Research for Costs
September 1, 2007
The TRICARE Management Activity (TMA) asked the Center for Naval Analyses (CNA) to evaluate how DoD is meeting the congressional mandate of ensuring that its senior military healthcare professionals possess the required executive competencies before assuming command or key positions. DoD and the Services established a joint medical executive skills development program (JMESDP) to meet these obligations. The foundation of that program focused on 40 executive competencies that represent unique skills military health care executives must possess. We evaluated various components of the five medical executive education courses currently offered within the MHS as well as JMESDP. We found that DoD uses a multipronged approach through job experience, education, training, professional certification, and core competency development. We also found that the definitions of the core competencies are vague and difficult to evaluate precisely. Currently, no uniform standards for medical executive skill attainment exist beyond general objectives listed in the core curriculum. Nevertheless, we found that the MHS is satisfactorily meeting its obligation. We offered recommendations to improve MHS’s ability to meet those objectives in the future, including strengthening HA/TMA oversight of JMESDP activities and formally designating the Joint Medical Executive Skills Institute as the training resource for the JMESDP.
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May 1, 2007
The Director of Medical Resources, Plans,and Policy Division (N931) asked The Center for Naval Analyses (CNA) to conduct an assessment of the feasibility of converting OCONUS active duty Navy medical billets to civilians. This feasibility assessment focuses on the impact of executing billet conversions as they relate to costs, quality of care, access to care, recruitment and retention, and medical readiness. Based on the billets provided for us consideration for conversion, we estimated the costs of the military billets and the costs of non-military personnel options for these same billets, including hiring local nationals; dependents of military assigned OCONUS; relocating civil service or contract employees from CONUS; and expanding the preferred provider network overseas. We estimated potential costs savings using an incremental approach starting with potential savings estimates without regard to whether the conversions are feasible. Then, we applied various feasibility constraints to provide cost savings estimates in more realistic scenarios based on the availability and actual likelihood of acquiring qualified substitutes for military health professionals. Although there are opportunities to civilianize some Navy active duty OCONUS medical billets, we find that there are substantial risks involved with the magnitude of the conversions as defined by the Quadrennial Defense Review
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November 1, 2003
Food service is a commercial activity. The provision of food service on the premises of other organizations is big business. It is highly developed, worldwide, and fiercely competitive. Corporations, universities, hospitals, resorts, entertainment complexes, and other such enterprises generally find it advantageous to use the services of outside providers. It is the long-standing policy of the federal government to rely on the private sector for needed commercial services. Nonetheless, the Navy is its own food service provider. It has almost 10,000 billets for mess management specialists and fills 95 percent of them. About four times that number of people-some military, some government civilians, and some contract personnel-fill other jobs in galleys afloat and ashore.
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September 1, 2001
The purpose of this study is to review the realism, and sustainability of estimated savings under the competitive sourcing program and examine whether the expected level of savings can be achieved and maintained over the long run without affecting the quality of services provided. To look at these cost and performance issues, CNA examined 16 competitions completed between 1988 and 1996. For the 16 competitions included in our analysis, we collected actual costs and all available performance information from the time of competition through FY 1999. We calculated the expected level of savings for each competition (based on the difference between the pre-competition costs and the winning bid) and compared these savings estimates with the post-competition costs.
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September 1, 2000
Early in FY00, the U.S. Army asked each of the other services to consider joining it in proposing, through the Unified Legislative and Budgeting (ULB) process, legislation that would change the military's personnel target from an end-strength goal to a goal based on average strength, calculated across the fiscal year. The Deputy Chief of Naval Operations, Manpower and Personnel (N1) asked CNA to evaluate the average-strength scheme to help the U.S. Navy formulate its response to the Army. We provided the N1 staff an earlier draft of this report that raised concerns about the scheme (as this final version of the report continues to do). The Navy shared the draft report with the Army, which decided not to continue pursuing the proposal.
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May 1, 2000
CNA was tasked by the Under Secretary of Defense for Personnel and Readiness to examine the DOD health care benefit. The basic idea is to examine what exactly the benefit provides and compare it to what other employers provide-especially the federal government through its health care plan and private employers through their plans. Our approach was to compare the benefits offered under the Defense Health Plan (DHP) to the Federal Employees Health Benefits Program (FEHBP) both from the point of view of the employer, who cares what it will cost and how attractive it will be relative to what other employers provide, and to the employee, who then places a "value" on the benefits provided. The cost of the program to DOD is examined with some simple comparisons of total cost and cost per user. The main focus, however, was to compare not only the health care benefit provided to active duty personnel, but all of the benefits provided with what the federal government and private employers provide to their workers. It's not just the absolute level of one specific benefit that matters, but how the total compensation that includes all benefits compare with what's offered elsewhere.
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May 1, 2000
The Department of Defense (DOD) is working with the Department of Health and Human Services (DHHS) to develop for its Medicare-eligible beneficiaries a cost-effective alternative for delivering access to quality care. This alternative, commonly called TRICARE Senior Prime, will give Medicare-eligible beneficiaries the opportunity to enroll in Prime with primary care managers (PCMs) at military treatment facilities (MTFs). TRICARE Senior Prime enrollees will have the same priority access to MTF as military retirees and retiree family members currently enrolled in Prime. At present, this program is in the demonstration phase. DOD should be concerned that many managed care plans have either withdrawn from the Medicare-Choice program entirely or reduced their service areas in the last several years as the Medicare-Choice plan has been phased in. The purpose of this report is to determine what factors have played a part in these withdrawals and how this could affect the viability of the TRICARE Senior Prime program.
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March 1, 2000
We report on a few publications that present quantitative conclusions on the impact of aging platforms on maintenance and operating costs. This literature review, though far from exhaustive, is meant to convey the idea that this topic has been examined before, and that work in this area is continuing. Some exploratory analysis of two data sets that were created for this purpose is presented. Both use the individual aircraft as the unit of Observation. One is organized around individual sorties in a particular month; the other contains summary maintenance labor data and is organized by aircraft, by month, for a 10-year period. Both provide additional evidence that maintenance effort raises with aircraft age.
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February 1, 2000
The Navy's Bureau of Medicine and Surgery asked CNA to examine several alternative pharmacy plans that would extend prescription coverage to the DOD 65+ Medicare-eligible population. The specific pharmacy plans examined fall under three general categories. After paying an enrollment fee, beneficiaries may receive prescriptions (1) through mail order, (2) at the military treatment facility (MTF) or mail order, or (3) at retail pharmacies or through mail order. This research memorandum describes these options and the costs to DOD for each.
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March 1, 1999
This annotated briefing examines if Defense Health Program (DHP) savings from Utilization Management (UM) are achievable. We examined the effects of reductitions in the DHP budget associated with efficiencies arising from practicing UM at military medical facilities and clinics. We looked at key measures of efficiency and cost between DHP and the civilian health care market. We also determined how the system would respond to cuts in the budget due to UM efficiencies. Finally, we created a mathematical model that captured the way that money could be saved by practicing UM within DHP. We found that the mandated UM savings are achievable; however, the DHP faces several potentially difficult problems that will make it hard to achieve the intended savings.
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