[inaudible] assistant secretary of defense for health affairs. Nd director of the health agencies. And Program Executive officer of Defense Health care and systems. T today, we have serious questions on how medical reforms have been accounted for in the president s budget for fiscal year 2021. We will have ce, members coming in and out. E are getting briefings on coindividual 19 covid19 as and there are other meetings going on but your full testimony is available. Last members had it night, like i did, to read through it. So well get started. Spectrum in the military Health Care System to benefit care, in many cases the justifications lacks adequate detail for the subcommittee to make informed decisions. And an update on the electronic system, m. S. H. Genesis. We look forward to hearing about these topics and more. To thank you for appearing before the subcommittee and now i want to recognize our distinguished mr. Calvert, for his comments. Mr. Calvert thank you, madam chairman. Thank you for referring to this horrible disease as covid19. From corona, california. I want to make sure we call it is. Hat it ms. Mccollum i did it for you. Mr. Calvert i thank you very much. To welcome the distinguished panel. This is critical for the military Health Care System. E are trying to keep the covid19 virus from impacting readiness while going through significant structural changes to the system. Include Treatment Facilities and consolidating shifting ities and other specialties to focus on readiness all while continuing to implement a new Electronic Health medical system. On your you have plate. Given these issues will impact the broad population to include personnel, dependents and retirees, i cant overstate importance of keeping us apprise of your progress and inform us when you need help. Must insure that health and safety are not adversely as a result of these structural changes. During my time, ill ask you to of these issues, starting with your preparedness and resourcing for covid19. The impact it has gloiblly and ill be globally your ll be interested in plans to mitigate on the force. Ill ask your views on the changes to the military Health Care System and their potential impact on readiness. Finally, i look forward to hearing about the progress on mplementing the new Electronic Health record. Thank you for your service. I look forward to your testimony. Chairman, i dam yield back. Ms. Mccollum thank you. Rs. Lowey and ms. Granger are helping to be joining hoping to be joining us and well break for any statements they wish to arrive. En they as i said earlier, your full written testimony will be placed n the record, and members have copies at their seats and i told read you i was rifted rifbetted reading riveted reading last night. N the interest of time, however, i encourage each one of you to keep your summarized tatement to three minutes or less. And i will let you know when youre at three minutes. I will do so gently. It might get a little louder with the gavel. Dingell, ant general off . He le will you lead us you, l dingell thank chair mccollum, Ranking Member, its an honor to speak to you today. He army is called upon to win ars its part of a joint force thats represented before you today. The chief staff of the army says winning matters because there is no second place combat. I and everyone in Army Medicine recognize the strength of our rely on our people, our soldiers, their families, and my vision s for life for Army Medicine is to make we remain ready, responsive and is complexity, change and uncertainty. Whether the support of multidomain operations, pandemic emergencies. Army undergoes modernization to support the multidomain battlefield, we will lead through change. We organize to remain relevant and responsive to the war fighter. Owever, our unwavered commitment to save lives on the battlefield will never change. Oured adversaries may have robust antiaccess and area will capabilities that test our ability to provide prolonged field care. Will uently, our medics as yustere ain life in locations. To remain relevant, we must leverage 21st Century Digital technologies along with Edge Research and development in order to remain proficient. Army medicines is assisting in prevens, deterrence, detection, and treatment of infectious diseases. Ebola to h. I. V. And the responses, Army Medicine is working with leading agencies to combat tions covid19. To medicines ability detect, weedetect ill have an enable and ready force. In closing, i want to thank the committee for allowing my colleagues and i to speak before this morning. America entrusts the military Health System, Army Medicine, services with this most precious resources, our sons and daughters. It is imperative that we get it right and we will. Ment and it sdwrment continued commitment and means we will rt be there ready to respond because Army Medicine is army strong. I look forward to answering your questions. Ms. Mccollum sir, that was timing. D with precision gillingham. Rear admiral beginningham on of the over 60,000 of men part of the have tare Navy Medicine team, mission of is linked to those we serve, the United States navy and the United States marine corps. Prevail across the military operations depends on their medical readiness and capability to enhance their survival on the highend fight. T its core, survivability is Navy Medicines contribution to lethality. To this end, our one navy is the people,ty platforms, performance and power. Meet gically aligned to these impair tiffs. Welltrained people working at ohesive teams on optimized platforms demonstrating high velocity performance that will proje power in support of navy superiority. I can tell you these priorities hold. Pidly taking on any given day, Navy Personnel deployed and are part of resuscitation, surgery teams, trauma care at unit ltinational medical in kandahar airfield, afghanistan, humanitarian aboard our hospital ships, and force help protection world. The theres no doubt that people are the epicenter of everything we do. Active and reserve, civilia civilians and in order to recruit, his we must retain the workforce. Focusedicine continues to specialties uding as well as Mental Health care providers. Mportantly, we are embedding 29 of our Mental Health providers directly with fleet, force, and training commands to improve access to stigma. To help reduce all of us haa responsibility to s have a responsibility to reduce suicide. The impact is devastating and commands. Ipmates and ollectively, substand the National Defense authorization act catalyzed our efforts to integrated system of readiness and help. Navy and marine corps leadership tremendous e opportunity we have to refocus transitioning le medicine. E m. H. S. Reform presents us with both challenges and opportunities. Progress made to date, however, all of us ecognize theres much work ahead. In summary, the nation depends on our unique medical expertise and support our naval forces. Again, thank you for your leadership. I look forward to your questions. You. Ccollum thank Lieutenant General hawk, please. Vice chairwoman mccollum, distinguished members of the ubcommittee, its my distinct honor to testify on behalf of guard, 00 active duty reserve, civilian airmen who comprise the air force medical service. Abroad, air force mettics answer the call medics answer the call across Disaster Response missions. From the clinic to the battlefield and even the back of airplane, our ability to deliver Life Sustaining care is in the challenging most challenging environments ensures that our warriors return families. Eir the air force medical service mediciney of aerospace and evacuation focuses on the need of air and Space Operators maintainers. Since september 11, air force air medical evacuation crews conducted more than 340,000 Global Patient movements, 13,500 Critical Care missions. Environment, d roughly 30 of downrange care is trauma related and the remaining is disease, nonbattle injuries. Hese injuries range from occupational, dental, muscular injuries. Ur training mirrors these scenarios to have wellrounded, work le medics who can under different conditions. As the National Defense strategy conflict and pure competition, the air force will lethality, realign areas. We will invest in our air edical evacuation platforms, ground surgical teams, and broadening every medics skill set. To deliver here in environments where we may not of functionle airfields or saith of ttateof equipment. Young medical te technician, drives home the last point. Airman mitchell was n her first deployment when alshabaab killed three americans. She ned by the chaos, assumed the role of lead medic, working hours triaging, with limited personnel and supplies, she operated well bove her pay grade and outside her comfort zone to save lives. Airman mitchell demonstrates the of what makes our medics critical. As the surgeon general, my responsibility is to prepare medic to do what airman mitchell did, and i do not take this task lightly. Facilities atment remain our primary readiness platform. Of times falls short offering patient volume, diversity and acuity needed to currency. Inical leveraging additional training opportunities through civilian and Government Health is paramount and will inevitably grow as we system. The health care military medicine presents unique challenges that a civilian Health Care System does encounter. Our medics will continue to rise to those challenges. Thank you for your continued i look forward to your questions. Mccollum thank you. Lieutenant general. Vice chairwoman mccollum, Ranking Member calvert, members committee, thanks for the opportunity. To my d a few comments colleagues. Our mission is readiness. Here are two distinct responsibilities. First to ensure that every person in uniform is medically job to perform their anywhere in the world. Second is to ensure our military the al personnel have cognitive and Technical Skills to perform military operations leaders may call on us to perform. The agency is accountable to the secretary of defense, onorable mccaffrey, the combatant commands. They assume responsibility for managing all military hospitals United States the in october of last year. Working closely with my we continue to view our medical facilities as eadiness platforms where medical professionals from the army, navy, air force both obtain and sustain their skills. These professionals deploy in support of military operations. Leaderships recent assessment of which medical facilities best support this eadiness mission provides the basis for moving forward in implementing these decisions. We intend to excuse this plan in ensures our patients continue to have timely quality medical care. Ill highlight a few important points. First, active duty family who are required to transition to civilian network roviders will incur little to no additional outofpocket costs for their care. Econd, all beneficiaries in these locations will still enjoy access to the m. T. F. Pharmacy. Implement changes in a deliberate fashion at a markets l health care can handle. If it is more constrained than reassess our well plans and potentially adjust them. The Surgeon Generals and i are proposed reduction are iform personnel coordinated. By thenization, required ndaa is due to congress in june. Ell ensure we are using the resources provided by congress in a manner that most effectively supports our readiness mission. Have established four Health Care Markets in specific regions country. Well be establishing additional markets throughout the year. Authority l have the and responsibility to allocate resources in a way that improves atient care and our readiness functions. Im grateful for the opportunity to provide further detail on our military standardize medical support to combat and commands, the military departments, and to our patients. Thank you to the members of this committee for your commitment to the men and women of our armed forces and the families who them. T fferty. Ollum mr. Calf mr. Caffertr area on behalf of defense, its of an honor to speak before you oday representing the military Health System who support our war fighters and care for the that llion beneficiaries our system services. Im pleased to present to you to budget for health iscal year 2021, a budget that prioritizes the midcal readiness of our military force and their force ss of the medical while sustaining access to b ity health care for our beneficiaries. Mr. Mccaffery we request 33. 3 health for the defense program. This proposed budget continues implementation of a number of comprehensive reforms to our by th system as directed congress and department leadership. Some of the significant reforms re the following consolidated administration and management of our military the tals and clinics under Defense Health agency. Right sizing our military to focus frastructure on readiness within our direct care system and finally, the size and composition of the military our al force to best meet readiness mission. In implementing these reforms, he department is guided by two critical principles. First, that our military clinics are first and foremost military facilities hose operations need to be focused on meeting military readiness requirements. That our m. T. F. s serve as the primary platform by Service Members are trained and deployed. M. T. F. s are our utilized as training platforms medicalble our military personnel to acquire and maintain the Clinical Skills for deploymentem and support of combat operations. The d, that as we reform military Health System we continue to make good on our commitment to provide our with access to Quality Health care. While we implement these changes Health System, we also continue to pursue our other initiatives that have contributed to the achievement of the highest battlefield urvival rates in history while providing World Class Health care to our millions of beneficiaries. Hat includes our continued deployment of our Electronic Health record and our ongoing cutting edge ur research and development programs, which congress and his committee have long championed. That work in that area is playing a significant role in of the whole of government effort on the covid19 issue. Thank the committee for your continued support of these efforts and to the men and health the military system and the millions depending on us. Us support has helped achieve and continue to drive forward unpair littled success and sustaining a military Health System that elivers for our Service Members, our beneficiaries and our nation. You. Ms. Mccollum thank you. Vice chairwoman mccollum, Ranking Member calvert, distinguished members of the subcommittee, thank you for your invitation. The Program Executive office Defense HealthCare Management systems, also as the peodhms. We will have a common Electronic Health system for service and their terans, families. Critical data on the battlefield to documenting karat military and veteran medical facilities, we the patient is our f focus. Our patientcentered model Broad Spectrum of eople who depend on m. H. S. Genesis. Systems do not create success. People do. We depend on the hard work of and our s, engineers, business professionals who our genesis team. To thank them for their support. Completeder, 2019, we trafficriestrafficries without issues. The medical staff at Travis Air Force base demonstrated genesis on n m. H. S. Day one when the patient arrived t the emergency room in sudden cardiac arrest two hours before the go live, the team had a choice. Genesis and h. S. That was the right decision. With every deployment, we hone ur process and improve capability delivery. For instance, establishing peertopeer training successful, so much so that we a workshop as we continued deployments. N summer, genesis will go to wade ellis. As we move forward we seek to process while ur meeting the unique needs of each site in order to optimize enterprise. The we have proven that it improves the patient experience. Nytime we can enhance patient care, we absolutely should. As part of that process, we will ontinue to assess risks and ensure fiscal stewardship making every dollar count. Making every dollar count is optimizing efficiencies. For example, within the next few months, we will launch a joint Health Information exchange with expanding d. O. D. Onnections with private Sector Health care providers. I am trul