Prior to the conference, leaders were personally interviewed and asked to better define their hopes and expectations, to document their perception of integration successes and challenges, and to better describe leadership options needed to insure a successful integration of this complex health delivery system. These interviews identified unresolved issues related to NCA integration. Key issues included perceived cultural differences, lack of trust, and diverging mission objectives.

Once these perceptions were identified and discussed, the group defined important missions and developed a synchronized integration campaign plan. A more coordinated approach to multiple defined missions was identified as a key to successful integration. The attendees recognized that inpatient and ambulatory surgery centers would be staffed with Tri-service personnel. In addition, all medical treatment facilities (MTFs) will play a proportionate role in completion of these regional missions.

Health-care services including primary care, specialty care, and subspecialty care must be performed to some degree at each of the MTFs. Veterans Health Administration (VHA) and civilian health-care partnerships will have a role in contributing to the success of this NCA mission. Initial Combat Casualty Care in the region will be centered at the Walter Reed National Military Medical Center (WRNMMC) with evacuation through the 79th Medical Group. Follow-on care may be provided by other military and VHA facilities.

Health Professions Education (HPE) remains a key mission and will include undergraduate and graduate levels of education, continuing education, and enlisted technical training. A major portion of the education programs will be performed at the WRNMMC and at USU. However, educational opportunities and assets will be available at other military facilities and in civilian health system. Biomedical research remains a top priority in support of Force Health Protection and HPE requirements. The plan is to utilize assets in our MTFs and at USU, as well as improve collaboration with other biomedical research institutions such as the Medical Research and Material Commands, National Institutes of Health, National Cancer Institute, National Rehabilitation Hospital, and the VHA.

Military medical readiness missions will be distributed across the region. The majority of the readiness mission platform assignments will be located at the larger inpatient and ambulatory treatment facilities. However, smaller facilities will also play a role in meeting the readiness missions.

The attendees developed a multi-pronged campaign plan that stressed the need for greater coordination and synchronization of the integration effort. It was announced that a senior medical flag officer, who will report to the Deputy Secretary of Defense, will be named as the Joint Task Force Commander for the NCA. This officer will oversee implementation of the BRAC Business Plan, related MILCON projects, the integration processes, and execute a level of authority over all personnel assigned to the MTFs in the NCA. Nominations from each of the Services have already been submitted and a selection process is underway to identify the appropriate officer. This process should be completed by the end of the summer.

At the end of the conference the campaign plan was briefed to senior leadership of the DoD Military Health System, including the three Surgeons General and Dr. Ward Casscells, the Assistant Secretary of Defense for Health Affairs. Conference accomplishments were stressed. he NCA Flag Group spoke in one voice and supported a well- articulated plan to ensure integration success. Broader inclusion and increased transparency were viewed as major keys in developing a Tri-Service Integrated Healthcare Delivery System. The system and all integration efforts must draw upon the strengths of all three services and USU to achieve the vision of world class patient care, renowned health professions education, and relevant biomedical and clinical research.

Another larger conference is planned for early October and will include much broader subject matter expertise and market participation. The goal of this conference is to reinforce coordination and synchronization efforts across the entire NCA MHS.