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Diabetic Care within the Military Health System
The Institute of Federal Health Care Roundtable
on The Role of Collaboration in Improving
Diabetes Care
COL John P. Kugler, MC, USA Deputy Chief Medical
Officer, DoD, TMA(HA)
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Overview of MHS-wide Programs

• The System-wide surveillance of diabetic outcome
  measures as indicators of quality clinical
  performance.
• The System-wide promotion of evidenced-based
  practices in diabetic care.
• The System-wide analysis of diabetic disease
  management programs.

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The System-wide surveillance of diabetic outcome
measures as indicators of quality clinical
performance.

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Diabetic Disease Burden for the MHS

• There is an estimated population of nearly 1700
  diabetics under the age of 18 receiving care
  within the MHS.
• As part of the MHS Disease Management
  Demonstration Study, it was estimated that there
  are approximately 230,000 diabetics receiving
  care in CONUS in both the direct and purchased
  care sector, between the ages of 18 and 64.
• The MHS Population Health Portal tracks nearly
  100,000 diabetics receiving care in the direct
  care sector (military treatment facilities).

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(No Transcript)
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MHS Clinical Quality Organizational Reporting
Structure
Senior Military Medical Advisory
Committee ASD/HA, DASDs, Surgeons General,
President-USU, Joint Surgeon, Medical Officer
of the Coast Guard
Clinical Proponency Steering Committee DASDs
Deputy Surgeons General
MHS Clinical Quality Forum Senior Quality Leaders
from HA, TMA, Services, and TROs with
representation from NQMC and NQMP as requested
(Scientific Advisory Panel, Clinical Measures
Steering Panel and Newborn Screening IPT working
groups)
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Joint Commission ORYX?

• All DoD inpatient facilities participate in
  ORYX? as part of the Joint Commission
  accreditation requirements
• Data collection for the majority of measures is
  via chart abstraction
• Data is provided electronically to the MTFs and
  Service leadership
• The MHS Clinical Quality Measures Panel
  continually oversee the processes and review
  ORYX ? data

• Core Measure Sets
• Acute Myocardial Infarction
• Heart Failure
• Pneumonia
• Pregnancy and Related Conditions Surgical Care
  Improvement Program
• Childrens Asthma Care
• Non-Core Measure Sets
• Disease Management of Diabetes
• Asthma Care
• Hypertension Management

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Outpatient Measures

• MHS Population Health
• HEDIS And Scorecard
• Measures

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MHS Population Health Portal HEDIS-like Measures

• Breast Cancer Screening
• Colorectal Cancer Screening
• Cervical Cancer Screening
• Appropriate Asthma Medication
• Diabetes - HbA1C test in past year
• Diabetes HbA1C control (direct care only)
• Diabetes LDL test in past year
• Diabetes LDL control (direct care only)

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Other Senior Scorecard Clinical Quality Measures

• MHS Tobacco Use Rate
• Influenza Immunization Rate
• MHS Body Mass Index rate
• No Problem Getting Needed Care Rate
• Beneficiary Satisfaction and Perception of MHS
  Quality

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The System-wide promotion of evidenced-based
practices in diabetic care

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Evidenced-Based Practice

• DoD/VA Evidenced-based Working Group develops,
  implements, and promotes clinical practice
  guidelines and toolkits for use throughout both
  Systems.
• Updated regularly and available to DoD providers
  on the DoD/VA CPG website at https//www.qmo.amedd
  .army.mil/pguide.htm
• Upcoming plans to develop and deploy an automated
  clinical practice guideline as point of service
  option in the Electronic Health Record. One of
  the earliest guidelines to be launched will be
  the diabetic CPG.

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The System-wide analysis of diabetic disease
management programs

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MHS-wide Disease Management

• Several MTF-specific, local Disease Management
  programs are available for diabetes care.
• A demonstration project was launched in 2007 to
  assess the programs from three different managed
  care support contractors providing Disease
  Management Services in the area of diabetes.
• Diabetes disease management program enrolls ages
  18-64, in the both the direct and purchased care
  sectors in CONUS. Outcomes to be assessed include
  impact on utilization, costs, effectiveness, and
  acceptability.
• Analysis of data will take place in Spring and
  Summer 09 for purpose of advising on future
  system-wide DM options for the entire MHS.

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Questions

• Point of Contact Information
• COL John Kugler
• Deputy Chief Medical Officer
• Office of the Chief Medical Officer
• TRICARE Management Activity
• [phone]
• John.kugler_at_tma.osd.mil