- Good afternoon, everyone.
So good to see so many familiar faces and
I'm happy that you're all here.
My name is Patty Barron, and I'm the director of
family readiness at the Association of the
United States Army, and welcome to
AUSA's 2017 Annual Meeting.
Can anybody tell me what number annual meeting this is?
Does anyone know?
(crowd murmuring)
(laughing)
I thought it was the 63rd.
Yeah, that's pretty amazing isn't it?
So, we've been around a little bit.
So, I would like to welcome not only our in-house audience,
but also our very robust online audience,
so welcome to AUSA's Annual Meeting livestream.
Thank you for joining us.
To our families in Houston and in Florida recovering from
the hurricanes you are in our thoughts as
you continue to rebuild.
To our families from Puerto Rico,
we want you to know that AUSA is doing everything that
we can to help the recovery efforts there,
and that we are especially proud of
Lieutenant General Buck Buchanan who and his team are
working very, very hard to provide much needed support.
It seems that this year was a year of
sadness in our country and much tragedy.
AUSA would like to pause to remember Denise Burditus,
former Joint Base Lewis-McChord area
AUSA subchapter president and wife of
former JBLM special forces soldier Tony.
Also to remember Sergeant First Class Charleston Hartfield.
Sergeant Hartfield and Mrs. Burditus were killed in the
Las Vegas shooting tragedy not too long ago,
and so we do pause to remember them.
We were busy this year,
and thanks to your encouragement and the
generous sponsorships of USAA,
we were able to conduct many family forums in
conjunction with other AUSA offsite events.
All the forums focused on health and wellness.
That was the series that we wanted to
really make sure we had a good voice in,
and we saved the very best for last.
Soon you'll be hearing from the Surgeon General of the Army,
you'll be hearing from the
Director of the Defense Health Agency,
and you'll be hearing from a panel of wonderful experts and
also family members who will share their story on the
path that they've had towards wellness.
So we are very honored to have them all with us,
and I will be introducing all of them soon.
We also conducted our first ever AUSA Facebook Live series.
It was called AUSA Spouse: Voice for a Simpler PCS.
Believe it or not, we reached over 60,000 people in
this Facebook Live series, so I was very excited,
and you know how I am very calm and cool most of the time,
but this time I got really excited.
(laughing)
Anyway, we were hoping to do more Facebook Live series,
and if you all have any suggestions for the types of
topics that we should cover,
please email me and let me know because we are all ears.
The forums and discussions are AUSA's way of
amplifying the US Army's narrative to family members and
to help further AUSA's mission to
educate, inform, and connect.
None of this would have been possible without
your membership, and today we're very proud to
unveil AUSA's family membership.
For just $15 per person, you too can add a family member as
part of your AUSA membership,
so you would ask me, "Patty, why should my family member
"join AUSA, why is that important?"
Because as a member you'll be a part of
our advocacy process.
You'll also receive information sent directly to you.
Now, ladies and gentlemen those of you that are spouses,
how many of you have missed something because
your soldier didn't bring home the
information that they were supposed to?
Well, if you join AUSA you'll get that
information sent directly to you.
And, finally by joining AUSA as a family member you have
access to local networking opportunities through
your local chapters through AUSA's 123 chapters that are
scattered nationwide and also overseas.
You'll be able to find your military home whenever you
PCS or you transition out because the chapters are
made up of people just like you.
This year's annual meeting offers new opportunities
and surprises as well.
Have you downloaded the AUSA app?
Everybody show me your hands if you've downloaded the app.
It's really pretty awesome, so we're real excited about it,
so make sure you download it if you haven't yet.
Amy, I know Amy has been having a bit of
a problem with her app.
We'll get you squared away I promise.
(audience laughing)
How about the walking challenge?
Are you all participating in the walking challenge?
Good, yes, absolutely.
You log in an awful lot of steps here,
and there's actually some pretty good prizes.
I think there's Starbucks gift cards,
but the grand prize is a weekend away that has
hotel and car rental covered, so that's not bad at all.
And, don't forget the entrepreneur training that
we're having on Wednesday.
We've been very fortunate to partner with
our friends over at the Institute for
Veteran and Military Families,
and they are conducting an ignite event which is
an all day training for female veterans and
female military spouses on how to either start or
maybe if you've just started the things you need to
know about having your own business,
so it's gonna be pretty exciting there.
You can still register and show up on Wednesday
and register to attend.
They have a little bit more room.
Okay, now it's time to get to the business at hand,
the 2017 Military Family Forums.
Let me start by thanking our sponsor for
today's forum, Geico.
Would Ashley Brenham please come up to the stage?
Ashley will just give us a few comments.
Real quick, Ashley has been with
Geico since 2012 after graduating from
the University of South Carolina
with a dual major in corporate finance and
insurance and risk management.
She began Geico's management development program,
and she joined the marketing department in 2016.
She is proud to manage the Geico and AUSA partnership.
(audience applauds)
- Hi, everyone.
I'll keep this pretty quick.
Geico is really proud to partner with AUSA.
You may be eligible for a special discount on
your Geico auto policy if you're a member of AUSA.
So either get a quote or call in to make sure that's on
your policy if you're already a policy holder.
Anytime you get a quote whether you purchase a policy or
not money goes back to supporting AUSA's initiatives,
so that's something that we're really excited about.
I'm happy to be here at this forum today.
I know how important health and family wellness is,
so I'm looking forward to hearing what everyone has to say.
Thank you.
(audience applauds)
- Thank you so much, Ashley.
Okay, now it is my distinct pleasure to introduce to
you our 44th Surgeon General of the Army and
Commanding General of the US Army Medical Command
Lieutenant General Nadja West.
General West is a graduate of the
United States Military Academy and earned a Doctorate of
Medicine degree from George Washington University School of
Medicine in Washington DC.
Her previous assignments include commander of
Womack Army Medical Center Fort Bragg,
Commanding General Europe region Medical Command,
and prior to her assignment as the Surgeon General,
she served as a Joint Staff Surgeon to the
Chairman of the Joint Chiefs of Staff.
She is an incredible woman, and a very amazing leader,
so please join me in welcoming Lieutenant General West.
(audience applauds)
- Well, good afternoon.
(audience murmuring)
Oh, come on.
Good afternoon!
Okay, we've got some motivated folks over there.
Good afternoon!
Patty, thanks so much for that very kind introduction,
and it's really an honor for me to be with you here today.
I just want to provide you some remarks here,
but I really want to hear from you too,
so hopefully we'll get through my remarks,
and I have a lot of team members here from the MEDCOM
that can answer some questions as well.
But I also wanted to just echo what Patty mentioned.
There's been a lot of tragedy that's really struck
over the last several months, several weeks,
and again just please keep everyone in your prayers for that
'cause we have a lot to be thankful for,
a lot of be grateful for of our families,
our friends, our service, and so as we think of those
that are going through some tragedies
let's make sure that we keep them
in our thoughts and prayers.
So, today's theme of this forum is It Takes a Team,
and our service members make up the team
that protects our freedom around the world,
and they deserve a coordinated and committed team
right here at home that can be relied upon
to care for their families, especially their spouses,
partners, children, and soldiers for life.
Caring for our families is also a shared mission
that takes a team, and I'm please to be able to say
that Army Medicine is a committed team
committed to that mission to provide premier,
responsive medical capabilities,
and see that our military families are cared for
physically, mentally, and spiritually,
but I need help with the chaplain for that.
Chaplain is here, Chaplain Melville,
but seriously that's also part of it.
That's also part of wellness and health,
that aspect of our being.
Before I continue I'd really like to state
how much I personally, and I'm sure that I can speak
for General Milley here, appreciate all
that you have done and all that you continue to do.
America cares for and supports you,
and we know that all the sacrifices,
the contributions that you've made to make sure
that your service member, your soldier is successful
cannot be repaid, can't really be quantified,
so each one of you deserves the appreciation
and respect of a grateful nation,
so I just want to thank you for that.
I also want to thank our panel upfront
for their participation today.
I'll leave the details of their comments to them,
but we're all here with a shared responsibility
and a collective purpose to promote and restore
the wellness to all of those entrusted to our care.
And as the medical branch of our Army
we have been specifically tailored
to provide for the health services needs
of those who carry out the mission
of the Department of Defense.
Any of those that they ask us to do
is a linked component of the joint force, our Army,
anything that they ask us to execute,
and to that end our Army leadership
has recruited, tailored, equipped, and organized
the right medical team needed to provide
the right capability to support the Army
as it executes its unified land operations
from the garrison to the deployed environment.
It's all about the team,
and so I want to highlight one of the teams
that enables Army medicine
to perform one of our missions,
and that's to promote and to restore wellness,
and that's the Army Wellness Center.
Next slide please.
So, the Army Wellness Centers
are performance triad platforms that are focused
on sleep, activity, and nutrition.
Those services that are designed
to build and sustain good health
and improve the overall healthy lifestyles of our soldiers,
family members, retirees,
and Department of the Army civilians.
I tell you, I have to pause here to say
I really owe a debt of gratitude to my predecessor
General Patty Horoho.
Those of you that know her, what an awesome leader she was
and for her to introduce just that very elegant
sleep, nutrition, activity that's taken off now
not just to be a medical priority,
but an Army priority.
She's really done a lot to further focus on wellness,
so I just want to publicly thank her here
because she really started us off on a path
that we're taking on to the next level.
Real quick story, I was in Vicenza, Italy
checking out of the
IHG visitor's quarters there,
and at the bottom of the receipt it had, you know,
sleep, nutrition, activity, performance triad,
so I took a picture.
The person thought I was a bit strange.
I was actually taking a photo with my phone,
so I could email it to General Horoho
just to let her know that now she has really
perpetuated this all throughout.
I'm proud here to be able to take it to the next level,
and I'm really proud of how our Army has embraced it
to improve the health and wellness.
So, our Army wellness centers are all part of that.
The aim is to promote wellness by helping our families
address lifestyle changes in areas that affect
both short and long term health,
reaching people where they live, where they work,
where they relax, where they rest, everywhere.
Our wellness centers empower the members of our Army family
to set their own goals for their health
and then to achieve them.
Many members of our Army family
struggle with the same issues
that our civilian community does,
and that's maintaining a healthy weight,
tobacco cessation, or just maintaining fitness in general.
I mean, trying to find time to work out,
trying to find time to do all the things
we know we have to do.
Our wellness centers can help us
get on the path to doing that.
Our health educators in the wellness centers
will work with our families to provide tools
to address lifestyle and behaviors
to help manage positive changes over time.
Our programs are evidenced based,
and they incorporate user friendly technology
to ensure successful achievement of goals.
Accessing the wellness centers especially allows
medical providers to have direction and oversight
of patient progress and also to provide
a coordinated care effort, so they can manage
their treatment protocols with
the programs being put together with the wellness center.
It allows for coordinated effort.
The wellness center staff also assist our family members
in setting goals with individualized programs
and advancing health coaching to put them on the path
again to achieve better health
'cause that's what we're all about for this.
Our wellness centers are staffed
by very highly trained and credentialed health educators.
They utilize advanced technologies
such as metabolic testing, the bod pod.
Who's familiar with that?
Yeah, the bod pod I got into that,
and I'm like I don't know if I'm gonna
get in that one for a while.
(audience laughing)
But, really it measures the exact caloric
content that you need to maintain a healthy
and appropriate weight,
and they also measure other assessments
such as gait analysis, all those different things.
Again, all of it a comprehensive prevention program
that can either help stop disease,
prevent it from ever happening, it prevents injury
and disability before it occurs
because that's what it's all about,
trying to prevent those injuries
before they become chronic and require treatment.
And, although referrals can be made to the wellness center
by medical providers or unit commanders,
we also make it as easy as possible
for our family members to walk in as self referrals,
and we reach out to our families
to promote awareness of the wellness centers,
and I do that with my command center major
when we got to the PCC.
We talk about the wellness centers
and how to access that, but I also ask you to help
to make sure that our Army families
know that our wellness centers are available to them
not just active duty because the health of our families
really does take a team.
Next slide please.
So, we have over 35 Army wellness centers
on or near garrisons around the globe
to provide easy access and will be opening more
in the future, and our most recent wellness center
opened at Fort Eustis huh just last month.
(crowd cheering)
Fort Eustis huh all right,
there's a Fort Eustis team over there.
Additionally we're exploring opportunities also
to use the mobile platforms to expand access
and allowing increased availability
to our Army National Guard and our Reserve soldiers
and families because I know a lot of these things
that I say I can see some of our Reserve colleagues
saying,"Gosh that's great.", but if you're not
around an installation you really can't access those,
so we're looking at ways to put as much as we can
on a mobile platform to go to drill sites.
Also, we've got applications for your phone
that have of course not a lot of the equipment
that's needed to do the analysis,
but a lot of the educational materials, menus,
and things like that that are free apps
put together by the Performance Triad team
that you can download and at least have
that educational piece while we're working
on better solutions to better service
our Guard and Reserve colleagues.
I encourage you to download those apps,
because they've really got some good information on there.
Two weeks ago I hosted some representatives of
our military and veteran service organizations,
and id like to share with you some of the
information we discussed with them here today.
Because it was really great dialogue with them,
and they said that was great information for them,
so I want to make sure that you have this as well.
Army medicine's uncompromising commitment to
quality of care and patient safety is essential to
make sure that we maintain medical and health readiness of
our total Army, but it's also vital for
the wellness of our families.
Our soldiers, families, and retirees definitely deserve the
best, and we are focused on providing the
highest quality medical support to
all those that are trusted to our care.
Next slide please.
As part of our commitment to excellence,
we measure our outcomes.
And our data on quality, safety, all of those,
against our civilian benchmarks,
because a lot of times I get questions of,
"How do we know we have good quality care?".
I know it because I'm the MEDCOM Commander and
I'm the Surgeon General, I'm proud of my team,
that's all great.
But is there anything quantifiable that we can
actually show the data and statistics?
And I'm glad to say the answer is a resounding, yes.
And you'd be really happy to hear some of the information,
so I'm gonna share just some of it with you here.
Again, as part of our commitment to excellence,
we measure our outcomes against our national benchmarks,
and that's administered by the
National Committee for Quality Assurance,
that measures performance on quality of care and
service and compliance against the Joint Commission,
which is a body that looks at and evaluates, assesses,
healthcare treatment facilities all across our nation.
We are subject to the same review and
assessment as our civilian counterparts.
And I'm happy to say as well, we do very well.
100% of our facilities are Joint Commission accredited,
so that kind of gives you one data point of
the level of quality that we have.
In addition, the Army medicine uses the American College of
Surgeon's National Surgical Quality Improvement Program.
That's a mouthful.
We call it the NSQIP,
is a measuring tool to improve our surgical quality.
And that again, is looking at all of our facilities that
do provide surgical capability.
I understand that all of them don't,
but the ones that do, 100% of them are
evaluated using these standards.
About 700, which is about 13% of our US hospitals,
actually participate in this NSQIP.
So overall, again, 100% of ours participate and
we're actually comparing ourselves to those who
choose to share their data.
Again, most people who don't have
great data aren't gonna share it,
so we are comparing ourselves to just the
top hospitals that participate across the nation.
So we are, again, comparing ourselves to those and
not only do we compare favorably, but recently the team at
Brooke Army Medical Center even received a
Meritorious Achievement Award from the
American College of Surgeons.
That's a great new story.
Again, comparing ourselves to the very top performers in
our entire nation.
And the names that you will recognize, the John's Hopkins,
those that are very high quality healthcare organizations in
our civilian sector.
So that's just, again, this slide just shows that
green downward trend is better,
going towards green is better.
So again, that shows where we are
in relation to those areas.
Next slide please.
A second area of interest, not just to our military and
veteran organizations, but I think all of us,
is the easy and convenient access to care.
Because that's another thing that we heard about,
some of the concerns about how easy it was to
access care in our treatment facilities.
So beginning in December of 2015,
when I actually became the Commanding General of
MEDCOM and Surgeon General,
I directed changes to our policies related to access.
And as a result of the hard work of a dedicated team,
and some member are sitting right here in this room that
did the hard work, patients and
Army MTFs can now make appointments six months out.
Primary care is now available during every training holiday,
and we have adjusted and extended clinic hours,
to accommodate appointments that are
more convenient to our patients.
These and other administrative adjustments have
increased the number of our
annual primary care appointments to about 6,800, 680,000.
That's a lot of appointments if
you think about it, annually.
37% increase in the availability of acute appointments.
And although these are remarkable improvements,
we continue to assess more ways to
actually even provide better access,
provide availability to those that
want healthcare when they need it.
We want our families to also be as healthy as possible,
but when they need to be restored to health,
we are doing everything we can to
ensure they're receiving the care that
they need as easy as possible as well.
Not only acute appointments,
but all the appointments of all those.
And we're doing this all while responding,
while the MTF Commanders are responding to the requests and
tailoring services to the Senior Commanders when
they may ask for specific functions and
specific capabilities unique to their installations.
Again, we want to be responsive to our patients and
to our Commanders, those that we are responsible to.
Next slide please.
And a third issue we discussed with our team there,
with the representatives,
our behavioral health system of care.
And again, all of you know this is an
extremely important topic and issue for all of us,
not just in the military, but also in our nation.
The behavioral healthcare of our soldiers and
our family members is extremely important.
Access to behavioral healthcare is
a key to maintaining wellness as well.
It's not just to treat an acute illness,
it's to maintain a longterm sense of
wellness and well-being.
So we know that about 58% of our soldiers are married and
about 47% of them have children.
We also know that it's not just our soldiers who are
experiencing mental health challenges,
it's their family members who are
subject to a myriad of stressors.
Our children are required to move and change schools,
make new friends, all this.
And sometimes doing this while one or
both of their parents are deployed, that's a lot to ask.
Spouses and partners face challenges of finding new jobs,
caring for children, tending to aging parents,
maintaining a household while worrying over the
safety and well-being of their deployed spouse.
That's a lot to ask of our families.
And research has demonstrated that
combat deployments have had a negative impact on up to
30% of family members, when we actually look at the numbers.
Army medicine recognizes these unique stressors,
and we have integrated behavioral health with
primary care and our out-patient centered medical homes that
deliver care to our active duty and our family members,
and also as a way to screen and
treat many routine behavioral health problems.
So rather than wait to be referred,
we have our primary care,
our behavioral health right there with primary care,
so you can take care of things right at the point of need.
We also have our expanding assets using
tele-consultation and virtual health platforms.
And our tele behavioral health is very,
very popular with our younger population.
I guess they're used to the technology,
the technology of talking to someone virtual is
actually something that they really prefer.
And I noticed that in a study we did in Europe when
there was a choice between seeing a live person or
virtual health, and the lines were about the same size,
so it wasn't about the line.
They actually chose the virtual health and
thought that that was really a positive way to get care and
to get their behavioral health.
We also offer behavioral health services to support many of
our military children in schools,
and that's been a really well received program,
of having behavioral health right there in the
school so children don't have to leave their schools,
either half day or full day out of classes.
Just the parent picking them up,
taking them to the hospital or taking them to the clinic,
they can actually get those services right there in the
classroom setting or in the nurse's office setting,
Without having to worry about the stigma of
being picked up to be taken to their appointment,
they can just go right to the school nurse and
get the treatment right there.
And also, the child and family behavioral health system is
a comprehensive behavioral health model that
emphasizes the public health approach,
collaborating and integrating with our Army medical home,
and also optimizing delivery of child and
family behavioral healthcare.
It also increases access, as I mentioned before,
to evidence based clinical practices,
value based outcome, and delivering care where the
family needs it, right there close to their school and
close to where they live and work.
So how do we know our patients are actually getting better?
There's a behavioral health data portal survey that
actually enables realtime feedback and
feedback informed care, and actually provides data to
promote improvement at the enterprise level.
This is focused on clinical outcome metrics.
And historically, measurement based care has
not existed on this scale.
This is a Army-developed system that represents a novel,
realtime standardized approach to demonstrate individual and
population health improvement,
from the enterprise level all the
way down to the MTF provider.
And again, this is a great tool to make sure we
understand and know if individuals are
actually getting better based upon the
interventions that are made.
In summary, Army medicine continues to implement and
sustain this behavioral health system of care to
generate readiness and also to
support recovery throughout all areas.
And I've got several behavioral health experts here that
can provide more details on that if there are any questions.
The next slide please.
Alrighty.
One thing id like to shift to really quick, just quickly,
and conclude my remarks here with a few comments on the
national opiod crisis.
And I know there's probably not one person in this room who
hasn't heard about that,
or potentially been personally touched by
this crisis that's in our nation.
And although I speak here for Army medicine,
I recognize that this addiction problem recognizes no
distinction between those who wear the uniform and
those who do not.
It's not unique to the military.
Army medicine has been looking really closely in
developing a strategy for pain management for
more than a decade.
We recognize that there are complex clinical and
social consequences with chronic pain,
and we are deeply concerned about the reduced quality of
life for those who abuse opiods and the
consequences for them.
For their families, their friends, their communities.
Let me provide some background from
the Army medicine perspective.
Opiod use peaked in the Army in about 2012.
And fortunately, through a concerted effort to
address this issue, there was reduction of
more than 19% in the total number of
soldiers who were given one or
more opiod prescriptions over the next four years.
The chronic use of opiods, defined as those receiving at
least 90 days of opiods in a 180 period,
peaked well before that, in 2007.
It decreased 9% between 2007 and 2012.
So again, a downward use of that within our ranks,
which again, a good news story.
It's not the end of the story,
but at least there's an attempt to try to improve and
use other alternative methods than opiods in treating pain.
Army medicine, again, focused awareness and attention and
improvement efforts on prescribing opiods.
And then contrast this to the worsening trends that
currently exist in our nation.
What we've done in Army medicine,
in 2010, we had an Army Pain Management Taskforce
was convened.
There was 109 pain management recommendations in order to
provide a standardized vision and approach to
pain management to optimize the care of
our soldiers and our families.
The recommendations were divided into the four areas,
and one was to build a full spectrum of best practices for
continuum of acute and chronic pain care,
based upon the best evidence available all
throughout the medical practice.
The second was to provide tools and infrastructure that
support, encourage practice and research advancement in
pain management to get after other alternatives to
reaching for the prescription pad and prescribing opiods.
Then we focused on the service member and the
family on this, and then we also synchronized a culture of
pain awareness education and then proactive intervention.
The taskforce identified some changes in standards,
data collection, personnel use,
and numerous other areas of improvement.
And again, a lot of these improvements are still underway,
but like I said before, we're not resting on our laurels,
we're not gonna be happy until we get this down as
close to zero as we can.
Again, more awareness efforts.
September was the pain awareness month campaigns.
The more that we can do this,
the more that we can actually get down to zero.
We actually had to have,
each provider had to take a two hour course in this,
on prescribing and the dangers of prescribing opiods and
the best practices in that.
And I as a provider actually went online and
took the course myself, it's that important.
Again, we continue to strive using other types of,
Tai Chi, acupuncture, yoga, all these other types of
alternative mechanisms and methods to help reduce stress,
to help reduce pain, and again,
to try to have another option other than opiod use.
And hopefully, we'll win the battle.
It's gonna be a long one,
and I think our nation's in a long one as well,
but as much as we can do to work together to get after this,
I think it's gonna benefit us all.
What I'd like to do is conclude with a short video.
We talked about wellness, how to improve health.
So roll the short video here,
and then I'll step off to allow the next speaker to begin.
(dramatic music)
- [Narrator] What will your last 10 years look like?
Will you be quick enough for a game of
tag with your grandchild?
Strong enough to embrace every moment?
(dramatic music)
Will you grow old with vitality?
Or get old with disease?
It's time to decide.
The average Canadian will spend their
last 10 years in sickness.
Change your future at makehealthlast.ca.
- I tell you, this one always hits me,
because I know what side of the video I want to be on.
And I know what side of the video that each one of
my members in the Army medicine team wants each and
every one of you to be on.
And that's the one where we have vitality and health.
Getting after wellness, making sure that we have
a good foundation in just the performance triad,
making sure that we have great behavioral health assets to
ensure that we take care of those stressors that
can also effect your health longterm.
To make sure we have the right access to all of our care,
right access to the care that you need to
make sure that we can keep you healthy.
Both primary care and specialty care,
that's exactly what we're here for.
I tell you, it was interesting, in his remarks this morning,
and those of you who heard Secretary Maddox,
it's always a treat to hear him speak.
He referenced a reply from Albert Einstein when
he was asked what he would do if he had
only one hour to solve, basically to save the
world from a very complex problem?
And he said that he would spend 55 minutes to find the
problem, it's that important, and then five minutes,
the rest of the five minutes actually fixing it.
It really hit me when he mentioned that.
What does that mean for me and my Army medicine team?
Defining the problem is the main part of it,
before you start rushing into something.
I think for us that's the same thing,
defining what is it that we want?
What is it that we want to do for our health?
How do we define the best way to take care of
our family members and our soldiers,
all those entrusted to our care?
That's what we've doing and that's what we try to
do in Army medicine, carefully analyzing what we must do to
support and to solve the complex problems of
health of those entrusted to our care.
It's gonna take more than 55 minutes, right?
We've been around since 1775,
but the balance, I believe, is right.
Trying to make sure that we are really looking at
how do we get after those really complex problems?
And spend the bulk of the time getting after it,
defining it.
What do we want to fix?
What do we want to do?
What do we want to look like?
What do we do to make sure that
our soldiers, family members, the wellness part of it,
what is that gonna look like for our future?
I think that will get us to the point where
we can come up with some very cogent,
well thought out solutions to ensure that we're all on the
left side of that photo or that video when we finish.
I would like to thank each and every one of you for
all of your kind attention here.
My God bless each and every one of you, bless our soldiers,
our families, our nation.
We're one team with one purpose,
and I look forward later to your questions.
Thanks so much.
(audience applause)
- General West, that was very, very helpful and informative.
Thank you so much, that was wonderful.
I think what we're gonna do is
we're take a three minute stretch break everyone.
I know you've asked me for those before.
So a three minute stretch break while we bring up the panel.
Now we have the great honor of
bringing up on our stage a panel of
distinguished family members and Army program leaders,
as well as national leaders.
This panel will be moderated by a very talented lawyer and
Army spouse, Mrs. Josie Beats.
Josie Beats served as the 2016/17 President of
the Military Spouse JD Network.
She's been involved with MSJDN as a member since late 2011,
including the launch of Justice for
Military Families program, which was the
first national military program to serve not just the
service member, but the families as well.
She previously served as a public policy coordinator for
the Tennessee Bar Association managing development of
legislation and public policy positions effecting law and
the legal profession.
This is the part that I love the best.
She is a member of the Louisiana State Bar Association,
the Tennessee Bar Association, the American Bar Association,
the National Association of Bar Executives,
the Women's Bar Association of D.C.,
and an attorney member of the
National Association of Women Judges.
She is married to an Army officer, I think he's a jag,
stationed at Fort Belvoir, Virginia,
and is a mom to two amazing kids.
Ladies and gentlemen, my very god friend, Josie Beats.
(audience applause)
- Thank you Patty, for that kind introduction.
I am the proud Army Spouse to Major Shawn Zetob who
about 45 minutes ago, as we were sitting upstairs said,
"Now why are you here again today?".
(audience laughter) Proving that communication is
very important in a marriage and
part of your wellness journey.
And then I said, "Honey, I'm moderating a panel about
"health and wellness.".
And he said, "Really?".
And what I'm going to assume he meant to say was,
"Of course honey, of course you're moderating this panel.
"In fact, you should be running the panel,
"you should be the only speaker because
"you are such an expert in maintaining the
"health and wellness of our military family.".
But as we were sitting around a table where
my two lovely children were fighting over a pack of
skittles ignoring the cheese pizzas I had brought for
them for lunch, I'm going to assume that
perhaps he was thinking differently.
(audience laughter)
I am so excited to be here with you today to talk about
warrior and family wellness.
It takes a team.
We have an amazing panel for you today,
I hope you will be engaged with our panelists and
ask lots of questions.
As health and wellness is a journey,
I today am your Uber driver,
hoping to learn along the way as well.
I am going to get us to our destination where
we will have more tools in our health and wellness toolbox,
from hearing from these leaders in our community.
First, I'm going to introduce our panelists,
and then you'll hear a little bit from each of them,
then we will discuss the resources that are available to
our military families, and then open it up to
questions from you all.
First, our distinguished panelists.
MaryAnn Campo is a proud Army wife with
18 years public health experience,
including a fellowship with the Center for
Disease Control and Prevention,
and the United Nations World Health Organization.
Since 2008, MaryAnn has worked with MEDCOM and MCOM,
and in 2015, she joined the
Surgeon General's Commander Initiatives Group,
where she became a dedicated advocate for
military caregivers.
She recently transitioned to the Army Public Health Center,
where she continues her work improving the
lives of military caregivers.
Amy Moore, US Army retired,
is the spouse of Kernel James Moore.
Kernel Moore died on November 29th, 2004 as the
result of a black hawk helicopter accident outside
Fort Hood, Texas along with six other soldiers.
Kernel and Mrs. Moore have two children, Megan Moore,
a law student at Methodist University,
and US Army Second Lieutenant Shawn Moore.
Amy is a champion of
surviving children's educational benefits,
including The Marine Gunnery Sergeant
John David Fry Scholarship.
She remains very active with her
local survivor outreach services office,
and shares her experiences with
casualty assistance officers and
casualty notification officer training at
her local installation.
Chaplain Joe Melville is the Fort Belvoir garrison Chaplain,
he started there in July 2017.
He most recently served as command Chaplain for
Army South from May 2015, and previously was Director of
Soldier and Family Ministry at the Office of the
Army Chief of Chaplains beginning in 2012.
He served as the MCOM Soldier and
Family Ministry Chaplain in 2011, 2012.
And was the Family and NWR Command Chaplain from July 2010.
Rachael O'Hern is the Executive Director of
Returning Heroes Home, a non-profit that works to
provide a home-like atmosphere and place of healing,
promoting family and social interactions for wounded,
ill, and injured warriors and their family members,
while receiving medical treatment at
joint base Fort Sam Houston in San Antonio, Texas.
Rachael holds a Master of Social Work from the
University of Southern California,
a Bachelor of Arts and Political Science from
Texas and A&M University, and a certificate in
non-profit Executive Management from Georgetown University.
She and her husband Larkin, a triple amputee and
retired Army officer, enjoy biking the river extension,
sampling chips and salsa, which I cosign.
(audience laughter) And cheering for the Spurs.
Kernel Miguel Howe, US Army retired,
is the inaugural April and Jay Graham Fellow of the
Military Service Initiative at the George W. Bush Institute.
As an endowed fellow, Kernel Howe represents the
Bush Institute's work to improve the transition of
post 9/11 veterans to civilian life,
and to foster veteran leadership to enhance our businesses,
communities, and nation.
In this role, he advocates for post 9/11 veterans and
builds awareness for the issues that effect their
transitions with a focus on employment,
education, and health and well-being.
Thank you all for being here today.
(audience applause)
With our introductions out of the way,
we will start with our first panelist MaryAnn-
- Campano. - Campano, thank you.
(laughs) - No problem.
Is this on?
Yes, great.
Well thank you so much for the introduction.
It is truly an honor to be part of this incredible panel and
to be able to share with you some Army public health and
Army wellness resources.
Next slide please.
I'm gonna talk to you a little bit about
my wellness journey with horses.
I have been riding almost everyday for the last 40 years.
By the time I was a sophomore in college,
I knew that I wanted to be a horse trainer,
and I had the great opportunity to study with
a member of the United States Equestrian Team.
So when I graduated from school,
I was able to actually pursue that dream,
and it was wonderful until I had an accident at age 27.
It was a banana peel slip.
I was on a young horse, all four legs went out to one side.
And I woke up in the ambulance with double vision and
a serious TBI and numerous broken bones.
The recovery took some time,
and also during that recovery, at age 27,
I was diagnosed with type one diabetes.
But in spite of all of these medical hurdles,
what was the biggest barrier for me to get back onto
my journey to wellness was losing that sense of purpose.
Because horses, really all animals, they're incredible.
They don't fret about the past or worry about the future,
they're really in the moment.
And if you let them, they'll bring you into
that moment with them.
It was a really rewarding career,
and in spite of having all of these
great medical specialists help me back to my wellness,
it actually would have been someone like
Chaplain Melville or a Chaplain probably who
could've helped me rediscover a new sense of purpose.
But I eventually found my way.
I was an AmeriCorps member and a case worker,
and was helping in a little community resource center,
and I loved my job.
And through that, then I got back to exercising,
even riding some of my calm horses,
really kind of living the performance triad.
Sleeping better, managing my diabetes better,
eating better, everything came together,
and I really was the best version of myself.
I shared this journey with you.
This personal journey of mine because I feel like each of
our health journey's is very individual,
and for some people I know it's gonna
concentrate around that physical aspect, but for me,
it was really getting that sense of purpose back.
And that's why, next slide please,
I'm really excited to talk to you about the
Community Resource Guide,
because I think Army Public Health Center really
recognizes that it does take a team to
really address all the different dimensions of health.
And what they've done with this is create a website and
an app where you can go and get
information across 50 installations in
one really user-friendly platform,
and you can search by subject or the name of the agency,
and it's really truly a one stop shop for
creating this inventory of all community resources.
I'll tell you as an Army wife of 11 1/2 years,
we've PCS'd five times,
and I'm definitely going here next time we PCS,
because I wanna know ahead of time.
I always feel like I'm scrambling when I get someplace new,
so this is just such a great tool to consolidate all of
the great resources we have.
And you can go to your app store and just type in
Community Resource Guide, and get that app,
or go to the website that's there.
Next slide please.
In the Army Wellness Center,
I know General West did a great job and
spoke eloquently about our Army Wellness Center,
but I think it's worth mentioning again,
because I love them.
This is really a gold standard, top tier mechanism to
help us really optimize our health and well-being.
It combines these passionate health educators who are
highly skilled, highly credentialed with the
latest and greatest in technology.
General West mentioned the bod pod, but they do all sorts of
testing around even stress management,
body composition, metabolic testing.
And the great thing is, they will give you,
as you leave, a course of action to take.
A very palpable way to move forward.
Next slide please.
And again, General West touched on this,
but I just want to say that in addition that focus on
sleep, physical activity, and nutrition,
I love the performance triad,
because when I'm well rested and well nourished and
physically active, I know that I can be at my best,
that I think clearly and my thoughts and
my feelings I an process the best.
And finally, I'm very short on time here,
about a program that I'm absolutely passionate about,
and hopefully can weave later in this conversation and
talk about it more.
But it's the Military Caregiver Heart of
Recovery Initiative.
And I just want to say that in the last two years,
we've been able to consolidate a lot of
different organizations across the Army to
prioritize this population who take care of our wounded,
ill, and injured soldiers.
And it's really been an honor to be a part of it.
Thank you all for this opportunity to
share our programs I'm so passionate about.
- [Josie] Thank you MaryAnn.
(audience applause)
Our next panelist is Amy Moore.
- Good afternoon.
To all the surviving family members and
to those who have assisted surviving family members in
their walks, my heart goes out to you.
My husband Jim was killed in a helicopter crash on
November 29th, 2004.
He and six other men were in the helicopter that
a guy-wire in inclement weather.
It's my honor to be here to speak with you about
our road to wellness in wake of the tragedy.
At the time, our children Megan and Shawn were 13 and 10.
And I remember upon notification as a mom,
the first thing that I thought about was them.
Because it's an innocence lost,
it was an event that I could not control,
and you feel a bit helpless.
But at the same time,
you realize you gotta be strong for your children.
And at that point, I just realized that I was gonna be
strong and I was gonna provide them with
the best childhood possible,
in spite of losing their dad at such a young age.
I mean, my parents I had for 50 years, over 50 years.
When I think about our road to wellness,
certain things come to my mind,
and I'm gonna talk about four of them.
Communication, family and friends, and routine.
Communication was always important in our family,
and it proved to be our saving grace after the accident,
because the kids and I were able to share with each other,
share with family, share with friends, stories of Jim.
So right away, people were comfortable in talking about Jim.
And that was so important, because he continued to
be a presence in our lives.
As far as family and friends,
our Army family kicked right into gear, Fort Hood.
We were just blessed with a wonderful military and
outside of Fort Hood, the civilian community.
With our family, we're blessed that on both sides,
Jim's family, my family, are very close,
so they enveloped us in love from the very beginning.
I think the part that became the hardest for us is that
we were a very independent and private family.
And when something like that happens, it's very public,
and you also have to learn to ask for help.
We had lived in government quarters for many years,
that's all the kids knew.
One of their first questions was, "Are we gonna be able to
"continue our school year at Fort Hood?".
And I was able to tell them, "Yes, absolutely you will.
"We'll finish the school year.".
And then I had to find a place to live.
So I was led to look in the Tidewater,
Hampton Roads area of Virginia,
and I reached out to neighbors.
Jim and I had lived there as newlyweds,
it's where Megan was born, and I reached out to
neighbors that still live across the street from
the only house we ever owned and sold,
and asked my friends to do legwork looking at schools.
Those of you who have moved,
that was always my biggest stressor was schools.
And now I was looking at a community where Shawn would
start middle school, Megan would start high school,
and they would be going there
under very different circumstances than
those they had had in the past.
They did the legwork for me and I was able to,
my parents came in in April of 2005 and
I was able to find a house that has become our home for
the last 12 years.
As far as friends, we are just blessed with friends that
we've had from childhood,
but primarily, our Army friends.
When we were in Fort Hood, the spouses deployed forward,
the husbands in this case, deployed forward,
those of us manning the home front became very close.
And we're getting ready, we have a girls weekend,
and we're getting ready to go on our 11th girls weekend.
As much as those are very important to me,
because it gave me an opportunity to
have my parents come in and stay with the kids and
I could go away, because all of
a sudden I was a single parent.
As much as it was important to me,
it was important for my friends to see that we were okay,
that the Moore's were gonna be okay.
We chose to live in an area, or I chose,
to live in an area that had a
very high military concentration,
and that's why we came to the Hampton Roads area.
And I have to say it was kind of the familiar with
the unfamiliar in that we were a military family but
we weren't in the military anymore.
When we first moved, the kids and I would go up to the
PX or go up to the commissary and
sometimes they would just say,
"Mom, can we just go drive through a housing area?".
It was very important for them to have that familiarity,
and it also was important to me to be able to
plug into a military community.
See many of my Fort Hood sis friends here in the audience.
So to sum it up, because I'm out of time,
the four things that come to my mind are communication,
family and friends, and routine.
I didn't get to routine, but routine was very important to
us as far as giving us a sense of
normalcy amidst the chaos after the accident.
Thank you.
(audience applause)
- [Josie] Next we'll hear from Chaplain Joe Melville.
- Good afternoon, I'm honored to be here today.
I'm the Fort Belvoir garrison Chaplain,
but I also am the Family Life Advisor to the Chief of
Chaplains on behalf of the Chaplain Major General Herley.
Good afternoon as well.
I wanted to just share a little bit about the
executive wellness or the wellness that
the Chaplain Corps brings.
Chaplains are placed throughout the Army,
throughout all ranks of the Army,
from the life cycle beginning at Battalion,
all the way up to General Officer and General Staff,
to help ensure that each person is able to
practice freedom of religion and be able to
help service members and family members in either coming to
grips with, staying connected with or
reconnecting with purpose in life.
So as we work towards wellness, as General West said,
we carry the spiritual aspect of the wellness program on
behalf of the Chief of Staff of the Army.
Scientific studies over the last 20 years have shown that
there's a consistent personal self-reflection that
can help reduce stress and anxiety,
depression, and substance abuse,
and have a significant positive impact on well-being.
That's a focus that we deal with, again,
throughout the entire life cycle,
whether we're deployed or we're working in garrison.
As we work with the staff and with the military community,
our focus continues to be around helping people connect with
their fundamental belief system,
whether executive leaders or their battalion leaders,
whether they're the most senior people in the Army or
the Privates who are just coming in and trying to come to
grips with their new life that they've never faced before.
So as we work through the process of trying to support the
Army and the Army system, our focus is based on some of the
work of Dr. Andrew Newburg,
a neuroscientist who had conducted and
analyzed brain scans of people in prayer and meditation.
Dr. Newburg says that our brains are set up in
such a way that God and religion become among the
most powerful tools for helping the brain to do its thing,
which is self maintenance and self transcendence.
A belief in God and religious practice isn't necessary for
the Chaplain to be of support to you,
nor is it necessary the individual to be able to
healthy self reflection and the Chaplain Corps is
continually helping everyone, again,
from the junior to the senior to come to connection with
their fundamental belief system.
Many of you are familiar with the programs we offer,
whether it's strong bonds or to enhance the
relationships that you might be in or
to enhance your ability to deal with stress and the
daily routines of military life or getting into the
routines of military life.
Or if it's the programs are on garrison at Fort Belvoir,
use it as an example, we have literally thousands of
people pass through the doors of
our facilities on a weekly basis,
in order to either come into connection again with God,
to be able to come into connection with their relationship,
whether it's family, couple counseling,
in order to enhance those relationships and
work in a fashion that helps them to
become healthier overall in their ability to
perform their mission and have health overall as
citizens of the United States.
To be able to function together and to be able to
work in the teams where they're gonna find themselves as
they serve in the military.
We provide, again, the religious services,
we provide youth services,
whether it's the team based youth services or
even younger than that, we provide those opportunities for
community and the development of community,
As was so eloquently stated before,
when we travel, we leave behind many of our friends and
we develop community where we go in the military,
and that's an important aspect of what I think the
Chaplain Corps brings, is the ability to develop the
community and to work with community.
Whether we're working unilaterally in the sense of
providing religious support or we're working in cohort with
ACS or the other agencies throughout the
garrison and throughout the Army in order to
help enhance the lifestyle and the life capability,
the life force of the individuals that
participate ein our military.
And with that, I will pause,
and say thank you for this opportunity.
I yield my time to the ladies.
(audience laughter, applause)
- [Josie] Thank you Joe, that was fun.
Next we have Rachael O'Hern.
- Good afternoon.
I wanna thank Patty for inviting me here to
be a part of this panel, that's really exciting.
As Josie mentioned in my introduction,
my husband is a triple amputee and he medically retired from
the Army this Spring, which makes me an
Army Veteran spouse, which I'm very happy about.
Patty asked me to share a little bit from the
family support perspective on wellness and resilience and
kind of what that looked like during our journey,
kind of separately and together.
He was injured in southern Afghanistan,
New Years Eve 2010, into '11, so it gets kind of tricky,
depending on which side of the dateline you were on.
He'd actually been home about a month earlier on
mid-tour leave, he'd deployed with 101st and we had
done a 5k fun run in Clarksville, Tennessee.
Some of you may have spent time there and
done the same fun run.
You get to dress to theme, which is very exciting,
so I had a Christmas tree headband or hat of some sort and
he had a flashing red nose and laughed a lot.
I think we both metaled maybe.
That was kind of where we were coming from,
and then we found ourselves in these
hospitals all over the world.
I met him in Germany and we hung out for
a few hours in Andrews on the way back to Texas,
and eventually ended up at Brooke Army Medical Center at
Fort Sam Houston, which happened to be under renovation at
the time, it was transitioning to joint and
I still don't really understand how all of that worked,
but at the time, there was no hot food to
be had when I was able to get to it.
So I ate a lot of peanut butter and jelly and
chocolate chip cookies or chocolate cake or
whatever was available in this little grab and
go thing in the basement.
And this seemed like a good idea at the time,
because it took care of the nutrition thing,
there was some food.
Chocolate cake is always a good plan when
you're trying to coordinate for the next surgery.
But the problem with that plan, as it turned out,
I was also sleeping at the hospital for a few weeks,
because I have trust and control issues and
wanted to chat with all of the providers.
(laughter)
So I was always wearing yoga pants,
so it did not come to my attention until I went to
put on real pants a few months later that
perhaps I had lost some fitness ground.
(audience laughter)
In the meantime, need to sort that out.
He was still in therapy at the Center for the Intrepid,
and if you have not been to San Antonio,
you really should, it's a miraculous place.
And I was pushing the wheelchair sometimes when
I was permitted, still needed,
so I didn't feel like I could
go do whatever celebrity trainers do.
I looked up wonder woman's workout.
Three hours a day for six months.
Not in the cards.
So I find a cattle bell,
because I figure this is something that I can do,
we were living in a hotel on the hospital annex,
and I'm like, "Oh I love cattle bells,
"this will work out fine.".
And it did.
But it was something that I had to
be very purposeful about and set time aside for and
sometimes skip things, like laundry.
Really get that as a priority for me.
While that was going on, we were also dealing with,
General West talked about, some pain management challenges,
and nutrition and helping him in that
family support member capacity.
And MaryAnn and I were actually talking about,
do I consider myself a caregiver or a family support member?
And I think at that time caregiver,
because that was the Florence Nightingale season with the
wound care and the medication counting and all of that.
And I think it really at this point he's phenomenal and
remarkable and walks everyday and
drives and all a manner of other terrifying things we
shouldn't think about for too long,
because physics is concerning.
(audience laughter)
In that family support kind of role, looking at,
okay we've got some pain management issues,
we've got a lot of medication on board here.
What are some things that we can do to manage this from
a hotel room where we have no kitchen?
There weren't many, but there were some.
And there are some things that you can put on the board and
you can put on the wall to work towards.
We had done that 5k together right before he was injured,
and that had been something that we enjoyed.
That's not going to happen at this point, right?
Be he found hand biking very quickly after he was injured.
I actually remember sending his trauma surgeon in
Germany a picture of him hand biking in April.
So it was very quick, and so I started biking,
which I hadn't done since I was, I don't know, seven.
However old you are when you bike.
But it was a great thing that we could do together where
we could be outside.
I'm a big believer in getting fresh air and
getting out of the hospital.
So those were some things that we managed to kind of
find together and work towards.
Oh man, and here I thought I was gonna be the quick one.
I get extra time, too, right?
(laughter)
So those were kind of my things.
Work towards goals that are manageable,
and that are important to you,
that are things that you care about.
I think a lot of people have a tendency to try to
fit themselves into other molds and do what
other people tell them to,
and that just didn't work well for me.
That was my experience in that recovery and building to
a longterm, sustainable place.
And with that, Miguel.
Or Josie, I guess.
Thank you.
- [Josie] Next we'll have-
(audience applause)
Next we have Kernel Howe.
- These are four stories that are very,
very challenging to follow for sure.
But I'll try to bring up the rear of the patrol.
I am Miguel Howe, and I am a soldier for life.
I am also the proud husband of a Army spouse for life,
Erica, who also continues to serve Army families to
this day as a Regional Director for
a great non-profit Operation Homefront.
I am both the son and son-in-law of Vietnan veterans and
Army soldiers for life.
And as of six weeks ago, I am now the father of
an Army soldier for life.
About 32 years ago this month,
my father called me into his study and said,
"Son, what are your plans?".
And I said, "Dad, I wanna go to college.".
And he said, "That's a great idea.
"How do you plan on paying for that?".
So I soon found myself at West Point and
eventually commissioned in the Army.
I fancied myself as a five and fly guy,
but as all of you, I absolutely fell in love with the Army,
with the lifestyle, with the people,
with the sense of purpose and community and belonging and
adventure and rigor, I loved it.
Erica and I were married right before I reported to
the Seven Special Forces Group,
so then spent the first 2 1/2 of
our five years married deployed throughout Latin America,
not counting pre-mission training.
During each of those deployments, all three members of
my family, Erica and our son Nicholas and
our daughter Haley, face significant health challenges.
And so we made the determination at that time that
it was best to begin our transition into civilian life.
But then 9/11 happened.
And so all of felt that call of duty to continue to
serve during a time of war.
That's exactly what we did for the next 12 years.
And like most of you in this room,
spending time in Iraq and Afghanistan,
appendance tour and recruiting command,
and we retired out of the
Seven Special Forces Group in 2013.
Not only our own personal wellness journey as a family,
but over those past 12 years,
watching all of our soldiers and
their families grapple with all six fears of wellness.
Physical, mental, emotional, social,
spiritual, and financial well-being.
So when I retired, and an opportunity I could not
refuse presented itself, the opportunity to continue to
serve our soldiers and their families and
our 43rd Commander in Chief as the
Second Director of the Military Service Initiative
following another great soldier for life, Kernel Andres.
His wife Cheryl is joining us here today.
So I began that work, begun by Kernel Andres,
as the Director of the Military Service Initiative at
the George W. Bush Institute in Dallas, Texas.
And at the Bush Institute,
on behalf of President and Mrs. Bush,
we are focused on fostering a successful transition on
reintegration from military service to civilian life for
all of our nation's military veterans,
their families, caregivers, and survivors.
We define a successful transition as
achieving optimal health and well-being,
and leveraging meaningful education and
employment opportunities.
We have four programs to that end.
In partnership with all branches of the service,
all of our federal agencies,
the business, higher education, and non-profit communities,
we work on an employment and education program.
Our health and well-being comprises our
Warrior Wellness Alliance to address those
invisible wounds of war, traumatic brain injury and
psychological health conditions,
like post-traumatic stress, depression, anxiety disorder.
We also have a military adapted sports and
peer network program, team 43.
Just this past weekend,
President and Mrs. Bush hosted 52 great warrior families out
at the ranch for the 7th Annual W100 Bike Ride.
Our fourth program is what we refer to as Collective Impact.
It is, how do we leverage,
how do achieve optimal efficiency through coordination,
collaboration, and synchronization of
effort of all of those sectors?
So most recently in June, we conducted,
we hosted a national convening to that end called Stand To,
where 300 partner organizations came together to
commit to achieving optimal health and well-being,
and leveraging meaningful education and
employment opportunities for all of
our nation's soldiers and their families,
for all members of all branches of
the service and their families.
I am a solder for life, Erica is an Army spouse for life.
Not only is this our life's work, but as you heard,
as the father of a soldier for life,
it is deeply, deeply personal and meaningful,
and I am honored to be here with you today.
(audience applause)
- [Josie] Thank you to all our panelists for
sharing their story.
Now we will move into our moderated Q&A where I get to
take advantage of the knowledge of these amazing experts for
my own personal use.
Hopefully you will also find it
entertaining and informative.
My first question is for MaryAnn actually.
And I want to ask you about the Heart of Recovery program,
and specifically about,
I wanna make sure we're not just
providing our caregivers with tools to be caregivers,
but tools that will recognize them as independent folks with
their own health and wellness journey to follow.
So can you tell us more about that program?
- I would love to.
Basically just the mission of our program is to empower and
educate and support our military caregivers to
improve their health and well-being and mitigate those
risks associated with caregiving.
And I need to clarify, it's not a program yet.
This is an initiative and we're in the
information gathering stage.
And I'm so glad that General West brought this
example up with what Albert Einstein had
said about defining the problem.
If you have one hour,
you would spend 55 minutes defining it.
And that's what we are doing right now.
We're going to be launching a survey in January,
Fort Sill, Fort Bragg, JBSA, JBLM,
to really find what our caregivers need to make sure that
our program is responsive and relevant,
and also where it should best be nested.
But in terms of what could be of assistance to caregivers,
there's so much in this Army community.
When I landed here and went to our first installation with
my husband and young son in Korea, I was blown away by
how many resources we have in one place.
And I think for military caregivers and anyone,
ACS is a wonderful hub.
They can help with pre-deployment,
you can get your pots and pans there,
you can get help with writing your resume,
you can get financial planning.
And all of these things are relevant to caregivers, too,
because most of them are transitioning and
we want to set them up for success.
And just quickly to mention a few others,
Military One Source, a wonderful resource where you can
get confidential assistance across all the
domains of health, from employment to understanding all the
different transitions in the military.
So those are just two, and then I think General West did
a great job of really covering sort of
how broad our Army medicine programs are.
But those are the ones that I would largely focus on.
And just to say for our military caregivers,
what we want to do is just
better integrate our existing capabilities.
And I am very proud about this fact,
with this task force that we've convened with
over 20 people across the Army and agencies.
And while we are in this information gathering stage,
we have been able to leverage these existing capabilities,
like our Ombudsman Program and the Wounded Soldier and
Family Hotline, who have now been trained on
caregiver needs and are serving as
a central hub to assist our caregivers.
We've also integrated caregivers into the IDES process so
that now when our soldiers are going through that process,
at the introduction, there are questions around caregiving,
and AWIC, it's a database that's used by Warrior Care and
Transition, now has more data points to acknowledge and
to report on caregiving.
So in spite of limited resources, I'm very proud of the
fact that we have brought together a lot of people who
are passionate about this and
we've really leveraged what we have here existing.
- [Josie] Great.
Thank you MaryAnn.
My next question is for Amy.
As I mentioned, I have a five year old and
a seven year old that I may sometimes struggle with
maintaining health and wellness.
And you talked about routine and
how you kept routine up for your kids.
Can you tell us a little bit more about the tools that
you used to do that?
- [Amy] When I was referring to routine,
what came to mind was the fact that upon notification,
I immediately asked, "How much time do I have before
"the information is made public?
"I need to get to my children.".
They were in an elementary school and a middle school.
So I had a friend drive me, and I picked them up,
and they both wanted to go to school the next day.
And one thing I learned from that is that,
I had talked to both school counselors, and I said,
"Under no circumstances do I want anybody,
"a teacher sharing that they lost a parent at a young age.".
I went into mama bear mode.
The reason for that is this was their walk beginning.
And as much as people might have thought that they would
help, it would hinder the progress in their walk.
But they wanted to go to school,
Megan made it through the whole day.
Shawn's counselor, who's in fifth grade,
called me at mid morning and said, "He needs to come home.
"He wants to check on you.".
We took their lead on that.
We kept the routine.
Shawn had a theater thing that he was doing,
and he missed a couple of rehearsals,
but he was there for opening night.
And it was our normalcy,
it gave us comfort to have the routine.
My routine was going for a run every morning,
then walking the dog, then jumping into
whatever volunteer activity I had going on that day.
And so I would say it just provided us with comfort,
because it was what we knew amidst a
tragedy happening in our lives.
- [Josie] Thank you.
Rachael, I have a question for you about PBJ and cake.
Sometimes my wellness journey is-
- Sticky, just take it slow.
(laughter)
- Sometimes my wellness journey also
includes some really healthful, nutritional habits,
like brownie batter at 11pm.
But how do we deal with failure?
How do you bounce back from recognizing that
you didn't make the best choices?
How do you make that 180 turn?
- I maintain those were good life choices,
and so I'm sticking with that. (laughs)
I think an important thing, at least for me to
keep in mind that's been helpful is
keeping things in context.
So you have seasons where, my dad was a track coach and
he would tell me to shorten your stride and
drive your knees on hills,
and lengthen your stride going down hills.
And I think sometimes you're just going uphill,
you just gotta work with what you got.
I gather there were some challenges with
the Army 10 miler yesterday.
Not the best day for running,
but that's the day the race was,
so you do what you can with what you've got,
and just kind of give yourself some grace to
cover the difference, should there be any.
- [Josie] Thank you.
Chaplain Melville, wellness is a family endeavor.
What tools does the Chaplain Corps have for us to
make it really across the board family involvement endeavor?
- Yes ma'am.
The Chaplain Corps is focused on, as was said earlier,
body, mind, heart, spirit, and relationship.
So as we look at the family aspect,
we have a variety of Chaplains trained in specialties.
Chaplains who are trained in
clinical pastoral education that work in the
hospital systems and in the medical units.
And then we have family life Chaplains who are
trained specifically to deal with
marriage and family therapy issues.
And even though we approach from
a pastoral care perspective, they have the tools and the
capability to work with families.
In fact, the development of the Strong Bonds,
although it started in a brigade,
it was quickly adapted and adopted by the
Family Life Program in order to proliferate the
opportunity to sit down with couples and to be able to
work with them and their families on those type of issues.
The Chaplain Corps, as I said, Fort Belvoir,
all of our doors are open for you.
And whenever you come into the Family Life Center,
the intent of that is to be able to sit down and
to work on issues, either to improve a
functioning relationship and get healthier,
or to work on a sometimes challenging relationship.
And all the Chaplains, whether family life or not,
provide pastoral counseling for those sorts of
relationship challenges.
And just like you were asking about,
if I may borrow the peanut butter and jelly,
in our spiritual walk, and in our relationships,
I would say, it may seem like a good life choice at the
time, and then you realize sometimes in
hind sight it may not be.
Not saying yours was,
just saying for some of the relationships.
And in light of that,
I would say if you're struggling either in a relationship,
struggling with family issues, or struggling spiritually,
rather than just kind of throwing in the towel and
walking away from it, we're here to help remind you,
as was well stated, give yourself some grace,
reach out for some grace,
and also reach out for some support,
and we'll be glad to provide that for you.
- [Josie] Thank you.
Miguel, I want you to bring this all together for us.
I'm really fascinated that wellness is part of
your portfolio at the Bush Institute and
that it's such a big part of what folks,
even outside of our own military community,
are concerned with.
Can you tell us a little bit about why that is and then how
do we think about transition?
How do we carry these habits into civilian life?
And how do we make partners out of
our civilian community on this issue?
- Well thanks for that, Josie.
But first I want to share a fun fact about this panel.
I've actually had a chance to spend some time with
Rachael quite often over the past year, year and a half,
and she met her soldier for life on the cross country team,
and I met my Army spouse for life also on the
cross country team.
Being focused on all aspects of wellness,
is interconnected, clearly.
(laughter)
That's kind of a daunting assignment that you've given me.
I'll kind of tie it back in this way.
And that is that the challenges of wellness are
absolutely the same challenges of transition from
Army service to civilian life.
Whether you have a member of your family who is wounded,
ill, and injured, or otherwise,
those domains of wellness, the physical, the mental,
the emotional, the social, the spiritual,
the financial, those are all the same domains and
the same challenges that we all grapple with
when we eventually take the uniform off.
And it's not just the soldier, it's the complete family.
I was struck by the discussion about familiarity.
Two and a half years after I retired,
I drove my son up to a bicycle race at Wichita Falls.
And we drove onto the Air Force installation,
and he took a deep breath inside and said,
"Dad, I feel like I'm back home.".
All six of those variables and all six of
those factors come together for overall wellness.
But when I talked about transition,
I talked about transition really in
three spheres that encompass all of that.
Education and employment, which is our new pathway to
our new sense of purpose and
belonging and financial readiness.
But then it's also health and well-being in
the rest of those domains and those spheres.
So it's about thinking and preparing for those same things,
actually General West talked about it.
She talked about the issues and the challenges of
behavioral health and the opiod crisis.
Those are much greater challenges in the
civilian sector than they are in the military sector.
All of the challenges that we grapple with
with wellness and transition are exactly the
same as our civilian brothers and sisters.
What is different is the operating environment.
The culture, the language, the training,
the resources, and knowing and understanding how to
navigate all of that.
Sometimes we get caught up inside the Army with
some of the bureaucratic frustrations and challenges,
and also by the mandate to always do better.
As we heard, General West driving the changes in MEDCOM to
always do better, and at the surgeon level as well.
If you haven't left service yet,
separation is a true appreciation for the
resources and the programs that we have in the Army.
We know where to go when we have an education challenge with
either our service members or with our family members.
Clearly on the medical side, we know how to plug in.
We know all about Army community services and
the Army Emergency Relief Fund if we've got some
financial challenges for our young soldiers.
When we think about transition,
all of that gets spread across great federal agencies and
organizations, great businesses.
There are 40,000 non-profits who report to
support military families and veterans and veteran families.
And countless communities across the country.
And so it's doing your homework and
taking ownership prior to that transition and starting to
learn about the culture and the language and
the resources that are available to
you out there and how to plug in.
Transition is more than just hap,
transition is more than just the six to 12 months prior to
separation and the 12 months after separation.
It's really conditions based.
And it's thinking through all the same spheres of
wellness that our families face in uniform and
knowing where and how to plug in for those resources and
those services when we take off the uniform and
our families join us in communities across the nation.
- [Josie] Thank you.
And we have time for some questions from the audience.
There are microphones in the center aisle if
you're interested in standing and asking,
please go ahead.
- Thank you very...
Is this on? - Yeah.
- Thank you very much for the opportunity.
I went over and asked if it would be alright to
ask this question ahead of time,
not wanting to interrupt this flow that
has come from the panelists.
I'd like to direct a question to General West if I could.
For the last two years, I've been connecting,
I'm Dave Silla, from Huntsville, Alabama,
and I'm the State President for AUSA there in Alabama.
For the last two years, we have been working with
the Surgeon General's Office and connecting the
Surgeon General's Office with some technology,
biotechnology that's available there in Huntsville, Alabama.
And they've done a great job at working through the
Global Force Symposium program that AUSA has,
and learning more about what it is HudsonAlpha does and
how it applies in the medical arenas to all of
you on this panel, whether it's through DNA tracking,
whether it's through genomic tracking and
things of that work.
Whether it's about programs for
our exceptional family members, those types of efforts.
Do you see Army medicine changing in the future?
And what it might look like.
And do you see arenas such as HudsonAlpha having a
more prominent role in the Army's medicine programs?
(woman talking distantly)
- Thank you so much for that question.
And I tell you, I also like how you tee'd that up for me,
I really appreciate it.
I absolutely do see a role for evolution in
the way we provide healthcare.
What my team, kind of our motto is,
conserve the fighting strength, since 1775.
That's a long time.
And we've been aorund for a while,
but just think of the evolution of what
we had as healthcare delivery back then.
You know, leeches and blood letting and trying to
make sure that the evil vapors and the
evil humors were wafted out of the body,
to the point where we are now,
where we actually have, just like you're saying,
we're getting into more tailorized medicine based on
someone's genomic makeup.
So I see in the future we're gonna have to do that,
especially in support of what our Army's being asked to do.
And that's one of the things.
Whatever General Milly says as far as what we need to
do for our future, I'm right along there parallel to
see what do we in Army medicine need to do to
make sure we keep up with that?
With multi-domain battle, there's gonna be a requirement for
us to have more capabilities far forward to be able to
do prolonged field care,
because we may not have uncontested air,
so we have to know how to do something alternatively if
we can't evacuate immediately like we've had
in the last several years.
So I see all types of technology.
In fact, our researchers, we have a wonderful team led by
Major General Barb Holcolm, at the MRMC,
which is the Medical Research And Material Command,
based at Fort Detrick, who are looking at what's the
next level of taking care of our,
how do we evolve medicine next?
And it's not just Army, we're working with our colleagues,
force phase on the Navy Surgeon General Mark Edinger,
Air Force as well.
And we actually have our colleague from the
Defense Health Agency, the Director here,
Admiral Rocky Bono.
And we are looking right now.
How is medicine gonna evolve in the future to
make sure that we're taking care of all of
our service members in this multi-domain,
multi-matrix area where it's not just us in
our lane and Army?
So I see the need for industry and
Secretary Maddox mentioned that this
morning very eloquently in the discussion about
what we're gonna need to do in acquisition.
We take the best practices of acquisition to make sure that
we've got a better rapid way of
fielding things for our forces.
We need to do the same thing in medicine.
What is going on in the civilian sector that
we can operationalize to use in our forces?
Kind of a long way to answer, but the short answer is yes,
I see the role for that because if we're not advancing,
then we're actually falling behind in
technology and medicine.
So thanks for that question, sir, appreciate it.
- Thank you, General.
Any other questions from the floor?
- [Woman] Hi, I'm short.
My name is Audrey Storch, and I'm from Huggs To Go,
but I'm not here for me.
I hope I don't get emotional.
I'm actually here representing hundreds of
thousands of military families.
We have a product, it's a huggable picture frame so the
children's deployed parent, and this one actually AUSA,
we did over 600,000 with the non-profit was donated to
all the children with a deployed parent.
That funding was cut over five years ago.
I don't want to start crying, I just had more calls.
I'm here for them, I spent my own money to come.
They want it back so bad, and I now sell it direct to
them at a huge discount to help out,
but I'm here to ask, how do we get it back to them?
Because without emotion, nothing else works.
- That is an excellent question.
I am definitely not qualified to answer for it,
I will not endorse, but say my children still sleep with
their daddy doll.
(laughter)
And occasionally fight over it as well.
So if we could have another,
but I will pay you for it this time.
But its' a great point.
How do you make it through deployments or separations?
- I had breast cancer,
and we went through separation anxiety,
went through chemo and treatment,
then my nephew went in the Marines,
and then the military families started calling me.
I'm sorry, I'm nervous, because I'm not here to sell,
that's not why I'm here.
I'm here because of the hundreds of thousands of
emails we get begging us,
because a lot of them don't make money, and I'm trying,
I'm spending all my own money.
And I can't anymore, I'll go out of business.
I want to help all of you guys,
and I need help to continue helping you.
Because they all said,
"You can't believe what this ragdoll has done.".
Kids with behavioral issues, special needs, acting out,
even the teenagers doing drugs,
it made such a difference in their lives,
this little ragdoll that they got to put daddy or mommy in.
And we have recordable, too.
- Thank you so much. - So what do I do?
How do I help them?
- Let's talk.
- Okay, thanks.
- We have one question more and
then I think we'll have to wrap it up.
But thank you all for being here today.
Feel free.
- [Woman] I have a question, but I have to say that
besides me leading an overseas chapter for the
Institution of the United States Army in
Kohat for the last 11 years involvement.
For the last six years I have been very active as
patient advocate for advanced cancer patients.
My question is related to two things in the military.
First, this is a fascinating panel, and previously also for
General West to explain how you involve sleep,
physical activity, and nutrition is marvelous.
But how you really put the pieces of the puzzle together,
like the multidisciplinary, this is implementable at
the end of the day for
all service members for their well-being?
And the second question, do you get their feedback?
Or actually not their feedback.
Are they the lead as a patient advocate now?
Like are the lead as patients and ... as patients are
just as members that all this should be around them?
They should be the lead as opposed to the
industry guidelines, with all due respect to them,
the quality of life for patients is the most important part.
How we can address these two issues?
Thank you.
- Great question.
Would anyone on the panel like to address?
- On the non-Army side of the house,
I will tell you that...
First of all, thank you for your question,
that is the exact same question that all of the
major organizations across government, non-profits,
businesses, and higher education are struggling to answer.
And that was the theme, I mentioned a convening we did in
June with 300 partner organizations.
And so the Army really has the opportunity to take the
lead here and be a model in terms of
how to integrate all elements of those domains together.
The event in June was the
first time 300 different organizations came together to
figure out, how do we tie together not only the health and
wellness issues, but employment and education?
Because they're all interrelated.
So we are starting to hear major employers across all
three major coalitions that hire our soldiers and
military spouses to talk about
addressing specific health and
wellness issues within the work place.
We hear the same discussions within higher education.
Back to the point that the civilian community faces the
same issues as ourselves on a much larger scale.
Recently I heard Jarod Lion is the CEO of
Student Veterans of America, tell an audience that in 2016,
40% of all incoming freshmen had
a diagnosed mental health condition.
That's a huge challenge to address.
40,000 non-profits tackling health and
wellness issues across all of those fears,
how do you cull through who are the best to
provide those resources and those services?
So while I don't have a specific answer to your question,
I want you to know that your question is in fact being
addressed at a national level down to a community level,
because there is now recognition with a focus on veteran and
military families that all of these issues are
interrelated and we can't disconnect careers from
education from health and well-being.
- [MaryAnn] And I'd like to add, too,
when we started with a caregiver initiative,
we looked at our higher headquarters.
And within DHA, there's an
inter-agency care coordination committee that
really does address all of those domains of care,
and all of those domains of health.
We try to prioritize what they address within the
family domain so that we were looking at the
spiritual component, we were looking at the education piece.
Our caregivers are being plucked out of their lives as
they know it, and they need that financial planning,
they need help with their resume and employment.
And I think our WTBs, our Warrior Transition Battalions are
also an excellent example of really providing that
comprehensive transition and assistance,
because they also incorporate all of
those different domains so that we have
a very holistic look at care.
And then just one more thing.
General West did mention the child and
behavioral health system, and one of their major tenants is
that they're really looking out for the other organizations,
they're really coordinating with the
other organizations that provide assistance to
families and children so that they can have an
integrated approach to delivering care.
- [Rachael] I'll just close out.
We do have a cancer support group for family members in the
Army building on Fort Sam Houston,
and it wasn't there when I was there.
As a family support member five years ago, seven years ago.
So it's something that I would say is on-going and
back to your public private.
That was a private building that the Army now runs,
and I think the social work department facilitates the
support group.
So I would say it's an evolving issue.
- [Josie] Please join me in thanking this
wonderful panel for sharing their stories.
(audience applause)
I'll bring Patty Barron back up on stage to round us out.
- Josie, that was incredible moderation,
and the panel was just fantastic.
Thank you so much, so much information in a
very short period of time, but all of it very,
very relevant and very heartfelt.
Thank you so much.
(audience applause)
So now you can take a little break,
another quick stretch break.
Okay, everyone our stretch break is over.
Time to get back to your seats.
Alright, we're gonna go ahead and get started,
and I'd like to introduce our next speaker.
So if you'd go back to your seats, that would be phenomenal.
Fantastic, thank you.
(whispering, overlapped chatter)
Okay everyone, I'm gonna go ahead and
introduce our next speaker,
so if you'll all take your seats.
Thank you.
I lost control.
Ladies over there on the left.
Okay.
(whispering, overlapped chatter)
Thank you, thank you so much, Patty Brown. (laughs)
Alright everyone, thank you so much.
Our next speaker is a person, again,
that is also just a very accomplished woman.
Vice Admiral Roquel Bono is the Director of
Defense Health Agency, also known as DHA.
Defense Headquarters, Falls Church, Virginia.
She leads a joint integrated combat support agency enabling
the Army, Navy, Air Force,
and Marine Corps medical services to provide a
medically ready force and a ready medical force to
combat commands in both peace time and war time.
In support of an integrated, affordable,
and high quality military health service,
the DHA directs the execution of 10 joint shared services to
include the health plan, which is TRICARE, pharmacy,
health information technology, research and acquisition,
education and training, public health,
medical logistics, facility management,
budget resource management, and contracting.
That's an awful lot of work.
The DHA administers the TRICARE health plan,
providing worldwide medical, dental,
and pharmacy programs to more than
9.4 million uniform service members,
retirees, and their families.
But she's a very passionate woman,
and really cares an awful lot about all of us.
Please welcome Vice Admiral Bono.
(audience applause)
- [Bono] Thank you Patty, that was so nice.
Thank you.
Hi, good afternoon everybody.
(crowd yells)
(laughs)
Thank you.
So if it's okay, I'll kind of stand here to the side,
because when I stand behind a podium, it just kind of
looks like the top of my head,
or it looks like this big box is talking, and not me.
Thanks very much for including me in y'alls event today,
and I'm just gonna say a couple of things.
It is really exciting to hear the stuff that's going on
across all of military medicine,
but it also fills me with a tremendous amount of
pride to hear the progress and the work that
the MEDCOM has been doing.
And my colleague, Lieutenant General Nadja and I,
Nadja West and I, we've kind of gone through this
journey of military health together.
And I don't wanna go into too many stories about it,
but we did kind of start out at the same time,
and it's really neat to be able to continue that
collegiality and that partnership even today.
And I have to tell you that the panel, just amazing.
Your stories are riveting, they're inspiring,
and you give me the insight that I want to
be able to take and figure out,
what do we need to do to make your healthcare plan,
your health plan work as effectively as possible?
So as you heard Patty talk,
I'm the Director of the Defense Health Agency,
and one of the big pieces of my portfolio is
the TRICARE health plan.
So I wanted to be able to spend a few minutes talking about
that, but I'm really more interested in turning it over to
you and hearing what your thoughts are.
Because when I came into the job nearly two years ago,
the thing that I wanted to do was I wanted to
be able to find a way to create this integrated system of
readiness and health around you, our beneficiaries.
And i firmly believe that our TRICARE health plan and
our military health plan is your health plan.
And part of what I had the honor to do is figure a way to
make it as responsive and as complimentary to your needs and
to what your challenges might be in terms of
health or in any other domain.
Because I think the panel did a wonderful job of
talking about the importance of being able to
address all the domains in your life, in terms of
being able to address your own health and wellness.
I share that conviction as well.
I think that also having worked with General Horoho in the
past and the work that she did with the performance triad,
it just, it makes sense, right?
I mean, these are things that we should be
paying attention to.
These are things that we all have the ability to address,
but thank goodness we also have now more resources to
help us be a little bit better with our activity,
our nutrition, and all those aspects of being able to
address what your own health and
wellness is going to be like.
So I wanted to just touch base on a couple of things,
and I wanted to talk a little bit about some of
the more recent world events.
We've had a lot of them, whether it's the weather,
whether it's intentional mass casualty that's been
going on in other parts of our country.
But it's important to realize that while those
things are going on,
while we hope that those involved are
kept safe or those where there's loss,
and we're able to rally around the survivors.
It's important to realize that your healthcare plan is
still there when these events happen.
With the recent hurricanes, one of the things we wanted to
do was make sure that we had access to
primary care managers, to physicians, to doctors,
for those of our beneficiaries that were
displaced because of the hurricanes or the flooding.
We wanted to make sure that they could be able to
find healthcare wherever they got displaced to.
We also recognize that in order to support many of
our beneficiaries, we also had to adjust some of
our authorizations for care as well as some of the
refill too soons on medications that
you get through the mail order.
So we try to pay attention to those kind of things,
we try to pay attention what's happening with
the MTFs that are in those areas where
we have these weather events.
We also had with the Las Vegas event,
we had some of our military trauma surgeons from
the Air Force, Military Air Force Base,
go to some of those local hospitals to help out with
taking care of those casualties.
And it's time like this that it reminds me that
the military health system really is a comprehensive,
global system, where we all surge regardless of
our uniform to do what we know needs to be done.
We don't even ask, we don't even ask who it
is we're taking care of.
We just know that as a military health system,
your military health system, we know what our call of
duty looks like, and we surge to take care of that.
I think that's something that we all can
be very proud of.
And it's also something that you need to know is
going on in the background every single day.
You've probably heard about some of the changes that
are coming to TRICARE.
I wanted to leave time to talk about those because
I know there may be some questions about some of them.
Maybe the co-pays, (laughs), and some of the things that
have changed there.
But I do want to stress that part of the
reason why we change some of these things from
going from three healthcare plans to two plans.
We still have TRICARE Prime, but we have condensed,
or we brought together, TRICARE Standard and
TRICARE Express into TRICARE Select,
because we wanted to simplify that.
Because we see what's happening in the commercial and
in the private healthcare sector,
and we wanted to be able to give you a product that
mirrors what's happening in the private healthcare sector.
So that's one of the changes, and we'll be starting that
in January of 2018.
You have at your seats, you have some of the fact sheets,
and you also have a little card there.
Because one of the things, and if you take nothing else,
if you just take that tiny card,
I think it's a little business card, it has Take Command...
Yes, I think you've got it right there.
Someone could hold that up.
Yes, thank you, perfect.
If you don't bring anything else, take that,
because one of the things it is is a reminder to
make sure that your dearest information is accurate.
Because in our efforts to make it as easy as possible for
you to transition into the new healthcare,
we will auto-enroll you into the healthcare plan that
you're currently in now.
And in order for us to do that,
we have to have the most accurate information on DEERS.
So take that and make sure that you start updating that,
and please help me get the word out to folks,
because we want this to be as seamless as possible,
and we want to make it so that you don't have to
do very much heavy lifting to make this happen.
There were also some changes to, as I mentioned earlier,
to the cost here, and we moved to a co-pay.
And on your seats and on the tables here,
you'll see on the sheet there,
if someone could hold that up.
The other one there, though.
That one, yes, that one.
On the back, I've actually gone ahead and
given you the co-pays that we had figured out.
And I know there are probably a lot of questions about that,
so I'll save time so that we can talk about
that a little bit more.
And finally, I wanted to tell you a little bit about
what's going on in pediatric care.
And the panel really reminded me about the importance of
taking care of families, and how much of our families is
not only our spouses, but our children.
And as a mother myself, it resonates with me about
that need to preserve routine,
and it really means so much.
No matter what challenge our children are facing,
being able to preserve that routine and
being able to give them that safe environment and
that access that they need is so important.
I think that's foundational to
every one of our military families.
I think the strength of our military comes from
the strength of our families.
And how well we take care of our families is what
tells us how successful we'll be in
our own military strength.
And as many of you know, and Miguel,
I'm sorry for the informality, (laughs),
I'm calling you by your first name,
but as you mentioned, we have legacies in military families.
So many of our military people that come into
our military today, we raise them from within.
So how well we do that is what signifies how
strong our military's going to continue to be in the future.
So I feel that's very important.
And some of you may know that we recently had
a report come out by the Defense Health Board to
look at our pediatric population.
And I'm really passionate about taking care of our families,
and especially our kids.
Some of the suggestions that the
Defense Health Board offered to us is number one,
we need to communicate more.
And I couldn't agree more, which is why I try to
make sure that I take opportunities such as these to talk to
y'all and more importantly to hear from y'all to hear,
what should I be doing?
What should I be paying attention to in order to
make sure our healthcare is working to the
best of what you need?
It also recommended that we move towards more
data-driven and evidence based care,
so that we're looking really at,
what does the science tell us?
And that's something I completely agree with.
I know that while we all have the bet intentions in
taking care of our families, we also want to make sure that
what we're giving them for care,
that we have a high degree of confidence that
it's actually going to help them.
So that was a recommendation that the
Defense Health Board gave us to
provide more evidence based care and to be able to
show how we've come to the decision about
making that care available.
And then one of the other areas,
and this has been a very challenging part for many families,
is how we take care of some of
our seriously ill children who may need hospice care and
state of the art care, and how do we combine that?
Sometimes because our kids respond differently to
different treatments, we've kind of been treating them like
little adults, and that's not the right thing.
We're trying to be more comprehensive in how
we take care of our kids.
And then finally, one of the other things that
we're working on here is, we have a very special population.
All of our kids are very special.
But I recognize that it's our retirees and
our very mature and our very young populations in
the military are probably the most vulnerable.
And so in taking care of our pediatric population,
we're looking very closely to see if we can extend some of
the benefits in our Echo Program.
And we're also looking to see how we can improve and
elevate the level of care that we can give to
those kids with Autism Spectrum Disorder.
Those are just a few of the things that we're working on.
I'm so grateful, I'm very appreciative of being included in
the conversation, because it truly gives me some insight,
listening to the panelists, General West was so helpful in
understanding what we can be doing and
what we should be paying attention to to create the
most comprehensive and integrated system of
readiness and health in your healthcare plan.
So let me stop there and give you guys an opportunity.
And actually, to get us started,
we do have a question that somebody asked on Facebook.
I thought I'd go ahead and take on this question because
I thought it was a really good way to show you the
approach that we're trying to take in the
Defense Health Agency with regards to your healthcare plan.
And the question has to do, the person is curious as
to when will acupuncture, chiropractic treatments,
and other similar treatments options be
approved for dependents?
That is a really great question,
because as most of you know, right now,
those treatments are not a covered benefit.
Yet in some of our MTFs,
we offer acupuncture, chiropractic treatment,
and other types of treatment modalities like that.
So one of the things that we're trying to do here is
we're looking at the evidence for outcomes,
for the outcomes associated with these treatments.
And we're looking at private and
commercial healthcare plans to see how
they're addressing these types of treatment modalities.
And we're looking to see if we have enough evidence to
start having that conversation or to ask the question,
what would we need to do to start including that
in your healthcare plan?
So I thought I'd go ahead and start off with
something like that, because in the past we would have said,
"Well it's not a covered benefit and
"you have to go to the MTF.",
but I want to try to take that question and
give it a slightly different perspective,
and that is let's loo at it.
And if there's value and if there's evidence that
there is benefit to this, then what would we need to
do that all of our beneficiaries had access to
that type of care?
So hopefully, that'll give you kind of
a sense of the approach that we're trying to take.
But I'd really welcome any of the questions here from
the audience or on the Facebook site.
So don't leave me hanging up here, just kind of quietly.
(laughs)
Yes ma'am.
- [Woman] Good afternoon, hi.
- Hi.
- [Woman] Thank you so much.
As always, a pleasure to hear you speak.
And I'm here on behalf of music therapy and
creative arts therapies.
I'm a guest of Captain Aveila and
his wife Claudia here today.
And just really to piggy back off the first question,
which was great.
I've done a lot of work at the National Intrepid Center of
Excellence at Walter Reed, and in the pediatric unit,
child and adolescent behavioral health on the hospital side,
we saw some really profound just breakthroughs in
recovery and assistance in prolonged stays or
treatment with the children and dependents.
So it works really well for the service members,
but also for the families.
There is pioneering research that's happening through
help of the National Endowment for the Arts,
and their Creative Forces initiative,
and that's open access.
Just to affirm that there are some new studies and
novel studies being done on creative arts therapies.
And then also asking, thanks to the
Intrepid Fallen Heroes Fund and the MOUs between the
DOD and Creative Forces, we do have at the Intrepid Spirits,
across the country, creative arts therapists embedded.
So how can the DOD even though the DOD, DHA,
MHS is not directly funding the positions,
how can we utilize the resources for
research and evaluation?
And how can we kind of tie that in where we can
get more studies that are supported by the DOD?
- You know, that's a great question,
because I think that in each of the topics that
we covered in the panel, and in looking at the
topics that General West spent describing to you,
I think this is what strikes me about our health and
our wellness, and our recovery.
It is such a complex process,
and there's no one solution that works for everybody.
And I think that's why the diversity of the panel that
you saw here and that you heard,
I don't think any one of them thought,
"Well this is the one way to address something.".
It's really kind of a combination,
and a lot of it has to do with your own individual makeup,
and sometimes we just don't know what that
entails unless we offer a broad variety or
a very diverse approach to addressing some of these
conditions or these circumstances that we're facing.
And so I think in that vein,
I think that's why it's so powerful to be able to
pursue that in a very rigorous, scientific way,
and to encourage people across the
different services and in industry.
And I think somebody had talked about
partnering with a biotech.
I think this is a great time to be partnering with
a lot of different commercial and private entities,
because as smart as we are in the military,
we just don't have all the solutions.
And sometimes there are people out there that
are working on things that if we had access to
what they've got, or if we had access or we had
better understanding of some of the solutions that
they had, it would be a lot easier to try to
bring that into our system.
I think that what you're doing, what your describing is
something that I'd like to see for a lot of
other conditions or a lot of other circumstances that
we have in our healthcare field.
So I think we should continue to have that conversation and
make sure that we're including as many of the folks that
are interested and that have
potential solution sets for that.
Thank you for that question, that's great.
- [Woman] Good afternoon, my name is Kathy Mokler.
And I have a question.
We're a little bit over a year out on the reintroduction of
the Nurse Advice Line,
and also allowing more visits to urgent care.
How has that helped with access to care?
- Really great question.
And before I answer that, could I kind of get from the
crowd, have y'all had a chance to do the Nurse Advice Line?
Okay, so a few.
And of those ones that were brace enough to
raise their hand, would you be brave enough to
share what your experience has been?
And if it helps, I won't make direct eye contact so
you don't feel self conscious. (audience laughter)
Yes ma'am.
- [Woman] We were at a wedding in California and
my child spiked 103 temperature.
I called, they told us the nearest urgent care to go to,
and they even called in and told me what pharmacy to
go to that would take TRICARE.
- Great, awesome.
Well that's wonderful to hear.
Anybody else's experience?
Thank you.
- We had a very positive experience with it, ma'am,
in that we were given advice that kept us from
having to take anybody to an emergency room.
- Perfect.
- We were able to take care of it with home care,
so it was very reassuring.
- Awesome, thank you.
Those are just anecdotes,
but that's what we were hoping to hear.
So I've actually looked at the figures,
and it does seem that while our overall access to
urgent care and emergency department has
remained just slightly under what we did last year,
what I'm noticing is that there are less ER visits.
And so we have a slight uptake on urgent care,
which is what we were hoping,
that if we needed to get folks in in terms of access,
we'd be able to get them into urgent care.
We're looking also at the authorizations,
and we started out a ... in which you had two referral,
well you didn't need referrals.
You could have two urgent care visits without
needing an authorization.
And as you know, the statute is
asking us to go to unlimited.
The thing that we found out though is when we have the
Nurse Advice Line, what we found is that we can
either direct the beneficiary to a more appropriate place,
and if you're traveling or you're in a place where
you're unfamiliar, we can actually find something that's
close there that takes TRICARE,
and that's also very helpful.
The other piece is that in some situations,
when we've had folks call to the Nurse Advice Line,
we've found that we can actually take care of the
care right there on the line,
or we're able to make appointments for them the
following day into the MTS.
Right now it seems to be working,
it's working so well in terms of the trend that
we were hoping to see, that we've expanded the
Nurse Advice Line a little bit more.
So we'll be checking to see if that's still an
effective way of handling some of our access,
and being able to refer people to the appropriate care.
Do you have a recommendation for us to consider or
do you have a thought on?
Okay, do you think we should keep the Nurse Advice Line?
Okay, good.
I like to have my MSO, BSO meetings myself on
a quarterly basis, so I'd like to make sure that
if this is working for you, let me know that,
and if you have some suggestions for
how we need to make it better, let me know that, too.
Thank you.
Yes ma'am.
- [Woman] Hi, I actually have used the
Nurse Advice Line twice with great results,
so yes, two thumbs up.
My question is about the new dental program,
and the lack of providers that live in this area.
I'm part of a couple of Facebook pages,
and the number one question is,
"Hey, my dentist has now left the network,
"so where are we going from here?".
Because if we can't find a dentist that's a provider in
this metropolitan area, I'm concerned about
our families that are in more rural areas.
And do you see this becoming a problem with
our civilian doctors who provide services for us?
And what's the way forward for both of
those sides of the equation?
- That's a great question, and thank you for asking it,
because one of the things that we're trying to with
your health plan, we saw a chance when we started looking,
when we switched over to our new dental provider.
And while we had, as part of the terms of their contract,
that they needed to have a large enough network that
people would have access to them within 10 minutes,
I realized in listening to our provider,
I mean our beneficiaries, that while that was okay,
many of our beneficiaries would like to have dentists that
are closer than the 10 minutes we had
specified as the drive time.
So I wanted to take that approach that,
in terms of building that network,
it's not so much how big the network is,
it's how close the network is to
where the beneficiaries are.
Does that make sense?
So I'm taking that same approach with the network for
the healthcare plan.
It's not so much that I have a really large network,
although it has to be large enough,
the more important thing in my mind is making sure that
the network is close enough to where patients actually live,
so that we can keep that access as
close to home as possible.
And help compliment whatever we have,
if there is any direct care assets there.
Does that get to what you were asking?
- [Woman] Not sure.
- Okay, could you help me understand?
Because I really want to make sure I've got the-
- [Woman] (talking distantly)
- Could you come to the?
- [Woman] We've actually been stationed in
a lot of rural places, so really when
you say care 10 minutes close to home,
I'm like, "Wow that would be really great.
"I'm just happy to get somebody a little bit further away.".
So that's the metric by which you're looking at?
- Not so much that, and I was probably,
I want to make sure that...
We still adhere to the same access standards we
already have in terms of availability and drive time,
so those things remain the same
but what I'm appreciating is while the
drive time might be preserved, what we really need to
be concentrating on is how do we improve that
access so that we don't have to go the full length of
that drive time to get to that provider.
In rural areas, and that's something that
I wanna pay really close attention to.
Here's the insight that I gathered though as
we brought on our new contractors for the 2017 contract.
Number one, we've got some really good contracts,
manage care support contractors,
because Humana and Health Net have been partners with us for
a very long time, so they know us and we know them.
But the other thing that I recognize is
they have commercial and private clients,
we're not their only clients.
And so I realize that their...
Somebody had mentioned, we've mentioned this a couple of
times today, we in the military,
we're a microcosm of the rest of the nation.
So our healthcare demands are not
that different from others.
And so being able to leverage what our contractors have for
their private clients is something that I hope we can
get available for our military beneficiaries.
So we still have those drive times,
I didn't mean to misspeak about that.
But what I am paying attention to is rather than
creating a network where the goal is within 30 minutes,
can we make a network where the goal is
a little bit less than 30 minutes?
Does that get a little bit better?
- [Woman] Kind of.
Are you gonna be able to do that?
- Well I think so, I do.
Because like I said, that's one of the things that
I realized, is that Humana and Health Net also have
private clients, and that's what their expectations are.
So why shouldn't I create conditions for having that
for our healthcare plan?
- [Woman] I think I would be more concerned about
the quality of the healthcare as opposed to
really how far I had to drive,
which is what concerns me about the dental program,
because dental help is part of your wellness package.
I can probably drive to 17 dentist in five minutes,
but that doesn't mean that they're gonna
take my insurance and I'm gonna be able to
get my teeth cleaned.
What are you gonna do about the dentist issue specifically?
- I think that's a great point.
And that's one of the other things, too,
for both our dental and healthcare plans,
we're also holding a certain level of
quality in standard of care for our providers.
And working with our contractors,
that's gonna be something that we're making sure that
the quality of the providers are what we expect and
what we deserve for our plan.
- So are they leaving the network because
we're not happy with the quality of their service?
Or are they leaving the network because
the payout is not what it's...?
Because that's what I hear,
but maybe there's another side to the story that
we need to share with our families.
Because what I hear is it's all about the money,
which we all know that's probably a lot true.
I mean, there's only so much to go around.
Am I making sense to you?
- Absolutely, yes.
And as a matter of fact, I mentioned my MSO, BSO.
I actually have the senior VPs for the
new dental plan come and listen to us because there was,
what you just talked about were some of the things that
we were very interested in understanding.
Part of the challenge is,
how do I work with our contractors so that they can
get us the providers that we need?
That we can also make sure that we're making it,
and you're right, I have to make sure I make it
profitable for them as well, but how do I drive,
how do I navigate that to make sure that
we get the access we need and we're getting the
quality and the patient safety?
I think it's a combination of that, and it's not one at
the expense of the other.
So working very closely with the
contractors is how we're doing that.
- [Woman] Okay, so last thing, I promise.
Can you just in leman terms then, what I should be saying to
my families, what is the way ahead?
You're working on a resolution for the issue,
can you give me 20 second answer?
- Yes, yes.
What you can do to help is if you could
ask your beneficiaries or your constituents or
your family members, help me understand when
they're running into that, so that I can make sure that
I actually address that.
Because what I'm finding is not necessarily one or two,
it's happening in certain areas.
By understanding if you're...
Are you in the metropolitan D.C. area?
- [Woman] Yeah.
- So understanding that, then I can go back to the
contractor and say, "Hey, this is not meeting with
"what we need to do.".
And we did the same thing for Tidewater.
- [Woman] Northern Virginia, too.
- You live in Virginia, too?
So we did that in Tidewater because we realized that
what you're describing was happening down there.
When I know these things,
then I can go ahead and start addressing them.
But if you could let us know that, and as a matter of fact,
I have folks here in the audience who,
if you can give us your information,
we'll look at it right away.
And the other thing is,
this is a shameless plug,
you can like me on Facebook.
(laughter)
And you can follow me @dh...
or you can follow my Twitter account @dhadirector.
But I'm serious,
because that way I can get that information.
- [Woman] Okay.
- But that's perfect, thank you.
Alright, there's a question.
"What can TRICARE and/or the Army do to
"streamline processes between DEERS in TRICARE?
"The link seems to break very easily.
"However, it's much more difficult to restore those
"connections, thus it causes lapses in care and services."
Really great question.
So one of the things that we're doing because we are
rolling over to TRICARE Select,
the new healthcare plan in January of 2018,
we're working very closely with DMDC, who does the DEERS,
to make sure that their system, their digital system can
keep pace with where we need to go with your information.
So we've been testing, actually this month,
and been getting some really good results on that.
So let me know if it's working, because come January,
we're gonna do this automatic enrollment,
so take your cards, make sure you take command,
and take those other small cards, too.
Help me get the word out.
We want to make sure that we can
do this automatically for you.
So I'm getting the big stop sign here.
She's really nice about it, though, I noticed. (laughs)
She was doing that for the panel,
and I couldn't even tell that you were like waving them off,
you did it so well.
These are some really good questions, and again,
thank you so much for including me in the conversation.
I'm inspired and I'm really motivate to hear y'alls stories,
and I'm also pretty excited that
you've given me some insight in some of the areas that
we want to make sure and address and
paying really close attention to.
More importantly, as we address some of these areas,
please help me out and let me know if it's actually having
the intended effect.
Because this is your healthcare plan,
and it's been my honor all these years to be a part of
it and to be sure that we're making that
integrated system of readiness and health for y'all.
So thank you very much.
(audience applause)
- Thank you so much.
My biggest take away, and I think for the audience is
that if there are issues and problems,
we need to let you all know about them,
both for General West as well I imagine.
It is something that we control our healthcare.
We also have to work with the folks that provide the
healthcare, and we have to let them know when
there are problems.
Thank you for that.
I am so grateful that y'all are still here and
thank you for staying.
It's been a great afternoon of a lot of good information,
some very compelling stories.
We've had some health issues in our family for the
last year or so and I can tell you from my perspective that
for us, the military healthcare system has
worked incredibly well and we are very,
very thankful for that.
Alright, we'll see you all tomorrow then, nine o'clock.
(audience applause)