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INTRODUCTION

The Department of Defense (DoD) comprises a complex health care system with a diverse beneficiary population and an annual budget that exceeds $52 billion. The Military Health System (MHS) seeks to offer high-quality and accessible health care services to its 10.6 million beneficiaries. It does this through a global direct care network composed of over 240 Military Treatment Facility (MTF) hospitals and clinics, supplemented by a purchased care network of community clinical providers. Access to care remains a challenge for the MHS, as many MTFs struggle to meet access standards and as the number of beneficiaries living distant from MTFs continues to grow. This has a significant financial impact on the managed care provider for the DoD called the TRICARE network. 1

The DoD has identified telehealth (TH) as a potential means of achieving efficiencies and better care coordination by leveraging resources across MTFs, services, and agencies (eg, DoD/VA coordinated care) and by reducing reliance on purchased care through TH-mediated expansions to direct care services. The goal in providing TH services is to improve access to care and avoid beneficiaries being referred to civilian providers, thereby reducing purchased care costs.

DOD health care is managed at the triservice (Army, Navy, Air Force) level by the MHS, which provides programmatic funding and serves as the policy arm. Health care delivery is a service-specific responsibility. This is important to understand as it affects delivery of a standardized TH solution across the DoD, with each service's active participation critical for success. To date, TH in the DoD has primarily been done by the U.S. Army, accounting for over 90% of all DoD TH activity and averaging over 5,000 TH consults/month across 22 time zones for more than 20 different medical specialties. 2

Since 1992, TH and telemedicine (TM) have emerged as valuable components of the MHS in both garrison and deployed settings. The MHS has a worldwide mission of supporting active duty service members, retirees, and their beneficiaries in peacetime health care needs, including the continental United States (CONUS), as well as for deployed active duty service members and retirees outside the continental United States (OCONUS). In OCONUS, these technologies enable the MHS to project medical expertise to far-forward, remote and austere settings. In CONUS, these technologies can have comparable or even greater impact by improving access to care, readiness, quality, and in certain circumstances (such as enabling more home-based care), lower costs. 3 Expanding the use of TH in CONUS might enable the MHS to reduce reliance on expensive brick-and-mortar facilities; extend the impact and reach of its patient-centered medical homes; enable a declining number of MHS specialists to support providers engaged in primary care, psychological health, and prolonged field care; and directly engage the tech-savvy young adults who comprise the majority of the MHS beneficiaries.

OPERATIONAL TELEHEALTH IN SOUTHWEST ASIA

Background

In 1992, ...

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