The Defense Department could save as much as $460 million a year by consolidating its fragmented military health system into a single joint medical command, a new government report says.

That idea is No. 2 on a list of 34 recommendations for eliminating duplicative functions and saving money across the federal government, compiled by the Government Accountability Office in a report released Tuesday.

If the idea to streamline the military health system sounds familiar, that’s because it is: Since the 1940s, at least 15 studies have addressed the structure of the military health care system, and all but three favored a unified system or at least a stronger central authority to improve management and coordination among the services. The most recent study was done in 2005 by the GAO itself.

But calls for a joint medical command have never gone anywhere because whenever the proposal surfaces, the individual services put up strong resistance.

In its new report, the GAO said the basic concept remains sound and has gained new importance in light of the deepening federal budget crisis and the military medical system’s soaring costs, which have shot up from $19 billion a decade ago to more than $50 billion today.

The GAO noted that the military health system — serving 9.6 million beneficiaries through more than 130,000 military and government medical professionals, a large network of private health care providers, 59 military hospitals, and hundreds of clinics worldwide — has multiple, and often overlapping, layers of authority.

Those layers start with the Office of the Assistant Secretary of Defense for Health Affairs. Then the Army, Navy and Air Force each has its own medical headquarters and associated support functions, such as information technology, human capital management, financial activities, and contracting. Each branch also has its own surgeon general to oversee deployable medical forces and operate its own health care systems.

“The responsibilities and authorities for DoD’s military health system are distributed among several organizations … with no central command authority or single entity accountable for minimizing costs and achieving efficiencies,” the GAO said.

The GAO noted that in the wake of its 2005 report, the Pentagon formed a working group to examine “several reorganization alternatives.” A year later, the group outlined three possible options: establish a unified medical command similar to DoD’s unified transportation command; establish two separate commands — one to provide operational and deployable medicine and another to provide beneficiary care through military hospitals and contracted providers; or designate one of the military services to provide all health care services across the force.

The effort stalled “because of an inability to obtain a consensus among the services on which alternative to implement,” the new GAO report said.

Instead, top Pentagon personnel and health care officials opted for a different approach that involved “seven smaller-scale, incremental reorganization efforts” designed to minimize duplicative layers of command and control; reduce redundancies in personnel and expenses; and squeeze efficiencies from combining common service support functions within each service, such as finance, information management and technology, human capital management, support, and logistics.

But the concept left the existing command structures of the three services’ medical departments over all military treatment facilities essentially unchanged — and five years later, the DoD officials have made only fitful progress in implementing four of the seven incremental steps approved in 2006, and have offered no guidance on “how and when to accomplish the three remaining steps,” the GAO said.

Had DoD and the services chosen to move forward on one of the three other alternatives studied by the working group in 2006, the GAO report said, projected savings would have ranged from $281 million to $460 million annually, “depending on the alternative chosen and numbers of military, civilian, and contractor positions eliminated.”

A number of the other 33 recommendations in the report touched on other possible redundancies:

• Urgent warfighter needs. The GAO said there are opportunities to consolidate and make more efficient the processes that the Pentagon has put in place to rapidly develop, modify and field new urgent capabilities for field forces in Iraq and Afghanistan, such as intelligence, surveillance, and reconnaissance technology, and systems to counter improvised explosive devices. GAO identified at least 31 entities that play a role in DoD’s urgent needs processes, which have consumed about $77 billion since 2005.
• Counter-IED efforts. The Pentagon created the Joint Improvised Explosive Defeat Organization in 2006 to lead and coordinate all military counter-IED efforts. But the GAO said many of the organizations engaged in the counter-IED effort prior to JIEDDO’s creation have continued to develop, maintain, and expand their own IED-defeat capabilities. Some of these entities have operated independently “and may have developed duplicate capabilities,” the GAO said.
• Intelligence, surveillance and reconnaissance. No single entity at the DoD level has responsibility, authority, and control over resources to meet joint priority requirements in the ISR realm that has been critical to counterinsurgency efforts in Iraq and Afghanistan, the GAO said. The ISR community has “extensive, structural fragmentation,” with numerous separate organizations sharing the same roles. Further clouding the picture is the fact that ISR funding comes from a variety of sources, some of which are classified.
• Tactical wheeled vehicles. The Pentagon lacks a coherent, unified strategy for developing and purchasing tactical wheeled vehicles that transport people, weapons and cargo, the GAO said, noting that “DoD could save both acquisition and support costs through a departmentwide tactical wheeled vehicle strategy that considers costs and benefits of the Joint Light Tactical Vehicle compared to other tactical wheeled vehicle options.”
• Prepositioned equipment. The Defense Department prepositions equipment and supplies worth billions of dollars, including major items such as combat vehicles, rations, medical supplies, and repair parts, at strategic locations around the world, both afloat and ashore to quickly support combat-ready forces. “Although the services are expected to operate in a joint environment, some prepositioning activities are fragmented among the services, with the potential for unnecessary duplication,” the GAO report said.
• • Business systems. The Defense Department’s business systems, which cost $10 billion a year, have “little standardization, multiple systems performing the same tasks, the same data stored in multiple systems, and manual data entry into multiple systems,” the GAO said.
• By Chuck Vinch – Staff writer www.armytimes.com