Operation Just Cause... ...for as long as it takes
By Douglas J. Gillert SAN DIEGO -- Fresh from a preventive medicine residency at the
University of California campus here, Navy Dr. (Capt.) Kathleen
Fischer guides an effort to screen the 193,000 Southern
California beneficiaries enrolled in TRICARE Prime, DoD's
managed health plan. Her goal: Target care where it is needed
and intervene in patients' health care when necessary.
For example, in an area where the population is mostly young
soldiers in a rugged training environment, there might be a need
for greater injury prevention and orthopedics. In a city with a
lot of smog or in the high desert, there could be a need for
more respiratory therapy. From Fort Irwin in the Southern
California desert to Naval Amphibious Base Coronado on the
Pacific Ocean coastline, Fischer oversees a plan to reduce
preventive diseases and injuries throughout TRICARE Southern
California.
By learning the health needs of a specific population, hospitals
and clinics can tailor their services to those needs, said
Fischer, head of clinical operations for the TRICARE region.
Fischer's residency was a virtual study of managed-care
populations. "How do you take care of an enrolled population?
The Navy, Army and Air Force have committed people to learning
this," she said.
Population health involves clinical preventive services for
healthy people and secondary and follow-up preventive care for
people who already have diseases, she said. In the past,
military medicine focused primarily on providing episodic care;
in many cases, it still does. When people are sick -- or think
they are -- they show up at the emergency room or sick call or
make an appointment.
"Some people show early, when they don't need help. Some show up
late, when a whole lot of damage has been done," Fischer said.
"We want to manage those visits and integrate them into the way
we do our business."
The idea is to get a bigger bang for the buck. Medics have
resource constraints just like most everyone else in DoD. The
money saved by preventing disease and managing care can then be
spent on improving prevention and treatment programs, Fischer
said.
TRICARE Southern California aligned its population health goals
with DoD and Department of Veterans Affairs guidelines that
focus on conditions that can affect population groups, such as
lower back pain, hypertension, tobacco-related illnesses,
asthma, diabetes and depression. To learn about population
needs, military treatment facilities in the region rely on the
Health Enrollment and Risk Survey that new TRICARE Prime
enrollees must complete.
"At our [headquarters] level, we're trying to develop other
tools, training aids and guidelines to help military treatment
facilities determine who needs care and when," Fischer said.
"There's a big payoff to targeting people. It may take some
time, but when we can target, patients become more vested in
their health care."
The toughest groups to reach are adolescents and post-
adolescents, a population that includes many young service
members and their families, she said. "They think they are
healthy and will never be ill and don't have to take preventive
measures."
Take tobacco use, for example. "Smoking doesn't cause much harm
early on but in the long term it causes cancer and heart
disease," she said. "We have to get young people thinking about
those consequences before they occur."
It's more difficult to assess the health behaviors and needs of
military beneficiaries not enrolled in TRICARE Prime, Fischer
said. "If you don't know who's out there, it's hard to target,"
she said. But the region tries to reach everyone. For example,
the managed care support contractor for the region, Foundation
Health Federal Services Inc., routinely sends information to all
beneficiaries in the region, not just Prime enrollees.
"Population health is here to stay," Fischer said. "It affects
readiness by making sure service members are in shape. It also
includes all other beneficiaries -- family members and retirees
-- in our preventive health efforts."
Civilian health maintenance organizations have taken a
population health perspective from the beginning, and Fischer
sees it as complementary to TRICARE Prime. But while civilian
HMO beneficiaries complain about their health plan's focus on
money, Fischer said military people should rest assured that the
Prime focus is on good medicine.
Sent in by Veterans News and Information Services
American Forces Press Service
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