Improving Trauma and Critical Care Proficiency and Readiness for Air Force Personnel in Critical Medical Specialties: A Pacific Air Forces Perspective.

Most U.S. Air Force medical personnel spend their time at military treatment facilities (MTFs) caring for patients whose ailments are far less complex or urgent than the severe trauma-related injuries they would see in war. This mismatch between peacetime and wartime medical care necessitates a deliberate effort on the part of the Air Force Medical Service (AFMS) as a whole and the Pacific Air Forces (PACAF) to ensure that personnel in critical medical specialties receive the training and hands-on clinical experience they need to save lives in a high-casualty environment. The goal of this research project was to investigate approaches for increasing readiness and proficiency. To develop a portfolio of readiness building activities, the authors analyzed manpower and personnel data, reviewed Comprehensive Medical Readiness Program (CMRP) checklists and relevant literature, engaged in discussions with the stakeholder community, and developed models of the assignment system and of skill acquisition and decay. They present their findings and recommendations for the future and have developed a prototype framework to demonstrate a possible method for deciding which readiness building activities and assignment policies to employ.

Washington's Medicaid Transformation Project: Engaging the health care and social service sectors to improve health care delivery and address the social determinants of health.

Across the US, states have initiated reforms to improve population health by coordinating efforts among health care stakeholders and addressing health-related social needs. Washington State's Medicaid Transformation Project (MTP), launched in 2017, seeks to achieve these goals by supporting the state's Accountable Communities of Health, independent organizations that convene and coordinate the health care and social service sectors in nine regions of the state. MTP places Medicaid funds in the hands of ACHs for the purpose of building health system capacity and carrying out health improvement projects. It includes new supports for aging, housing and employment, and substance use disorder treatment. Early lessons from MTP are emerging that can inform health system transformation efforts in other states. MTP demonstrates the advantages of creating new organizations to serve as regional conveners and coordinators. However, the introduction of new entities will require states to clearly articulate the varying roles of these entities and existing managed care organizations and state agencies. States will need to balance the tradeoffs of local control versus centralization. For example, it may be optimal to standardize electronic health information exchanges but allow organizations flexibility to adopt other interventions that match their local context. In addition, states should build treatment and comparison groups into their program designs in order to generate high-quality evidence about the impact of new health care delivery and payment models.

Addressing Social Determinants of Health through Medicaid: Lessons from Oregon.

States and policy makers have expressed a strong interest in using Medicaid to address social determinants of health (SDOH). While this approach holds promise for improving outcomes and reducing costs, using Medicaid to pay for services outside the medical system creates challenges. This article examines efforts to address SDOH in Oregon, which, as part of its 2012 Medicaid waiver, incorporated health-related services that lacked billing or encounter codes and were not included in Oregon's Medicaid state plan as a strategy to improve outcomes and control costs. We examine the varieties of health-related services that were used and describe the specific challenges in deploying and paying for these services. We conclude with lessons from Oregon that can help states and the federal government as they work to address SDOH.