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Highlights

Pursuant to a legislative requirement, GAO provided information on the Department of Defense's (DOD) military health system (MHS), focusing on: (1) the need for national capital area (NCA) military treatment facilities (MTF) and DOD's strategy for assessing such needs; (2) identifying any obstacles hindering DOD's ability to make coherent needs assessments; and (3) whether current care coordination among NCA MTFs could be improved.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Department of Defense To ensure, among other matters, that the defense medical system is properly sized, that inefficiencies and overlaps among MTFs are eliminated, and that readiness is effectively managed, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the services' Surgeons General to complete the development and implementation of a comprehensive tri-service medical resource planning and allocation strategy that clearly defines the cost of readiness and justifies nonreadiness peacetime care based principally on cost-effectiveness analyses.
Closed - Implemented

Recommendation status is Closed - Implemented.

DOD concurred with the recommendation to complete and implement a comprehensive tri-service medical and resource allocation strategy. DOD implemented such a strategy, called Military Health Optimization Plan, in its Northwest TRICARE Region on January 10, 2000, and declared that optimization would be an ongoing process among its military treatment facilities.
Department of Defense To ensure, among other matters, that the defense medical system is properly sized, that inefficiencies and overlaps among MTFs are eliminated, and that readiness is effectively managed, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the services' Surgeons General to emphasize MTF beneficiary enrollment as a key element of tri-service strategy, and make every effort to enroll as many MTF users as possible so that the services and the MTFs can truly manage health care.
Closed - Implemented

Recommendation status is Closed - Implemented.

DOD concurred with the recommendation. In March 2000, the Assistant Secretary of Defense for Health Affairs issued a policy memorandum to improve MTF enrollment capacity. A demonstration was initiated in October 2000, in TRICARE's Region 11 for this purpose. During its visits to Region 11 in October 2001, GAO found MTFs that had initiated activities to increase enrollment and workload at their facilities.
Department of Defense To ensure, among other matters, that the defense medical system is properly sized, that inefficiencies and overlaps among MTFs are eliminated, and that readiness is effectively managed, the Secretary of Defense should direct the Assistant Secretary of defense for Health Affairs and the services' Surgeons General to ensure that the overall strategy identifies and provides for significant care coordination opportunities such as in the NCA.
Closed - Implemented

Recommendation status is Closed - Implemented.

DOD concurred with the recommendation. DOD is identifying and implementing resource sharing opportunities among the medical treatment facilities in its Northwest Region as part of its Optimization efforts. As a result of a two-year demonstration of resource allocation/optimization in DOD's Northwest Region, the TRICARE Management Authority's Director of Resource Management has committed to developing an activity based resource management tool to be submitted with the fiscal year 2004 budget.
Department of Defense To ensure, among other matters, that the defense medical system is properly sized, that inefficiencies and overlaps among MTFs are eliminated, and that readiness is effectively managed, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the services' Surgeons General to work with the line commanders and key stakeholders such as cognizant congressional committees and key members, advocacy groups, and others to obtain support for the implementation of the strategy.
Closed - Implemented

Recommendation status is Closed - Implemented.

DOD concurred and, in their agency comments, stated that actions taken to obtain line commanders and others' support were accomplished.
Department of Defense To ensure, among other matters, that the defense medical system is properly sized, that inefficiencies and overlaps among MTFs are eliminated, and that readiness is effectively managed, the Secretary of Defense should direct the Assistant Secretary of Defense for Health Affairs and the services' Surgeons General to periodically report progress toward developing and implementing the strategy to cognizant House and Senate committees.
Closed - Implemented

Recommendation status is Closed - Implemented.

DOD concurred with the recommendation. DOD stated that the appropriations committees were given a copy of the optimization plan on September 23, 1999, and that they will brief interested House and Senate committees and subcommittees as requested.
Department of Defense Developing and implementing the tri-service medical resource strategy may require actions by and coordination with other Department of Defense Assistant Secretaries; therefore, as appropriate, the Secretary of Defense should direct the affected Assistant Secretaries' support and participation.
Closed - Implemented

Recommendation status is Closed - Implemented.

In agency comments DOD stated that senior leadership within DOD and the Military Departments had already become engaged and were expected to continue their involvement in the implementation of the optimization plan.

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