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New plan to dramatically change today’s health systems

WASHINGTON (AFNS) -- With the goal to move from healthcare to health, the Air Force Medical Service (AFMS) has created a dynamic plan that promises to revolutionize health and human performance systems as they exist today.

The Human Performance Concept of Operations (CONOPS), created by Air Force medical planners, strives to not only prevent or ameliorate disease, but to promote performance. The plan centers on three pillars of human performance: sustainment, optimization and enhancement, and will serve total-force beneficiaries, to include retirees and family members.

"I consider this plan to be foundational for the future of the AFMS, as it will help establish how we support a changing and evolving Air Force," said Lt. Gen. Thomas Travis, the Air Force surgeon general.

According to project manager, Col. Anthony Tvaryanas, assigned to the 711th Human Systems Integration Directorate, Wright-Patterson Air Force Base, Ohio, the plan was driven by the emerging view that health is more than achieving some degree of health status, such as avoiding or controlling communicable and chronic diseases, and beneficiaries now want health as a resource for doing the things they want or need to do to perform.

"To provide the best health outcomes and maximal value to the nation, we must move from episodic, disease-centric care structures to population health oriented systems, and within these population health systems there must be a focus on human performance," Tvaryanas said.

"Performance within working populations can be defined as human availability, being present and fit for duty," Tvaryanas said. "Within many non-active duty populations performance may translate to more individually targeted goals. For instance, performance may mean fitness for work in non-military jobs, quality of life, or activities of daily living."

The new framework will reorganize AFMS in-garrison healthcare around three new and integrated systems: the Air Force Medical Home; Human Performance Operations Center (HPOC); and the Clinic Innovation, Test, and Evaluation System. The CONOPS lays out key components that will be needed to understand the performance requirements of populations served by the AFMS, evidence-based interventions to sustain human performance, and the type of delivery platform required to carry out the mission.

"This re-design effort, conducted using a systems engineering approach, also provides a significant opportunity to address the human systems integration of our medical personnel within our health delivery systems, thereby optimizing their performance," Tvaryanas said.

As described in the plan, beneficiaries will be identified as members of subpopulations that have shared health and performance risks and/or needs. Future Air Force Medical Home primary care teams will be tailored to specifically meet these needs and address the full cycle of care. Similar to an air operations center, the Human Performance Operations Center will gather, analyze and disseminate information and maintain a strategic view of population health and performance. It will also enable teams to deliver integrated sets of evidence-based interventions as well as coordinate the efforts of the primary care team with other AFMS capabilities. The Clinic Innovation, Test, and Evaluation System will ensure that the Air Force Medical Home is focused on continuous learning and process improvement.

Critical to the success of the Air Force Medical Home, is a human performance integration team, a voice at each installation, which will ensure two-way communication between the base and the HPOC. The integrator will maintain continuous situational awareness of population health and human performance, coordinate preventive and performance services, and facilitate a community approach to population health and human performance sustainment.

In February, planners rolled out the first stage of the effort, called the Base Operational Medicine Cell (BOMC 1), which will restructure Flight and Operational Medicine Air Force wide into separate primary care and occupational medicine clinics. Additional BOMC iterations in BOMC 2 and BMOC 3 will be orchestrated over the next three years, and result in creating two value streams: occupational medicine and Airman availability.

"BOMC is essential for the success of the new system," said Lt. Col. Lynn Berry, the chief of flight and operational medicine standardization, Air Force surgeon general, and AFMS Air Force Medical Home team lead. "It's the first of many iterative steps to evolve the current MTFs to the Air Force Medical Home, which is the backbone of the plan at the base level."

Planners set up feasibility test sites for the BOMC 1 concept at Seymour Johnson Air Force Base, North Carolina; Joint Base McGuire-Dix-Lakehurst, New Jersery; and at Ramstein Air Base, Germany, to validate standard clinic products created at Keesler Air Force Base, Mississippi, which is serving as the innovative test bed experimenting with future iterations of BOMC.

"Initially there will be little change noted by beneficiaries, but when BOMC is fully implemented, they will see proactive, streamlined, and patient-centered exam workflows," Berry said. "Additionally, complete operational dispositions will be performed by a dedicated staff to improve quality and unit responsiveness. Lastly, return to work and case management programs will be implemented for service members with significant duty limitations. In other words, there will be a dedicated, highly trained team performing all the military assessments and examination with a return to work function."

Once established, the new system will help to change Air Force culture and lead to realizing the new AFMS vision: "Our supported population is the healthiest and highest performing segment of the United States by 2025."

"Our goal is longevity with good function, and the challenge for the AFMS is not only preventing disease and overcoming it when it occurs, but also helping our beneficiaries achieve that goal," Tvaryanas said. "Patient and mission-driven performance goals become the organizing construct for planning and delivering health services."
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