By Ken Yale, Senior Advisor, Health Strategy, Technology and Innovation, Department of Defense, (former CEO, TRICARE Health Plan)

April 2024 – It was a sunny California morning, returning home from dropping the kids off at school, when I got the call, “your security background check cleared, and drug test results are in, you’re good to go.” It was just a formality in the process required by the Department of Defense, allowing me to lend my decade of experience developing and launching healthcare innovations in Silicon Valley to modernize the TRICARE Health Plan. TRICARE, the program serving 9.6 million active-duty military personnel, retirees, and their families, had not seen major changes for over a decade and we estimated my work would take 3 to 6 months. That call was Friday morning, March 13th in 2020 and by the next Monday everything would change.

The month of March 2020 will forever be etched in our minds, not only as the beginning of the pandemic that took so many lives, but also the start of new ways to view, structure, and interact with the healthcare system. As much as things changed, however, some stayed the same and even got worse, for example: the continued increases in health costs, staffing shortages and problems with access to care, delays in preventative care and a huge rebound in chronic illness, and concerns about the quality of services. The pandemic amplified the gaps and shortcomings of our healthcare system, and in many ways changed our thinking about healthcare delivery and finance.

March 2020 was also the beginning of the next chapter in my career, transforming one of the largest government healthcare programs during a pandemic. Instead of the advertised 3 to 6 months, it went on for three years and would expand to include modernizing the entire military hospital and clinic systems and reorganizing the Defense Health Agency (DHA). By the end of the second year the pandemic was over. We not only transformed the TRICARE Health Plan by instilling a wide range of commercial healthcare innovations, we also overhauled the Strategic Plan as the pandemic fundamentally changed health care delivery.

Today we’re pivoting to stabilize the entire Military Health System – more than 50 hospitals and health systems and hundreds of clinics. The largest, including Walter Reed National Military Medical Center, Joint Base San Antonio (Wilford Hall Air Force and Brooke Army Medical Centers) and Balboa Naval Medical Center, are resource intensive tertiary care health systems with major roles in Military Medicine. Many of the other hospitals and clinics are like community or rural hospitals that struggle to operate in a resource constrained environment – reflecting the current US healthcare ecosystem, with staffing shortages, increases in operating costs, and hospitals going out of business. To modernize this entire system would require new thinking and entirely new ways of doing business.

To begin, in 2023 we overhauled our DHA Strategic Plan. The new plan’s central themes are to optimize healthcare delivery in this new paradigm, leverage technology to improve patient and physician experiences, and create an integrated delivery system. To execute on the new strategy we stood up an Innovation Accelerator (see Accelerate! By John P. Kotter ; also What Sets Successful Startup Accelerators Apart.

Next we performed an assessment (“as is”) and envisioned our goals and objectives (“to be”). We found what most hospitals in the United States have come to acknowledge: legacy business and administrative processes from the previous century and clinical protocols and processes designed to maximize payment by procedure and volume, all working for an electronic medical record system (required under government “meaningful use” requirements) rather than having the technology work for clinicians and patients.

The work continues into 2024 and beyond. What comes next is large scale Business Model Transformation and instilling modern digital health technologies. To accomplish this, we are undertaking business and clinical process redesign at five venture sites. This is a major undertaking, requiring a detailed understanding of both physician and patient journeys through the hospitals, and then changing all our processes to optimize productivity and physician and patient experiences. Finally, we’re developing strategies to guide adoption of digital health technologies and harness artificial intelligence and machine learning to improve both clinical and administrative operations.

In March this year we launched a Digital Front Door called My Military Health to accelerate adoption for our 9.6 million members. And on April 19, 2024 we issued a “Commercial Solutions Offering” for an end-to-end Digital Health Solution to power the Business Model Transformation. The Digital Health Solution will improve Patient Experience, Provider Practice, and mine our new Data Lake for actionable information. Some of the capabilities we seek are reality today, while others are aspirational – nevertheless we are determined to transform our healthcare delivery system by making it Patient-Centered and Competitive in the marketplace.

The pandemic was an inflection point for all of us. It amplified the problems in financing and delivering healthcare and stretched our hospitals to the breaking point, yet it also has provided a unique opportunity to find what is wrong with our healthcare system and fix it. We are just at the beginning of this long journey, and for the benefit of our clinicians and patients, it is a journey well worth taking, as we have begun at the Department of Defense.

About the Author

Dr. Yale is a senior healthcare executive with a track record of accomplishments in commercial health insurance and government sponsored health programs. Recently he led innovations of the TRICARE Health Plan, and is currently working on business model transformation of the military medical hospitals and clinics, and executing a digital health strategy and Digital Front Door virtual care platform. Previously he led development of value-based products and services, and implements AI and advanced analytics using his legal, clinical, and data analytics expertise.

Prior to his current work, Dr. Yale was Chief Clinical Officer at Delta Insurance Company, VP of Clinical Solutions and Medical Director at Aetna (now CVS Health), Chief Executive at UnitedHealth Group Innovation Incubator, Senior VP at Matria Healthcare and CorSolutions; General Counsel at UL Solutions (former EduNeering); and Founder/CEO of Advanced Health Solutions. Early in his career, Dr. Yale was Special Assistant and Director of the White House Domestic Policy Council, and Chief of Staff, White House Office of Science and Technology.

Dr. Yale provides leadership and active participation in: Stanford School of Medicine; National Academies of Medicine Leadership Consortium, Digital and Data Architecture Workgroup; Coalition for Healthcare Artificial Intelligence (CHAi); the American Medical Informatics Association, and the Healthcare Information and Management Systems Society. Dr. Yale received a BA in Sociology and Population Statistics, a DDS in Dentistry, a JD in Law, Science and Medicine, and a Data Science Certificate. He is a frequent writer and speaker on technology and regulatory topics, and author of several books on healthcare, technology, and data science.