Sue Hosek, a RAND economist, summarized for task force members results of major study completed in 2001 on options for establishing a joint medical command.
RAND interviews then with military medical experts and leaders, she said, “found a lot of sentiment that, if you had to have something, a joint command was better than a defense agency.” The Defense Logistics Agency, she said, “was frequently mentioned, and not as a positive model.”