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DoD Medical Materiel Standardization Programs
CAPT P. Jan Chandler, MC, USN Staff Director, Defense Medical Standardization Board
1423 Sultan Drive Fort Detrick, MD 21702-5013
(301) 619-2001
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Overview
• Purpose of Medical Materiel Standardization
• Military Healthcare System (MHS) Medical Materiel Standardization Programs
• Organizational Structure & Relationships • Program Methods & Outcome Measures • Future Plans
Defense Medical Standardization Board
24 May 2006
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Purpose of Medical Materiel Standardization
• Patient Safety & Sustainability – Operational Interoperability – Operational Compatibility – Operational Supportability
• Cost Reduction – Economies of scale – Reduced logistics tail
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Operational Capabilities of Care
1st
Responder
Forward Resuscitative Care
Theater Care
Definitive Care
The concentric rings represent the Level or Capability of Care.
Medical capabilities are progressively enhanced from the inner to the outermost ring.
Medical Materiel considerations:
What is the most suitable product for the inner most level of care that requires that medical capability?
How far “out” can that product go?
Defense Medical Standardization Board
24 May 2006
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Medical Materiel Standardization Programs
• Defense Medical Standardization Board (DMSB) • DMSB Staff Office
• Pharmacy Benefits Program under Director, TRICARE Management Activity
• DoD Pharmacy & Therapeutics Committee • Beneficiary Advisory Group • DoD Pharmacy Board of Advisors • Pharmacoeconomic Center (PEC)
• MHS Multi-Service Market Managers (MSMMs) • TRICARE Regional Business Offices
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Medical Materiel Standardization Programs
Program Est. Current Policy or Guidance DMSB 1945 •DoDD 6000.12, 29 April 1996
•DoDI 6430.2, 17 March 1997
Pharmacy Benefits Program
1998 •Title 10 USC Sec. 1074g •32 CFR Part 199
MSMMs 1998 •Deputy SECDEF TRICARE Governance Policy Memorandum, 20 January 2004 •Tri-Service Regional Medical Logistics Support Programs Implementation Guidance (Version 4.0), October 2005
Defense Medical Standardization Board
24 May 2006
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Medical Materiel Standardization Programs
Program Focus of Standardization DMSB •Operational Forces
•All Class VIII Commodities •Global
Pharmacy Benefits Program
•Direct Care & Purchased Care •Pharmaceuticals •Global
MSMMs •Direct Care •Primarily consumables •Regional
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Defense Medical Standardization Board (DMSB)
FHPC
ASD(HA)
DMSB Chair
F H P & R
DMSB Staff
Clinical SME Panels
Army Executive Agency Staff Principal: DSG
Defense Medical Standardization Board
24 May 2006
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ASD/Health Affairs Director/TMA
Deputy Director/ TMA
DASD (C&PP) CMO/TMA
Pharmacy Operations Directorate
Clinical Proponency Steering Committee
DoD P&T Committee
DoD Pharmacy Benefits Program
Army Executive Agency Staff Principal: DSG
Pharmacoeconomic Center (PEC)
DoD Pharmacy Board of Advisors
DMSB (Joint Deployment
Formulary)
Beneficiary Advisory Panel
Senior Military Medical Advisory Council
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Multi-Service Market Managers (MSMMs) ASD(HA)
Director/TMA TRICARE Advisory
Committee
TRICARE Regional Director
TRICARE Regional Director
TRICARE Regional Director
TRICARE Regional Directors (SES/Flag)
TRICARE Regional Advisory Committee TRICARE Regional Advisory Committee TRICARE Regional Advisory Committee TRICARE Regional Advisory Committees
TRICARE Regional Business Office
TRICARE Regional Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office Multi-service Market
Manager Tri-Service Regional Business Offices (9)
TRICARE Regional Business Office
TRICARE Regional Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office Multi-service Market
Manager Tri-Service Product
Review Boards
TRICARE Regional Business Office
TRICARE Regional Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office TRICARE Regional
Business Office Multi-service Market
Manager Clinical Product Teams
Multi-service Market Manager
Multi-service Market Manager
Multi-service Market Managers
Regional Logistics Support Program Authority Multi-service Market
Manager Multi-service Market
Manager Multi-service Market
Manager Multi-Service Market
Managers
Army Executive Agency Staff Principal: DSG
Senior Military Medical Advisory Council
Deputy Dir/TMA
Medical Logistics Proponency Committee
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24 May 2006
UNCLASSIFIED
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Tri-Service Regional Business Offices (TRBOs)
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24 May 2006
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*TRO North has 2 MSMMs and 3 TRBOs,
TRO South has 2 MSMMs and 2 TRBOs,
TRO West has 3 MSMMs and 3 TRBOs,
& CG, European Regional Medical Center has 1 TRBO
Standardization Program Relationships ASD/HA
Director/TMA
Deputy Dir /TMA
DASD(C&PP) CMO/TMA
TRICARE Reg Directors (3) (SES/Flag)
Clinical Proponency Steering Cte
DoD P&T Committee
Multi-Service Market
Managers*
TRICARE Overseas
Reg Offices (3)
TRO Deputy Director
Tri-Service Regional
Business Office
Tri-Service Product
Review Board
DASD(FHP&R) Deployment Hlth
Support/TMA
Force Health Protection
Council
DMSB
MLPC Tri-Service Regional
Business Office
Tri-Service Product
Review Board
Clinical Product Teams
Clinical Product Teams
Pharmacy Operations Directorate
PEC
DoD Pharmacy Board of Advisors
DMSB Staff Office
Clinical SME Product
Selection Panels
TRICARE Advisory
Committee
ESC: Combatant & Component Commanders
TRICARE Reg Advisory
Committees
Army Executive Agency Staff Principal: DSG
Beneficiary Advisory
Panel
Operational Forces Touch Points
Senior Military Medical Advisory
Council
Focal Points for Standardization
Key:
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24 May 2006
UNCLASSIFIED
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Program Methods: Similarities
• Clinical SME Panels • User preference in
conjunction with scientific evidence
• Market analysis • Executive (SES/Flag) review
Defense Medical Standardization Board
24 May 2006
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Program Methods: Differences
Program Focus of Standardization Efforts
DMSB Medical commodities (all categories) to meet operational compatibility and interoperability requirements
Pharmacy Benefits Program
Pharmaceuticals to provide uniform services and “best value” for beneficiaries of the MHS
MSMMs Medical materiel (primarily consumables) to provide “best value” products for the direct care system
Defense Medical Standardization Board
24 May 2006
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Program Methods: Differences
Operational Direct Care Purchased Care
Med/Surg Supplies DMSB MSMMs N/A
Equipment DMSB MSMMs N/A Pharmaceuticals DMSB Pharmacy
Benefits Program
Pharmacy Benefits Program
• Efforts are complimentary • Redundancies are avoided • Collaboration across programs is mutually beneficial
Defense Medical Standardization Board
24 May 2006
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Outcome Measures: DMSB
0
2000
4000
6000
8000
10000
12000
2002 2003 2004 2005 2006
Year
Num
ber o
f Uni
que
NSN
s
RX Products MCF (non-RX)
Medical Contingency File (MCF) Growth
Result of Cooperative
Standardization Effort
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Outcome Measures: Pharmacy Benefits Program
$551
$7
$65 $99
$139 $148 $168
$211
$514
$0
$100
$200
$300
$400
$500
$600
FY99 FY00 FY01 FY02 FY03 FY04 FY05
New Methodology to align with VA
Old Methodology $ M
illion
s
Source: DoD Pharmacoeconomic Center; Prime Vendor Data
MTF Cost Avoidance from Pharmaceutical Contracting or Other Incentive Agreements
Defense Medical Standardization Board
24 May 2006
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Outcome Measures: MSMMs
$0.00
$5,000,000.00
$10,000,000.00
$15,000,000.00
$20,000,000.00
FY00 FY01 FY02 FY03 FY04 FY05 FY06
Projected Cost Avoidance Actual Cost Avoidance
Program Cost Avoidance Projections and Actual Results from FY 2000 Forward
Source: TRISERVICE Regional Standardization Program Report 06 March 2006
Defense Medical Standardization Board
24 May 2006
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Future Direction • Institutionalize evidence-based, data driven
standardization processes • Increase collaboration across the spectrum
of medical materiel program activities – Visibility of program activities – Data sharing – Standardize processes and methodologies
• Improved standardization metrics • Emergence of an overarching integration or
coordination function at the DoD or Joint Services level
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Defense Medical Standardization Board
24 May 2006
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Backup Slides
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Multi-Service Market Manager (MSMM) & Regional Logistics Support Program Authority
(RLSPA) TRI-SERVICE REGIONAL BUSINESS OFFICE ALIGNMENT (TRBO), FY05/06
MSMM TRBO
CG, Walter Reed Army Medical Center TRBO, Walter Reed AMC
CDR, Portsmouth Naval Medical Center
TRBO, Portsmouth NMC TRBO, Wright Patterson AFB
CG, Eisenhower Army Medical Center TRBO, Eisenhower AMC
CG, Wilford Hall Medical Center (AF) TRBO, BAMC AMC
CG, Madigan Army Medical Center TRBO, Madigan AMC
CDR, San Diego Naval Medical Center
TRBO, San Diego NMC
CG, Tripler Army Medical Center TRBO, Tripler AMC
RLSPA TRBO
CG, European Regional Medical Command (Army)
TRBO, Europe (European Regional Medical Command)
Defense Medical Standardization Board
24 May 2006
UNCLASSIFIED
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Differences in Calculating Pharmaceutical Cost Avoidance
Market Price Without Contract
Old Methodology
New Methodology
Ave FSS Price
Ave Actual Market Price
Contract or Agreement Established
TIME
PRICE
Contract Price
Price discounts Companies give to gain business in DoD
Source: DoD Pharmacoeconomic Center
