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Air Force Medical Reform

Lt. Col. Robert Heil

Lt. Col. Robert Heil

RAF CROUGHTON, England --

I wanted to take this opportunity to explain the changes that have been made to the Military Health System (MHS) and help decipher the Air Force Medical Service (AFMS) transformation. The passage of the National Defense Authorization Acts (NDAA) for Fiscal Years 2017, 2018, and 2019 directed the largest ever military medicine transformation. Driven by these requirements, as well as Department of Defense (DoD) and Air Force initiatives, the AFMS is undergoing significant transformation to maximize its ability to provide medically-ready forces and ready medical forces in support of operational missions and National Security priorities.

Congress has directed the MHS to develop an integrated system of healthcare and readiness by increasing standardization of the benefit, and providing improved readiness support of uniformed personnel. The DoD and the Air Force are driving reforms to facilitate improving readiness and to increase the agility and lethality of the warfighter.

All Military Treatment Facilities (MTFs) became subject to Defense Health Agency (DHA) guidance and policies on October 1, 2018. Ultimately, the goal of the transition is to improve access to care as DHA manages the entire MHS as a single enterprise, coordinating resources more effectively across all the services. As of Oct 1, 2019, the DHA has assumed authority, direction and control of all Continental United States military treatment facilities, including Alaska. That means that DHA has the responsibility and accountability for the execution of day-to-day administration, management and operations of MTFs via direct support from the services. Overseas MTFs, including Hawaii, will transition at a later date in order to fully define MTF requirements and synchronize with the respective Combatant Command and identify specific operational support requirements.

Restoring readiness, increasing lethality, and cost-effective modernization are central priorities of the Air Force strategic plan. In an effort to improve combat readiness, a pilot program was initiated to reorganize from three medical squadrons into two squadrons: an Operational Medical Readiness Squadron (OMRS) and a Healthcare Operations Squadron (HCOS). The resultant model focused on MTF actions and resources on the medical readiness of expeditionary Airmen. Subsequently, in February 2010, the Secretary of the Air Force directed the Air Force Surgeon General to restructure MTFs to support an operational readiness model. The goal is that the AFMS must maintain the Air Force’s most valuable weapon system-its Airmen. This reform will focus medical care on operational medical readiness to rapidly restore the availability, deployability, and lethality of the Total Force. The basic Medical Squadron Reform model consists of two squadrons: 1) Operational Medical Readiness Squadron (OMRS) empaneling Active Duty, focusing on the medical readiness posture and availability of our expeditionary forces, and 2) Healthcare Operations Squadron (HCOS) empaneling and focusing on family and retiree care. Larger MTF’s will align a third squadron, the Medical Support Squadron (MDSS). The goal is to codify the resources required to maximize airman deployability, employability, and availability, and also maintain our Ready Medic mission while providing high quality care to all of our beneficiaries.

Implementation of the new Air Force organizational model is limited to 42 clinics (25 large clinics, 17 small clinics) within the continental United States. Medical Centers, Hospitals, Ambulatory Surgery facilities, Graduate Medical Education (GME) facilities, overseas MTFs, and limited scope facilities will not reorganize into this new model at this time. This allows leaders to gain lessons learned from the initial implementation, refine the model and reduce challenges presented before transitioning them at a later time. The two medical squadrons within the 501st Combat Support Wing are both limited scope Military Treatment Facilities. However, it is important to know that all MTFs are authorized to incorporate empanelment realignments to either form active-duty-only clinics or to ensure entire squadrons are empaneled under one Primary Care Manager (PCM) to ensure continuity, familiarization, and help meet mission requirements. This will be an advantage to implementing the Airmen Medical Readiness Optimization (AMRO) initiative. AMRO enables Patient Care Teams to optimally medically manage their Airmen. Activities include timely scheduling of specialty consultations, appropriate follow up with the Patient Care Team, troubleshooting barriers to care, and monitoring Airmen adherence to treatment plans.

The Air Force is still responsible for organizing, training, and equipping our medical force. There will be a service commander at the Military Treatment Facility who remains responsible for operational readiness activities. All Military Treatment Facility-based activities tied to operational readiness will fall under the command of this service commander, who will report through the Air Force chain of command. The Air Force Medical Service and the Defense Health Agency will work together to ensure medics are provided opportunities for maintaining readiness skills and clinical currency.

The transition is meant to increase standardization in the delivery of medical services amongst the three military services over time. As a result, patients will receive consistent care across the Military Health System regardless of their service affiliation. The changes that are being made are critical in building an integrated healthcare system within the military services and ensuring that the Air Force Medical Service is ready, relevant, and resilient.