New categories for MHS delivery
This idea is being submitted intentionally without fine details because the innovation is in the ideological framework.
The idea is to categorically separate the delivery of services to rope-in the expanding definition of care. This would better define and measure strategic initiatives while spending fewer current and future dollars. Note that this image is not meant to represent an organizational chart. Personnel could potentially contribute to two or more categories . Funding would remain the same but costs would be assigned to these main sub- categories.
"Healthcare" category is defined, coded, and measured the same as it is now. However, ongoing lifestyle education, counseling, and many rehabilitative services would no longer be called “care.” Those functions would now be in the category of Lifestyle compliance support. This category does still have significant preventive services such as screenings and immunizations and the work occurs in a clinical setting. The justification for these activities is that this is part of the agreed-upon benefit level and Hippocratic dedication to practice.
"Lifestyle Compliance Support " category is the group of services that involve educating, assisting and monitoring people in things they could otherwise do by their own initiative. This includes lifestyle education for nutrition, tobacco, physical activity, remedial and rehabilitative exercises to improve flexibility and conditioning, stress management, etc. These can plausibly be done in a less expensive non-clinical space with personnel often at lower pay-grades. The beneficiaries participating in these support activities would no longer be referred to as patients but as clients because these activities are not in the "healthcare benefit" category. There would not be consults or referrals but rather recommendations from healthcare to lifestyle support. The measuring system would not be headcounts but outcomes, including changes to attitudes, behaviors, and knowledge per dollar spent. Client satisfaction would also be measured. One way to look at these services is that they are an expectation and a sunk cost instead of looking at them solely as a way to reduce future cost/disease burden. The focus then of measuring could be lower cost delivery that is more customer friendly, convenient, accessible, and at least equally satisfactory as similar services that are currently being coded as a form of healthcare. This would also preclude future expansive mission creep to more types and quantities of lifestyle coaching types of services being funded as expensive hospital healthcare benefits. This lifestyle support could be done as appointments, classes, or in a linear queuing staffing to create manpower flexibility.
"Future Health" would have a clearly different focus from the above categories and would include the following characteristics: The mission is communication and changing department-wide norms, It is not real-time cost/benefit. The strategic goal is to realize a healthy/ready population a decade or more from now. The target audiences would be healthy and relatively young. The audiences would be large and the communication year-round. The target audience for future health are called “community members” not patients. This category would be measured in changes to attitudes, behaviors, and beliefs and indirect measures such as total military tobacco resale. Statistical projections from population surveys would be conducted. The most clear distinction of this category is that it cannot be implemented in a clinic or in appointments.
"Occupational & Biological Science Support" includes occupational health, industrial hygiene, audiology, sanitation inspections, etc. which are separate from the above three categories. This is not a patient care category. The beneficiaries are referred to as employees or workforce.
These four categories would provide a platform of tremendous clarity for costs, internal communication, expectations, and progress in improving population health, readiness, Tricare benefit, and operational support.