Current health care choices could affect future benefits

  • Published
  • By Capt. Brittany Martin
  • 82nd Training Wing Public Affairs
SHEPPARD AIR FORCE BASE, Texas --  The Sheppard Air Force Base Clinic was ranked number six of the Air Force's 83 medical treatment facilities for its continuity of care, management of patients, number of emergency room visits and customer satisfaction with visits.

While Sheppard's clinic received four awards last year resulting in $115,000 in cash awards, the real impact of the 82nd Medical Group's efforts will be seen at the Air Force and Department of Defense levels.

Col. Scott Guermonprez, 82nd Medical Group commander, said the focus is not on the Sheppard budget but on the single checkbook held at the DoD level.

As discussions continue for potential cuts in missions, personnel and health benefits for the DoD, one thing is certain - changes will be made. Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson discussed the defense health program Feb. 24 in an interview with the Pentagon Channel and American Forces Press service.

"Our defense health program budget was about $19 billion in 2001; this year's budget is about $53 billion," he said. "So we clearly need to not only focus on accessing quality care, but producing value for the amount of money we're spending on health care."

The 82nd MDG is focused on producing value per dollar spent on health care at Sheppard by providing continuity of care to well-managed patients and recapturing care on base.

Value care begins with well-managed patients who consistently receive care from the same physician who is familiar with that patient. About two years ago, the Air Force surgeon general began an initiative to assign each patient a provider-led team. The team is better able to manage patient trends, concerns and treatment through continuous care. Sheppard was one of the early adopters of the system.

"That team is who you're supposed to have a relationship with," Guermonprez said.

Guermonprez said on average, a well-managed patient requires 2.5 visits a year while a poorly-managed patient requires four. Additionally, a provider-led team is better able to produce a consistent medical record which will follow the patient and ensure better care in the future.

For the DoD, care provided on-base creates savings for the defense health program, a much needed expense cut. Sheppard has the potential to save $8.2 million annually by using its on-base care capacity instead of downtown services.

The cost for an off-base visit ranges from $225 - $512, while an ambulance trip costs $600. Additionally, off-base visits typically end with direction to follow-up with a trip to the primary care provider on base.

Commendably, the 82nd MDG reclaimed $2.1 million in care over the past five months by increasing access to care and appointment availability at the Sheppard Clinic.

Filling prescriptions is another area which significantly reduces costs, both for the defense health program and for beneficiaries. In an extreme example, a prescription costs $6 per bottle if filled by the base clinic but costs $280 per bottle if filled off base. The military deals directly with manufacturers, so cost is greatly reduced when medication is provided through the on-base pharmacy.

If seen off base, the Sheppard clinic has made filling prescriptions on base easy. The formulary is available online for the off-base doctor's reference, and the prescription can be faxed directly to the Sheppard pharmacy.

Although the only immediate benefit seen by the beneficiary is the reduced copay, the savings to the military is real.

"We want to see as many patients and fill as many prescriptions as we can," Guermonprez said.

To that end, the 82nd MDG is soliciting the enrollment of an additional 5,000 on-base personnel. The Sheppard Clinic has also opened enrollment to retirees, which not only creates saving for the military but also benefits retirees who are often burdened with numerous prescriptions and frequent visits. As a bonus, the cases seen in retirees help doctors, nurses and technicians maintain clinical proficiency through more varied and unusual cases, many of which more closely mirror the trauma injuries seen in theater.

Using off-base care as a matter of convenience has real costs associated for the military.

"These are real costs that the Air Force is paying," Guermonprez said. "It is still a sealed system."

The 82nd MDG is working to educate the base population on how to better access care, how to make responsible decisions on obtaining care and what day-to-day health decisions will benefit all military members and DoD healthcare beneficiaries in the long run.

With overall rating moving from 11th to eighth to sixth in the past few years, the 82nd Medical Group continues to make improvements to operations, capacity and customer satisfaction.

"The challenge is on for next year," said Lt. Col. Patricia Fowler, 82nd Medical Support Squadron commander.