Preparing the Military Health System for the 21st Century

Assistant Secretary of Defense for Health Affairs Jonathan Woodson, MD, discusses the launch of the Defense Health Agency and the changing meaning of health and readiness at the DoD.


Assistant Secretary of Defense for Health Affairs Dr. Jonathan Woodson sits atop a massively complex health care system. With an annual budget of > $50 billion and 133,000 military and civilian health care providers, allied health professionals, and health administrators spread around the globe, the Military Health System (MHS) is exceedingly complex. Keeping the system running is challenging enough, but Woodson is focused on transforming it into a more nimble, efficient, proactive and cost-effective health care system.

Federal Practitioner recently talked with Dr. Woodson about the challenges of transforming the MHS. We also discussed the Defense Health Agency and how global health threats like Ebola fit in to the MHS mission. The following is condensed and edited, but the complete interview can be heard here: Jonathan Woodson on Military Health Readiness.

The Military Health System Mission

Assistant Secretary of Defense for Health Affairs Jonathan Woodson. The Department of Defense has a unique mission. So yes, we do deliver health care; but we deliver health care on a global basis. And in fact, we are the ones who are asked anytime there is a crisis to set up health care systems in austere places as a key enabler to those who would go in harm’s way and defend our nation.

That is a sober undertaking, and we undertake it with the full understanding that in today’s world, the American leadership and the American public expect us to not only deliver the standard of care, but really go above the standard of care and advance care anywhere in the world....If you look at the experience of the last 12 plus years of war, and you look at what has been accomplished in terms of combat casualty care, we have advanced that strategy for care.

At the beginning of the war, it was clear that we were operating from a traditional platform but a number of experts recognized that what we needed to develop was a system that could drive change based upon data. The Joint Trauma System was born, which analyzed the outcomes of just about every case that was treated. But more importantly, [it] mined the data and rapidly changed the strategies for care as we found optimal ways of delivering care.

This included everything from our strategy for evacuation and the development of critical care air medical transplant units that provided prompt evacuation from the battlefield and echelons of care so those service members would receive very sophisticated advanced care, to strategies for employing new drugs, new techniques, new training strategies for medics and bringing critical care skills closer to the point of injury. Across a wide swath of strategies for delivering care, the system has been constantly improved.

And now we see from the data that despite the fact that we’re taking care of more severely injured individuals, the fatality rates have dropped. An individual who makes it to a role 3 facility—whatever the injury severity—has a 98% chance of surviving.

This has culminated most recently in terms of this transfer of knowledge with us signing a partnership agreement with the American College of Surgeons, which will allow us to further interact with the civilian communities in terms of trying to define optimal ways for caring for injured patients. This will be good not only for us, but it will be good for the civilian communities as well.


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