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Webinar

How the Defensive Health Agency community is digitally transforming

Go inside the modernization of the care experience for Service Members.  

- Hi everyone. I'm George Jackson, executive producer and host of Gov Exec tv. I'm excited to welcome you to today's program, optimizing a continuum of Care through digital transformation presented by Optum. Serve as technology, user experience, expectations, and the healthcare needs of service members and multi health system beneficiaries evolve their care experiences should too, ensuring a comprehensive continuum of care is critical and challenging.

Amidst all that digital transformation, the defense health community is navigating those waters right now to become more responsive to beneficiaries through a person-centric approach.

How will their digital transformation streamline service delivery and optimize the care experience? Let's find out. I'm joined by a great set of panelists Today I'd like to welcome Brigadier General Lance Rainey. He's commanding General for Medical Readiness Command East as part of US Army Medcom and Director of Defense Health Network East at the Defense Health Agency General. Welcome. Great to see you, sir.

- Hey, George, great to be here today. Appreciate the opportunity to discuss some of the great things that are happening right now across the DHA and to get your insights as well as eventually insights, I think from, from a much larger group. So thank you.

- You got it, sir. Also, joining us, Brigadier General Peter Swanson, US Army retired. He's vice President of Business and Market Development at Optum Serve and former Deputy Commanding General of the 807th Medical Command. Peter, welcome. Great to see you.

- Great. Glad to hear George. Glad to be with you again, general Rainey, it, it's always good to be with a former colleague as we take a look at how we are responsive to the military health system and our beneficiary population, of which I am a part.

- Well, let's dig right in, gentlemen. General, general Rainey, give our audience maybe some foundational context for the larger conversation to kick us off. Tell us about DHAs role in the healthcare system. You support millions of benefactors, what are you trying to accomplish, sir?

- Yeah, so let me put DHA and military healthcare in context really quick. So you are right. As part of the Defense Health Agency and the military health SY system at large, we do multiple activities in supportive healthcare. There's healthcare delivery for over 9 million personnel that DHA is responsible for. Much of that healthcare delivery is done through the Tricare Health plan, and it's done through the same organizations that a lot of the civilian population receive care from.

However, a lot of that care is done through what we call our direct care system, and those are the military healthcare facilities, medical centers, clinics, health health centers that are out there on the various installation and, and bases and Air Force places as well. Now, those were organizations that were previously managed and operated specifically by the services.

So Army, air Force, Navy all played a role, and then there was a decision made and enforced by law through Congress that hey, efficiencies can be gained, things could be standardized, and we could have a better system if we consolidate under a single agency. And that's where the Defense Health Agency stepped in.

So starting around 1819, that consolidation began as the services transitioned, the, the oversight, the the resources that they managed to the Defense Health Agency. And that's where we find ourselves today. So both DHA and the services are still actively involved in it because this direct care system does two very important things.

One very similar to what happens in the community. It's healthcare for our soldiers, it's healthcare for our family members, it's healthcare for retirees. But the other aspect of it, which is absolutely critical, is it supports the generation of operational forces for the services.

It's where we train our doctors, our nurses, our medics, our PAs, our nurse practitioners, the full gamut of those resources and medical professionals that are, are required to support not just healthcare here, but healthcare forward in a deployed environment.

It's where we learn our skill sets, it's where we sustain 'em and practice, practice them every day so that when we need to go forward as part of an operational exercise, an operational event, or you know, god forbid war, we're ready to exercise those skillset. So that, that's the context of where, where we are now, just like the rest of healthcare, not just in the United States, but across the world.

We are challenged right now by resources post Covid and some other things, resources, in order to perform those missions that I identified, healthcare, delivery, generation of readiness, generation of those healthcare professionals in support to a point where it's, it's time for us to change outside of the traditional healthcare delivery model, driven by resources, but also driven by demand

If you look at the way people now interact with any service oriented organizations, it's much, much different than it was 20 years ago. Shoot, even five years ago, especially with the development of ai, much more different than it was even two years ago. So we as the Department of Defense, the defense health agency and healthcare within the military health system, we have to evolve and that's what this activity is towards.

So a few print, a few tenets, and then we'll get into some of the specifics later. But you know, first we, we have to go back and take what was a traditional system of patients come to us, they visit our facilities, we take care of 'em within a 20 minute timeframe, and if we can't, you schedule another appointment and you come back to us later.

And everything is really done centric to the healthcare system, not necessarily the patient. So General Crossland and Defense Health Agency team is turning that around where first and foremost, obviously quality and safety is at the very top of everything we do.

But the quick second is we do things in the perspective of those we care for. What are the needs of the individual? And then not only that, what are the, what are the ways in which individuals want their healthcare delivered? What are the ways that we can facilitate care in the most effective and efficient manner for those that we care for?

You know, for, for those familiar with primary care, in my background, I'm a family practice doc and I've, I've lived primary care the majority of my life. So we were all excited when Patient-Centered Medical Home and that initiative came forward.

And a lot of what we discuss is very similar to Patient-Centered Medical Home, but the real difference is we put the patient under PCMH, we put the patient in the center of our traditional healthcare system, we modified things a bit, but ultimately we did not modify outside of some of the standard processes that have been been in place for shoot almost a century.

What this does is now take it from the patient's perspective so that our first thought is how do we enable this individual, the care that they need in a way that supports them and is most efficient and effective from that perspective. - General, if I could ask a quick follow up.

I was reading up ahead of this program on something called the Accelerate Care transformation model. It sounds like what you're talking about aligns to that, but what is that model and how does it sort of serve as a North star to you and your colleagues inside of DHA? Okay,

- So that, that's terrific. And that's exactly, that's the process through which we're moving this forward. You know, DHA identified five venture sites as an accelerator initiative. So a large organization, you know, with any large organization, one of the most, the, the greatest challenge when you wanna do change is how do you do that and still continue your day-to-day mission?

So these five sites across Army, Navy, and Air Force, and these were, these were medical treatment facilities, some clinics, some, some hospitals. And it's, it's where we began to put certain tenants into place that support a new model of care. We knew where we wanted to go. We knew the, the principles in which we we were gonna get there.

The specifics is what is always a challenge. The devil's always in the details, obviously. And these five sites allowed us to do that or begin to do it in a controlled manner where it wasn't disruptive across the enterprise, but we were able to truly get feedback from folks delivering healthcare on the ground on a daily basis. And that's where the accelerate care transformation came, came about. It's within those five sites, which will continue to be accelerator sites.

But what we've done is over the last year, we've captured best practices in line with those principles that, that we've worked towards. And now we're gonna start to progress those across the, across the enterprise, progressively across the enterprise. Obviously not, not all at once.

And what we found in those sites, especially as we look at being patient focused, and in addition to that, by, in consideration of that patient focus, a lot of what we we are doing is virtual based. It's moving outside of that 20 minute brick and mortar into what many will call the life space of the patient, meeting them directly at their need and meeting them in a way where, where, where they're comfortable and it can be done in a timely manner and is as disruptive as as possible to, to their environment.

Now, one of the ways we do that, it's looking at that front end aggressively. It's actually our team set out and they mapped out a what are the requirements in terms of the individual and what are the resources that we have, not just within the organization, within the facility, but what are the resources that are available across our, from the perspective of that patient, all resources that could be resources in the local economy, that could be resources outside of healthcare.

We have multiple programs where we assist families, where we assist soldiers with everything from, from wellness to financial stability, you name it. And then considering first primary care as well as behavioral health, how do we coordinate those resources in the context of the patient? And then how do we facilitate whether it's escalation from one end to another into that next level so that as we do this right, we get patients in front of providers that truly require that level and the, the availability of the resources within a facility within, within an MTF as opposed to what can we manage outside of that.

So certainly looking at the front end, looking at the various resources, early engagement, so the traditional appointment lines that we've used in the past, and unlike probably most of the planet, our patients are still conditioned to wait in line for various things. We have taken that for granted for quite some time. It's time for us to move beyond that, and that's exactly what we're doing.

So the expectation will not be that you call and wait 30 minutes to be told, Hey, I'm sorry we don't have anything today, but we can see you in a week. Or even worse, yeah, you can go to that acute care down the clinic, which you should have been able to do right away if that's, if that's really where we're at. So, so that, that's the first end.

The second end is really expanding how we do virtual care, making it easy, not just for those we care for our patients, our people we're responsible for, but our staff, you know, as I mentioned earlier, we, we live a world of everything we need to know, everything we need to do, I can do through the device that I have gonna carry in my pocket or have in my hand at all times.

So we, we are leveraging technology and incorporating technology into, into some of our existing technology or electronic medical record that facilitates delivery of virtual health in a way that truly is value added, not just to the patient, but to our providers and the staff that support those. So, thank you, sir. That's where we're at.

- Peter, similarly, let's lay a little groundwork from your side as well, and I'll give you a little context going into my first question here, 9 million personnel. That is a massive figure, and these are year longs efforts. My assumption is that, you know, now that you've seen this from both sides over at the 807th medical command, now with a a leading industry provider, what does that evolution look like from your perspective?

And what is industry doing right now that, you know, to the general's points, trying to incorporate that new patient-centered care design? Like what does that look like from an evolutionary perspective on your end, sir? - Yeah, George. Great, great question. And I, I would start things off by just saying that it's encouraging, it is fascinating to watch the Defense Health Agency undertake this.

Your, your point is well taken in terms of nine plus million beneficiaries who are distributed worldwide. It's a unique beneficiary population. It's an incredibly deserving beneficiary population. I I'm actually one of those beneficiaries. And so I think all of us are invested in the success of the transformation efforts that General Rainey has just shared with us under general Crosslands leadership.

So it's, it's both a privilege and a responsibility now in industry with the team at Optum Serve, which is the dedicated business unit of Optum and the broader United Health Group that faces the federal sector understands what the requirements of, whether it's the Department of Defense, the Department of Veterans Affairs, health and Human Services or others, understanding what their requirements are, where we can share knowledge from industry to government and in return, and then actually coalesce on what some of those significant challenges are.

And for us, the privileges to draw on the nation's largest healthcare system to identify capabilities or learnings that, that we have learnings that we have derived from efforts undertaken and determine how we actually bring those to bear in support of that large and deserving beneficiary population. I think one of the challenges for us as a, as a very large organization, is always kind of aligning all of those resources and bringing them to the prospective government client or the government client that we already are supporting.

And then again, just making sure that we are responsive to those requirements or demands. For example, we support the defense health agency currently with the military health systems nurse advice line. So 24 7, any type of care, navigation or support that those beneficiaries need access to. Its Optum care teams and registered nurses that are being responsive to a beneficiary 24 7.

We, we support lesser known efforts, perhaps in the Defense health agency. We support the in integrated clinical services team and the defense health agencies, you know, chief information operations Office, office through our Optum Enterprise Imaging actually being responsive to all of the, the picture archiving and communication system that make all of those clinical images available to a provider or a care team within the military health system where they need it and when they need it.

And so again, it's just a privilege to, alongside this organization as they're working through a really complex change management initiative through all of that person-centric digital transformation. And I would say that it aligns very well with some of our core tenants, which is to create a better consumer experience for all of our beneficiaries within the Optum Enterprise to help people live better lives and to make healthcare more accessible and the health system work better for everyone.

- General Rainey, as Peter sort lays that out, I'd like to stay for a moment on challenges he mentions aligning resources as a potential one complex change management strikes me as another potential big challenge for a large initiative like this. What do you see from your end, sir? What are some of the top challenges that you and your teams are taking on?

- Okay, so be, before I hit challenges, I, I wanna, I wanna hit on why we are appropriately positioned right now to, to really move in this direction. You know, the, as as we look at partners like, like Peter's team at Optum, as well as others that are out there, they are as excited about, actually some of 'em are even more excited about this as we than, than we are because what we are able to do within our system, e even though we often measure ourselves by the same revenue generation and we'll call it revenue generation that our community does, we're a capitated system.

You know, Congress provides us a budget, the we decisions made, how much of that is gonna be spent on healthcare, and then we have the ability to, to do what needs to be done with that money without being limited by, well you've gotta a code to this many encounters and so forth. Workload isn't necessarily tied directly to how we're funded. We use it to right now measure how we distribute resources and, and other things.

But the measures that, that we have used in the past and that we've adopted from the community don't necessarily measure the value of the healthcare that's occurred. And is it truly in the best interest of the patient or is it designed to ensure that the bottom line is covered for an organization. So we're, we are primed to, to make changes that truly drive value without being constrained by a system that is still about how much money or how profitable is your system. So that's, that's the one of the one challenges we don't face.

The challenge associated with that is we're still building a set of metrics that truly measure value. You know, there's great outcome metrics when you look at health that are out there, but looking, and often those are long-term, whether it's mortality, morbidity, et cetera. We're looking to develop or we're developing metrics now, and that is part of one of the challenges that we're working through.

So we can assess how effective and efficient is the systems that we're developing working today as part of the transition and even more so long-term, how are they working tomorrow and, and how do we move forward now challenge other challenges. This, this is a change, as I mentioned earlier, a lot of what we have, what we continue to do across most of the enterprise right now in healthcare, it's, it's the same traditional processes that have been in, in place for 70, 70 years, 70 plus years.

So breaking those processes within our healthcare system, the individuals who are delivering healthcare, et cetera. And one of the areas where there's, I'd say has been one of the bigger cultural challenge challenges, so is this culture change is behavioral health, for example, you know, behavioral health is an incredibly individual and and personal experience that that's driven between a provider and their patient and their support team as you take and try to move that outside of what many have just done their entire career, where it's you sitting in front of me having a discussion about how you feel or I can observe your reactions, I can observe your body movements and so forth.

All those subtle cues that that help you communicate to, to an individual, Hey, this is how I really feel and so forth. Some of that you, you lose associated with, with virtual health. So working that transition in a system as large as ours can, can be difficult. And like most areas you'll, you'll find a part of the population that will grab it immediately and move forward. Especially as we look at that is definitely what the economy's moving towards out in the, in the private sector.

And then there are others who are very hesitant not just to adapt the virtual aspect, but any change at all. So, so really emphasizing and, and changing the culture of our healthcare teams. So that's one. And then of course the process is associated with that change. Again, a huge enterprise that has systems and acquisition processes that are, are I, I won't call 'em archaic, but they are incredibly slow, especially in today's environment where technology changes, technology changes almost daily where huge advances can be made in short periods.

And if you don't adapt those you're behind. And then of course there's the culture of the population that we take care of. You know, we, we take care of from day zero to to day last, we have, we deliver babies, we take care of children, we take care of families and, and our service members, and then we take care of retirees all the way through the end of life. And all of those rep representing multiple generations have their own unique needs.

So as we start to implement technology that for the most part is readily accepted by the majority of what I would say is the population behind me, but, but readily accepted, we still have those that, that are set in their ways and who are comfortable with face toto face visits. So it's building a system and that, and that's why the patient-centric aspect is, is very important that accommodates both of those and does so in a way that we can do it with resources we have today.

This is an absolute no growth environment across all of DOD as we have to reinvest in, in DOD at large for modernization and to be ready for the threats that are out there, not just to that today, but tomorrow. So as we approach this new model of care and as this new model of care evolves, those are, those are the things that we consider - Peter, I'd like to sort of draw back to one of the general's points around being a, a capitated system.

He doesn't have unlimited budget needs to do what needs to be done with the amount of money that's allotted by Congress. And we've kind of danced around this point to this sort of part of our conversation, but tech can be an enabler there, an enabler for efficiency, an enabler for, you know, this change from the burden of legacy IT infrastructure to kind of more modern approaches that the general has outlined thus far. Could you talk a little bit about maybe the, the potential that new tech or new technological approaches have to address that capitated system aspect, sir?

- Sure. You know, that's a great question. I think that all of healthcare is wrestling with the cost of healthcare. It's not just something unique to the federal sector as, as a challenge in terms of resourcing. I, I would say that we, we are trying to be more both efficient and effective in our delivery of healthcare, in support of our member population. And I think that there are two aspects of value-based care, which is a term used commonly in the healthcare community right now.

But on the payer or insurance side, which is where general Rainey's conversation about capitated arrangements centers, we within the United Health Group are certainly looking at value-based care on the payer side. We actually have the largest number of covered lives under value-based care arrangements. And so our investing heavily in how the system actually is responsive to the member or beneficiary's need, but delivering that care more efficiently.

But then in terms of your question, George and or surrounding technology, I'll shift over to kind of healthcare delivery, the delivery side of healthcare as well. One of the things that we're excited and and interested in as the military health system has procured and is going to implement their digital front doer, we have gone through that similar digital transformation as well. And that is part of the person-centric model of care that General Rainey has already referenced in our conversation today.

Again, we see that there's great value in that. There's some really formative articles that have been published in the Harvard Business Review on consumer or member expectations in terms of the delivery of their health benefit. I think all of us are challenged to be responsive to them, to a actually attract and and maintain the, the loyalty and the trust of our beneficiary population. And so we went through that digital front door deployment that's known within our enterprise as Optum guide and it certainly is the, the member facing or beneficiary facing, facing user experience platform.

But one of the things that our team has done along the way is we have an undergirding personalization engine. We understand that healthcare is personal in nature. There are some who will fully migrate and quickly adopt all of the digital transformation efforts, but we know that the human touch and that establishment of trust still matters. No one will ever replace our healthcare professionals and the care teams and, and how they are actually able to respond to the beneficiary population.

So we actually have a personalization engine that starts to understand a particular beneficiary's preferences as they engage their health benefit. And then another capability that we have deployed is a population stratification engine. You know, the military health system is unique in that it by and large has a very healthy and young beneficiary population when you focus on active duty service members and their families.

Not that they don't support the, the full range of generations in, in their beneficiary support mission, but for a health system to actually identify high risk or potentially high cost beneficiaries and potentially engage them differently. So if there's a high risk beneficiary and we're leveraging technology to provide key indicators to the system when that particular member or beneficiary is in need of some type of engagement and perhaps has not followed up on some type of follow-up care or medications that we know to be essential or of benefit in, in the ongoing mitigation of any health conditions that they have, how does the health healthcare system actually identify that and then respond in a different manner rather than kind of the, the passive engagement of the healthcare system and the active engagement by the beneficiary?

How are both leaning toward each other and, and when the member or beneficiary is, is not, how does the healthcare system function more responsibly to that particular beneficiary, which again brings in preventative care ultimately, it's highly likely that reduce the cost burden on the healthcare system itself. And so that employment of technology is all part of delivering value to the beneficiary. And so we're heavily invested in that in our own digital efforts to again, deliver care more efficiently, improve the lives of our beneficiary population and provide a better person-centric experience of healthcare.

- Yeah. Hey Peter, I'll tag into that and you nailed it. When you, you talk about that digital front door in that proactive management, you know, the, the target is to, to be there to support our patient, our patients. And really if you look at general crosley's plan within the DHA, we're moving beyond treating patients. It's really about treating people. It's about taking care of those that we're responsible for and to be most responsive. It's about understanding them better.

It's about communicating effectively as early in the process and through that understanding and eventually through the data as well as the technology beginning to guide them proactively through whether it's AI enabled navigators or even a distribution of, of a combination of both, both navigators that are, that are human and and managed that way, and then others that are managed autonomously through various systems. So, so that is part of, as you mentioned, the digital front door concept. As we look at this new model of care, the digital, a digital front door will be a part of that, that entry point for the the individual person is absolutely critical to get them as early as possible to, to resolution of their need.

Now that's certainly technology enabled. It is it the, I'll tell you the, and Peter, you know, this, the technology is there right now. There are systems out there that do this. Now within DOD this is something that we are, we are working forward where right now there are, there's acquisition processes in place to look for, look at various products. As we pilot these forwards, we've defined, hey, this is what we're looking for in a product and our requirements. And that will, I anticipate within the next couple of years be something we'll have in place that will really take us to that next level of taking patients to people and us enabling not just their care, but their wellness.

- And, and if I can jump in, George, I mean there are incredible opportunities here in all of this digital transformation. And one of the opportunities that we are very close to in terms of being responsive to the military health system population is as the digital front door is employed, one of the capabilities that will be tucked behind that digital front door is the nurse advice line. And, and we know that combining digital tools with human interaction as you bring those together to enhance the patient or the person-centric experience, that is kind of the best possible outcome when you're, where you're leveraging technology to enhance the experience, you, you're not foregoing kind of the human interaction.

And so the nurse advice line, well the modality of engaging that may change where more beneficiaries will choose to engage through chat-based mechanisms, that human interaction is kind of irreplaceable. But there are also incredible opportunities because the, the defense health agency has just gone out and, and they now have a virtual health platform that they are rolling out to support their beneficiary population.

And one of those incredible opportunities that we see is actually kind of connecting that ecosystem as these digital tools become available. And in particular as that virtual health platform becomes available to military health system beneficiaries, there's now an opportunity to walk that beneficiary through the care and support navigation that's provided by the nurse advice line. And when it's indicated, actually make a warm handoff to a provider on that virtual health platform that will now be available to military health system beneficiaries.

And you're immediately satisfying the care need of the beneficiary. In some cases, you might actually be experiencing some cost avoidance as a, as a opposed to that beneficiary actually seeking care in their own community, going to an emergency department when in fact that care need can be satisfied by a military health system provider on that virtual health platform that is now available. So these incredible opportunities exist to connect that digital ecosystem and we look forward to seizing some of those opportunities in support of the defense health Agency

- General as Peter sort of outlines that sort of push, I'll call it, to improve customer experience for those patients. One potential benefit that strikes me is also, I'll call it maybe the employee experience. How is this impacting things like medical errors in healthcare management? How is all of this data, all of these metrics for efficiency, improving things for the staff at all of your facilities?

- You know, I'm glad you brought that up because I I've hit patient-centric and, and patient-focused multiple, multiple times. You know, there's a text or a book that I I think many of us read early on, or at least I read a few years ago. It was called Patients Come Second. And it was all about you gotta take care of your people to ensure that they take care of your mission, which is which are the people that, that, that we serve.

So by no means is this, we're all in and, and we don't consider our staff, as a matter of fact, as part of this and recognizing that because of the transition between DHA because of post covid, because of multiple factors just changed that have has occurred within healthcare. We, as we looked at many of our facilities over the last couple of years, we realize that we're not where we need to be in terms of job satisfaction and just basic morale. You know, there is tons of purpose to be found in healthcare and that's why a lot of people go into healthcare.

That's why most of us stay in healthcare. You have the same with the military, tons of purpose in serving your country. But the last four years there have been multiple distractors from that. As I mentioned, everybody experienced covid in the challenge it placed. We saw folks leave the the healthcare system, our healthcare profession across all aspects. We, within our system, as I said, we made the largest change. I think we, we certainly made within the past 50 years to the military health system, huge change. And then we at the same time deployed an electronic health record, which MHS Genesis.

So the Cerner product that we brought on board, again, huge changes as it relates to workload. So no surprise that as we look at it, looked at our staff, there are challenges. So coupled with this effort is also a staff wellness initiative that, that moves with it. And there, there's things that are part of the accelerator site that we're using. We have other pilots that are ongoing that look at devices that our own employees can wear to monitor their wellbeing through all the proxies that exist out there through heart rate, respiratory rate, sleep, et cetera activities

. So beginning to gather data and then improving communication. The, the other aspect is we're a lot smarter in terms of how we are applying the technology that's out there. We learned great le well so far we've learned great lessons. Often we experience things and we don't learn anything from it. But MHS Genesis is in, and its rollout has taught us that when, when a new system goes forward, it's not just about the system, it's about the people, it's about the processes, it's about the workflow, it is about a change in culture and we didn't approach it from that manner.

We are not making that same mistake with the technology that, that we're bringing in. First of all, for the virtual visits, absolutely. In the five sites that we have piloted, it is, it is the rage, it is truly enabling technology vice what many have experienced throughout their careers, which is technology that gives you better data, but is it disabling from the healthcare delivery standpoint, I may be able to see a patient and understand them a little better through an electronic me medical record that's provides continuity, but it takes, if I spend more time documenting in that record than I do, providing that healthcare that's, that is not something that adds purpose to what we do every day.

So we are out, I would like to say we're smarter and we have learned lessons from our recent pushout and those lessons are being applied as we bring in scheduled virtual visits and various products as well as, as we formulate the requirements of this front door. So yes, we are very concerned about our staff and it is patients first, as I mentioned earlier with the PCMH kind of comparison. First and foremost, we're thinking about how do we effectively and efficiently enable the care that is being received, not just the care that is being delivered and that care that is being received is from the perspective of the patient. So, great question, and I appreciate you bringing that up because I don't want folks at all to think, oh yeah, we're just gonna do more with less and, you know, row row harder and live that.

That's, that's not the way it works. Certainly concerned. And we will develop our teams as we move forward. - George, you, you mentioned in, in forming your question, you know, leveraging technology, but how technology actually addresses you. You use the term medical errors. One of the things that I think healthcare writ large is wrestling with right now is the emergence of artificial intelligence and how we actually leverage artificial intelligence in responsible ways. And again, I know that there are executive orders, the Department of Defense has its own, you know, responsible artificial intelligence implementation, I would say as an integrated health system.

We within Optum also have our own, you know, AI governance. And, and that's incredibly important for a variety of reasons. Most notably, you know, what, what you raised is how do we ensure that technology enables the delivery of healthcare and does not replace the responsibility of those humans who are engaging with the beneficiaries that they're responsive to and supporting. Just earlier this week, we were actually up at an event at Fort Dietrich in Maryland that the defense health agency, J six, integrated clinical services team hosted. And it was fascinating because we, we certainly want to evaluate how we bring artificial intelligence into different aspects of healthcare delivery.

But perhaps one way that we ought to be thinking about it as well is not just artificial intelligence, but augmented intelligence. And that's a term that the government officials from the Defense Health Agency used in conversation just earlier this week. And in the context of the event earlier this week, the augmented intelligence, you know, for medical imaging, you know, could look like this a a, a mammography exam for a female beneficiary in the military health system, you may actually have over 10,000 images associated with that mammogram.

Well, so how do you actually bring technology to bear in a way that augments the intelligence of the radiologist who's viewing that image And, and already there is kind of augmented intelligence and medical imaging that's already being employed where the microcalcifications in that particular examination are viewed and they're flagged and they're highlighted. So it actually draws the radiologist's attention to the places where he or she should actually apply their energy and effort focused on the preventive care of that beneficiary.

So that's one example of many where you actually want to augment the intelligence, you want to amplify certain things that a healthcare provider or a care team should actually be oriented on in that effective delivery of healthcare to a beneficiary. And so we within our enterprise, I think are evaluating that closely and carefully understanding where artificial intelligence becomes a decision support tool, but never should replace the actual engagement of the trained healthcare professional who's engaging with that beneficiary.

And then conversely, where is artificial intelligence and administrative processes something that the full weight of art, artificial intelligence can be brought to bear because it is truly administrative, enables and supports effe effective and efficient healthcare delivery, but does not actually, you know, present any type of concern in the delivery of healthcare to the beneficiary - General. We're on that point. I welcome you to jump in there too. Like how are you approaching artificial intelligence or maybe to seal Peter's words that augmented intelligence.

- Yeah, so I, I'll give you my thoughts on artificial intelligence. You know, we, we've always been augmented. I I used to call my, my books my peripheral brain, you know, we augmented by the various systems that are out there, old school books and then, you know, we've got computers and then now we've moved to really that next level. And you know, medicine has always been a combination of a couple of things. We, we, we call it the art and the science of medicine, you know, with the science being exactly that.

It's what we understand through studies, it's what, how we know things, work, disease processes and so forth. And the art being, how well do we understand who we're applying that to, whether that's an individual, whether that's a population or otherwise, what are the 1000 different variables that have to be identified and addressed so that the therapy that I know to be science applied usually in large scale studies to populations that may or may not look or live or be anything like the patient that is, is in front of me.

Through continuity and through interaction, you begin to know your patients. You begin to understand are they gonna be compliant and if not, why are they not gonna be compliant? So it's all those things that you gather over time and allows you to take the science and then through art, actually make the science effective in the individual that you're providing. AI is, it takes some of what we used to derive through that art, all those various, all those variables that exist out there, things that are phenotypic, genotypic, multiple meds out, even outside of the traditional medical information and databases that we leverage, especially as we look at soldiers and soldier performance.

How do we know our soldiers to a degree through the data that's out there and through the artificial intelligence ability to take and, and mesh that data into potential actions or outcomes to help us deliver healthcare. So not that, and I, you know, I any physician listening to this art will always be there. The human interaction will always be there, but the more, more of the art that we can turn into science, the more consistent we're gonna be as a healthcare delivery system.

- Peter, in the time that we have left, I wanna bring back to the forefront of our conversation something that the general raised relatively early on as far as one of the goals for the military health system, and that's expanding how we do virtual care. Could you give us maybe a state of the landscape to kick off that portion of our conversation, sir?

- Sure, I'll approach it first from kind of a commercial healthcare standpoint. So, and, and we often use the term consumerism, which really means that, you know, our members and beneficiaries oftentimes have choice. And so we need to be responsive to emerging and changing gener generational behaviors that is going to change the modality by which, you know, the, the coming generations engage their health benefit and navigate their health benefit. And so that consumer focus I think is critical for healthcare systems to be attuned to as we move forward.

General Rainey also mentioned something which I think is critical, which you know, is how do we move, how do health systems move into the life space? He used that term, and I think it's very appropriate, you know, the majority of anybody's life space is, is not thinking about their health benefit and not engaging their health system. But so how does a health system actually kind of come into that life space?

I, I, I think, you know, very practically speaking, virtual health is a way to extend into the life space. It's a way to actually make the, make things more responsive to the beneficiary. It, it's certainly when and where it's appropriate to have a virtual health health visit. It's more convenient for the beneficiary can again, quickly respond to the particular healthcare need that they have at the moment.

So I think that there are many ways in which we're engaging in, in the virtual health space, and it's not just the synchronous visit of a, of a virtual health visit where you're actually engaging directly with, with your healthcare provider, but it's asynchronous tools that a member or beneficiary may choose to engage on their own that are available to them as a health related resource. So there's a variety of ways in which we're attempting to more comprehensively and more responsibly engage our member and and beneficiary population in that virtual space.

- General Rainey, I welcome you to pull on any thread that Peter raised there, but I'm also curious, you know, a year, two years, five years down the road, what's the vision for that virtual care element inside A DHA? What do you think that landscape looks like, sir?

- Well, I, I think, and we'll look at it from the patient's perspective and then look at it from a healthcare perspective, you know, from the patient's perspective, it's something that when I have an issue, I have a single point that I can begin with and I can move into that digital front door or through that digital front door. And if I need things, I and I can be guided to what I really need, you know, there's what I want and then there's, there's, there's what I need.

So it's really finding the, the balance between those two. And some of that might be self-help. Some of that may be, hey, we'll call 9 1 1 for you right now. Where are you located? Stand still. And, and if there's someone around you do this. So immediate response to guiding you to a virtual visit where ideally you've got, you fall into a, if required a visit with a provider who can, in a touch of a button, know your history, know the challenges that you face outside of just that first visit and truly understand you and resolve your issue rapid.

And then if you need to be transitioned quickly to specialty care of some type from primary care, that can be a handoff from, so it's a seamless transition in access of all aspects of healthcare around the patient from the provider and the healthcare team perspective. The way I see it is when, when our system is engaged by a patient, we know it and we know pretty much to a certain degree what that might be because we know and have data that tells us what that patient's at risk for and some other things.

And then we can, we can then f facilitate rapid resolution as a provider and then as a provider and as a healthcare system. I know my population, I know those as you mentioned earlier, Peter, about those who are at true risk, those who are high utilizers and we've managed that population to a degree that whether it's true illness that's striving them to need or it's anxiety that's striving them to need, we have begun to address that.

So we know our population better through the data that's available and the analysis that can occur both through standard and AI properties. And then the patients have ease of access with rapid resolution of, of their identified problem. And then that the entire healthcare system is doing that at once. It's not the serial aspect of what we do now, which is just incredibly frustration frustrating for most of the folks that, that we take care that that's kind of the way I see it.

- Well, gentlemen, it has been my distinct pleasure to get a sense of both of your Dile, general Rainey's quote there, peripheral brains today. My guests today have been Brigadier General Lance Rainey, commanding General for Medical Readiness Command East as part of US Army Medcom, director of the Defense Health Network East at DHA, the Defense Health Agency and Brigadier General Peter Swanson, US Army, retired Vice President of Business and Market Development and Optum Serve and former Deputy Commanding General of the 807th Medical Command, general Rainey. General Swanson. Thanks so much for your time today.

- Thanks George. Thanks Peter as well. Appreciate the conversation. - Yeah, thank you. It was a privilege to, to be part of this conversation. General Rainey, always good to see you. Thanks for, thanks for hosting us, George.

- Absolutely. And to our audience, thank you for joining. Look for an email with a link to the on-demand broadcast so you can share it with other people who are working to optimize a care continuum through digital transformation efforts. A final thanks to Optum serve for making important programs like this one possible. For Gov exec, I'm George Jackson. Have a great day. 

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