Research for military medicine

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Region 11 Health Care and Administrative Costs
September 1, 2001
This briefing begins with an overview of how this study began. It then outlines the three specific areas that CNA was asked to study and presents the findings for each of these tasks. First, we would examine administrative costs that are associated with the managed care support contracts. Our second task was to examine several commercial performance standards to be used as benchmarks in our analysis of the military health care system. Finally, we were to examine Region 11 utilization and cost.
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The MHS Optimization Project: Estimating the Potential for Recapturing CHAMPUS Workload in the MHS
September 1, 2001
This annotated briefing reports the results of a study for the Office of the Assistant Secretary of Defense for Health Affairs (OASD/HA) and the TRICARE Management Activity (TMA) on the Optimization Plan of the Military Health System (MHS). The plan is designed to make the MHS more efficient as well as to increase the overall health of DOD beneficiaries. Our main goal is to determine the link between optimization and several measures of system efficiency. We explore how greater efficiency can increase system capacity so that current workload that is going to the managed care support contractors (MCSCs) can come back into the MTFs). This "recapture" of CHAMPUS workload is the main focus of this study. We examine recapture in several ways: by the military's medical treatment facilities (MTFs) providing more of the inpatient (IP) workload (the overnight stays that go "downtown") and more of the outpatient (OP) visits that today might go to civilian providers. Some of the workload may be part of the Prime network of civilian providers that the MCSCs have set up for DOD beneficiaries, but the majority is for non-network services for which DOD ultimately pays. For both IP and OP workload, we examine whether MTF physicians can provide more of these services and compare the "complexity" of the work with that provided by civilian providers. Lastly, we examine the demand for services, by measuring the demand rates of DOD beneficiaries and how well that demand is managed by local MTFs.
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Long-Term Health Consequences and Sources of Health Care for RPOWs
September 1, 2001
The goal of the Repatriated Prisoners of War (RPOW) program and the Center for Prisoner of War Studies is to evaluate the former prisoners and their experience to learn how to help others from future conflicts. CNA was asked to do a descriptive study of the general health status of prisoners of the Vietnam War, nearly 25 years after their repatriation. We have shown that the RPOWs are now in poorer health than those in the control group and a group of like-aged retired military personnel.
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Provision and Use of Navy Medicine Primary Care: Empirical Background for Optimization
August 1, 2001
The purpose of this research memorandum is to report and comment on the findings of an analysis of Navy Medicine Primary Care (NMPC) to members of the Primary Care Product Line (PCPL) Advisory Board (the Board) and to the Bureau of Medicine and Surgery (BUMED). This report is part of the support that CNA is providing to the product line. It analyzes Ambulatory Data System (ADS) records of visits made to Navy Medical Treatment Facilities (MTFs) during FY 2000, as well as data from two Department of Defense (DOD) surveys that provide information on the satisfaction of users of NMPC. Its intent is to provide empirical information as background to the Board's and BUMED's optimization activities. In this report, we describe what NMPC is, based on what primary care providers (PCPs) do in Navy MTF primary care (PC) settings, and identify how and to what extent the content and nature of NMPC varies by provider and setting. This approaches NMPC from the supply side - what care is provided by whom, and where. Its focus is not on how much care is provided (e.g., number of visits) but rather on the nature and distribution of that care (e.g., percentage of visits by clinical content and provider type).
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Patterns of Ambulatory Mental Health Care in Navy Clinics
June 1, 2001
The purpose of this paper is to describe ambulatory mental health care in Navy clinics We examined outpatient mental health visits in terms of absolute numbers, focusing on patient characteristics, clinic characteristics, and visit characteristics. We use absolute numbers instead of rates because Navy Medicine does not know definitively for how many beneficiaries it is responsible for providing care. This research provides the membership of Navy Medicine's Mental Health Executive Board with a picture of recent military beneficiary use of mental health services at Navy clinics. This analysis is for use by the Mental Health Executive Board to inform its decisions regarding the Navy's provision of mental and behavioral health services.
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Evaluation of Access and Quality of Health Care Under the TRICARE Program (FY 2000 Report to Congress)
May 1, 2001
CRM D0003492.A1/Final The FY 2000 Evaluation of the TRICARE Program was performed jointly by the CNA Corporation and the Institute for Defense Analyses (IDA) for the Office of the Assistant Secretary of Defense (Health Affairs). The objectives of the evaluation were to assess (1) the effectiveness of the TRICARE program in improving beneficiaries' access to health care, (2) the impact of TRICARE on the quality of health care received by Military Health System (MHS) beneficiaries, and (3) the effect of TRICARE on health care costs to both the government and MHS beneficiaries. This documents represents the Center for Naval Analyses' contribution of the Evaluation of the TRICARE Program, FY 2000 Report to Congress. The full report also included IDA's evaluation of the costs to the government and beneficiaries. The TRICARE evaluation project is an ongoing effort that provides an annual report to the Congress as the program matures.
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Operational Medical Manpower: Profiles and Requirements Determination Processes
February 1, 2001
The purpose of N81's M&P IWAR (Manpower and Personnel Integrated Warfare Architecture) 2000 is to examine the alignment of the Navy's operational capabilities and requirements. The examination focuses on four areas: civilian staffing, medical manpower, reserves, and retention. This study supported that effort by addressing the medical manpower issue. Our specific tasks were: provide a comprehensive profile of all operational medical personnel assets by Navy fleet and Fleet Marine Force (FMF) organizational structure; identify capabilities provided by each medical unit by platform or related organizational entity; identify the medical manpower requirement determination process for both the Navy fleets and FMFs; assess the requirement determination process, examine differences and inconsistencies within and between Navy fleets and FMFs; and, identify opportunities to achieve balance and consistency in the distribution of medical manpower resources.
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Evaluation of the Virtual Naval Hospital
December 1, 2000
The Virtual Naval Hospital (VNH) is a digital medical library administered over the Internet by the Electronic Differential Multimedia Laboratory, University of Iowa College of Medicine in collaboration with the U.S. Navy Bureau of Medicine and Surgery (BUMED). A CD-ROM version of the VNH is also distributed to Navy health care providers. Its purpose is to deliver authoritative medical information to point-of-care medical providers to help take better care of patients. Evaluations of the VNH to date have focused on information needs of medical providers and readership of the World Wide Web (WWW) site. No analysis of VNH utilization patterns, derived benefits, or media preferences has been done. The goal of this evaluation is to provide an analysis of the VNH that can be used to document lessons learned, and planning for future services that might be offered.
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Behavioral Health Care Delivery Models and Examples: Contractual to Functional Integration
November 1, 2000
Navy Medicine has identified mental and behavioral health as one of the major product line areas for which it wants to develop a strategy for providing these specialty services. To inform this strategy development process, we provide a review of the mental health care delivery models that dominate the U.S. health care delivery system, assess where the Navy stands in comparison to current delivery trends, and outline salient issues regarding potential changes that the Navy should consider as part of its managed care evolution. This report focuses on three types of delivery models: contractual, functional and educational.
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Provider Satisfaction Study
November 1, 2000
As the military health system (MHS) evolves to meet the managed care environment of the peacetime benefit mission, Navy Medicine in particular, and DOD in general, must continue to concern themselves with three principles: (1) Navy Medicine will attract and access quality individuals; (2) the medical department will retain the best of the people accessed; and (3) the best people will want to remain in the military because of the challenge, training, professional ism, and overall environment of Navy Medicine. DOD implemented TRICARE to maximize the quality of healthcare while minimizing the cost of that care. To meet this goal, military medicine must continue to attract and retain quality personnel under this changing work environment. Given these challenges and concerns, the Navy Surgeon General asked CNA to evaluate physicians' job satisfaction within the existing climate to determine whether major problems exist that adversely affect relation of specialists. We have examined Navy physician retention and compensation patterns over the past decade, and find that there has been a decline in retention for the majority of specialists, but the cause and extent of the decline are difficult to quantify. We have attempted to identify the main drivers behind this decline, including compensation, work environment, and promotion opportunity. Contrary to anecdotal evidence, there has been no decline in promotion opportunity] however, we do find that the military- pay gap has been widened by 4 to 24 percent for most specialties during the 1990s.
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