By Dr. Barclay Butler, DHA

Just days ahead of the October 1 roll out of DHA’s new Military Health System (MHS) multi-year plan, FedHealthIT’s Executive Vice President Susan Sharer spoke with Dr. Barclay Butler, the interim Assistant Director for Health Care Administration (AD HCA) in the DHA. As the AD HCA, Dr. Butler is responsible for leading the development and execution of the plans for the DHA to assume authority, direction, and control (ADC) of all of the military medical treatment facilities (MTFs) in the MHS over the next three years, and achieving the DHA’s Quadruple Aim of increased readiness, better health, better care, at lower costs.

Fulfilling the Quadruple Aim

The underlying framework for transformation within the MHS is the Quadruple Aim, which focuses on the four key components of improved readiness, better health for patients, a better experience of care for both patients and providers, and reducing per capita cost. This becomes the DHA’s value equation and is the cornerstone of efforts towards value-based care.

Phase 1 of the plan to transform the MHS includes the DHA assumption of the ADC of three of the Services’ hospitals and their external clinics: Womack Army Medical Center in Fort Bragg, NC; Naval Hospital Jacksonville in Jacksonville, FL; and Keesler Medical Center in Biloxi, MS. In addition, three subordinate Air Force clinics are included: the 4th Medical Group at Seymour Johnson Air Force Base in Goldsboro, NC; the 628th Medical Group at Joint Base Charleston in Charleston, SC; and the 43rd Medical Squadron at Pope Field, NC.

The next stage will last a year while expanding the policies, procedures, and business performance measures to meet the goals of the Quadruple Aim business plan. This will include looking at the drivers of each organization in terms of what is needed, what their patient population looks like, whether there is anything unique to support (such as a highly deployable unit, or supporting a large number of retirees), and potentially a balancing of resources across organizations to address those external drivers.

Next year, the roll out will focus on the Eastern Region, followed by the Western Region, and then finally the overseas MTFs in the Europe-Atlantic and the Indo-Pacific areas.

Positive Disruption Meets the Value Equation

In evaluating new processes, technology, and strategies used to identify what will be a positive and worthwhile disruption, we use our value equation to gauge the net effect of a particular consideration. Our value equation helps us to understand whether an innovative idea improves readiness, overall health, care experience, and cost impact. We don’t want to be distracted by shiny new objects that don’t really add value. Sometimes a simple change in the care model for a specific kind of injury or illness can have the greatest impact across the board.

We’re experiencing positive disruption now in the way we are working to standardize the delivery of care across Army, Navy, Air Force, and DHA to create a streamlined MHS that is focused on creating efficiency, eliminating redundancies, and creating savings while leading to true reform of the overall MHS.

Blockchain is one shiny new tool that has potential. As we look to exchange data across a multitude of vendors, one way to ensure trust is with blockchain. Blockchain can be used to create an immutable transactional record, documenting what a doctor has added to the health care record, with data that has been verified and validated, that the patient has seen it, and that it can then flow to other care providers for further sharing with the integrated care team.

Change Management and the Impact on Culture

In any type of transformation, the shift in culture is key. If you can change what people do and how they think and feel about their jobs, you can change the culture. Within the MHS, we’re talking about an Army Medical Department that has been around since 1775, and a Navy Medical Department that has existed since the late 1800s. They have a way of delivering care that is embedded in their very bones. The question now becomes: how do you take these differing embedded cultures and align them?

There is Kotter’s 8-Step Process for Leading Change that highlights some key takeaways, including: 1) creating a sense of urgency, 2) accelerating the effort and not letting up, 3) empowering broad-based action and removing barriers, 4) creating and communicating the vision, and 5) building a guiding coalition. Ensuring senior leaders have a clear vision of the final goal is the biggest challenge. The Service medical departments are steeped in their culture and tradition for a good reason and now are being asked to move forward under a new model. It takes time to turn an historic culture and mindset and refocus it on a future vision.

Sense of Urgency

There are two types of risks. The first focuses on moving too quickly. Here, items may be missed, or mistakes can be made that can lead to operational failures. Conversely, the other type of risk is in not moving quickly enough. Here, the focus is lost over a couple of years. That I would call a critical failure and this is much more difficult to overcome. The military is very good at identifying and correcting operational mistakes, as long as there aren’t too many, because this can undermine confidence in the overall plan. The goal is to balance the transition at the right pace; we want to be moving quickly ahead, but not too quickly to where patients are burdened by change. It goes without saying that we’d never put patient safety or care at risk in any scenario. This is non-negotiable.

Partnership Opportunities

In 2017, we were charged with continuing to extend our partnership efforts and to engage with vendors who have solutions that can impact our value equation. We were also charged with using more innovative contracting to reach those vendors.

The relationship we have with the Department of Veterans Affairs (VA) as they are driving towards the same instance of MHS GENESIS, is that this will now allow for an easy exchange of information between the two Departments. This is an important step for moving forward. Another step includes extending partnerships beyond the TRICARE support contractors to other care providers. These vendors can provide excellent care to our patients. They also bring a wide variety of electronic health records to the mix. The trick here is to get that health care data back into the Servicemember’s record. We do that by using the Health Information Exchange (HIE). Congress is encouraging us to continue to develop relationships outside of our current boundaries, to bring in patients from other care centers to provide our surgeons with a case mix that supports their battlefield skillsets, and to be able to move care to other partners where areas of excellence may exist.

Understanding that our ultimate goal is the Quadruple Aim of readiness, health, experience of care, and per capita costs, our partners who can help us get there will largely factor into the equation.


Barclay P. Butler, Ph.D., MBA, as a member of the Senior Executive Service (SES), serves as the Acting Deputy for Health Care Administration. Prior to this position, he served as the Component Acquisition Executive (J-4) and Senior Procurement Executive for the Defense Health Agency (DHA). As the J4, Dr. Butler was responsible for oversight and approval of all acquisition matters for the DHA, including those undertaken by the Program Executive Officers, as well as the Agency’s directorates and offices. Prior to this he was the Director of Healthcare Technology Integration for the DHA, and served as the Acting Chief for Infrastructure and Operations (I&O), Health IT Directorate, DHA. As a health technology integrator, he was responsible for progress towards a fully interoperable Healthcare record for the DoD through coordination efforts with Health and Human Services (HHS) Office of the National Coordinator (ONC), other Federal agencies, private sector health delivery organizations, and Standards Development Organizations (SDOs). Dr. Butler has over 35 years of experience as a military and civilian Healthcare Information Technologist supporting the delivery of Healthcare IT services improving quality of care, improving the experience of care, improving military readiness, reducing the cost of care, all while delivering improved value.



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