The military health care system, which is comprised of 70 hospitals, 400 ambulatory clinics, 400 dental clinics, 184 veterinary clinics and 130,000 uniformed personnel, receives only $2 billion in federal funding annually, Embrey said.
Although young service members and their families constitute the majority of patients treated in the military health care system, those patients are responsible for a relatively small percentage of the costs. Embrey said the defense department, as a result, has shifted its focus to chronic disease management for older patients who are responsible for a larger proportion of the system's expenses to minimize costs.
"A very small percent of the population we provide health care to is responsible for 35 percent of the health care costs," Embrey said. "That implies a significant need to manage disease better."
Expenses can also be limited by promoting more preventative measures, such as discouraging unhealthy behaviors like smoking.
"Part of the challenge that we have had to deal with is making sure that individuals understand that the biggest factor in their long-term health is the choices they make," she said.
Embrey identified the "Big Five" chronic diseases as congestive heart failure, asthma, diabetes, depression and coronary heart disease.
"If we can somehow get these under control and pay particular attention to managing these effectively by engaging the individuals at risk and reducing their vulnerability in this area, then we can do a lot more to reduce overall costs," she said.
Embrey emphasized importance of incentivizing preventive health care to improve patent health. She proposed that this be achieved by changing the current system, in which physicians are rewarded for the complexity of injuries and illnesses, rather than the extent of their prevention efforts.
"We want the best outcome to be rewarded, and not the highest value output," Embrey said.
Over the last six years, the military health care system has worked to create a multidisciplinary environment for physicians to share information, conduct research to implement evidence-based care, use innovation through technology and best practices, reward outcomes, rather than outputs, and focus on prevention, Embrey said.
The defense department is also aiming to incorporate new technologies into old systems by measuring the effectiveness of pilot programs.
"We never questioned what we were doing," Embrey said. "In fact, when a new breakthrough came through we said, Why should we do that,' and now we're saying, Why shouldn't we do that.'"
