The Military Health System (MHS) is increasingly dependent on information technology to drive its mission of providing healthcare to American warfighters, but when it comes to investments in its brick-and-mortar assets the approach has been decidedly low-tech.
That's changing. Decision support technology first tested in the spring of 2008 for a biennial revision of MHS' facility capital allocations will become a fixture in future planning, and may extend to other areas like IT.
The technology, a suite of software products from a company called Decision Lens, enables a structured, groupbased approach to making capital investment decisions. For MHS particularly, the process will help set priorities for future spending.
"We have a not unlimited checkbook and a big portfolio of requirements," said Clayton Boenecke, of the capital planning branch in the Portfolio Planning and Management Division, a part of the Department of Defense's (DOD) Tricare Management Activity. "We have to have a way of figuring out what are the most important."
It's a model that could be used for any DOD entity, he said, including IT.
One of the drivers for MHS to establish a new way of doing things was seeing the Veterans Administration and its capital development system, he said. Now, MHS will be able to collaborate with the VA and decide how their building investments can best meet DOD healthcare needs.
The problem with the previous system, as it developed over time, was that there was no consistent way to set priorities. The default method was to set an overall budget target and then allocate funding based on current building inventory.
By that method, the Army could get up to 48 percent of the total, with the other services getting substantially less. So the overall inventory, worth over $200 billion, kept getting older while none of the major MHS projects were adequately addressed.
It got even worse when Boenecke and other officials had to defend the funding requests they made. "The OMB [Office of Management and Budget] would ask us what our number one priority was, and we couldn't come up with anything that was compelling or convincing," Boenecke said. "We took hits because we couldn't defend the feeble amounts of money were asking for anyway."
That left the MHS facing flat funding allocations when the dollar was buying less and less, and with no good way of articulating its needs to either the DOD or Congress.
Attitudes changed radically following the Washington Post's revelations in 2007 of badly subpar facilities at Walter Reed Army Medical Center for housing and treating wounded veterans. Even though the issues involved were broader, Boenecke said, it was the stories about the hospital's Building 18 that got everyone's attention, and with that the realization that all of the DOD's medical facilities need to be paid attention.
"Now we had people who wanted to assure there would be no more Building 18s," he said.
The Decision Lens suite provides a hierarchical, analytical process that is completely visible to everyone involved, said Ed Ponatski, a senior partner with health consulting firm Martin-Blanck & Associates, which is advising the MHS. It walks people through the process of evaluating what each step means, and then optimizing each project according to an overall set of priorities.
"For the first time ever after the exercise last year we were able to explain to the Secretary of Defense that we had a basis for out funding request," he said.
One of other important things MHS can now do is bring people in from the outside who might have other views that need to be considered and have them included in the process, Boenecke said.
The technique will be used in the spring and summer of 2010 to once again revise the investment process and criteria, Boenecke said, and every two years after that. "It's part of a transformational overhaul," of the way the MHS does business, he said. "The ramifications are much more extensive than we thought possible."
