Optimizing Healthcare for a Maritime Force


C&CC magazine sat down with RDML Pecha in order to give readers insights into how USMC Health Services views it challenges for the present and future.

Though significantly smaller than the Army, RDML Pecha reminds us the Marine Corps is nevertheless an important expeditionary force always prepared to be sent abroad on short notice for combat operations, and as such faces its own battlefield medicine challenges. Like other services, the USMC must also address trials on the home front. To this end, the admiral also discusses the continued health and healing of garrisoned Marines and Wounded Warriors and the programs—some of which are in partnership with civilians his office is working on to improve their lives.

RDML Pecha was interviewed by C&CC Editor Kevin Hunter.

C&CC: Please talk about your role as USMC Medical Officer, HQ USMC Health Services.

RDML Pecha: The Medical Officer of the Marine Corps is informally known as “TMO.” It’s a great position, not only for me, but for any of those asked to fill the role because it requires regular interaction with top Marine leaders. There’s just something different and exciting about watching leaders of Marines go about their business, a certain esprit, a certain ethos. So for me, it’s a real privilege.

At the same time, it’s a real challenge because as a Navy medical officer I work closely with BUMED and my Navy colleagues. Unlike the Marine Corps, where essentially all the physician positions have a direct operational component, BUMED has the huge task of operating and managing a worldwide hospital system. That’s a very different mindset and it requires a different skill set and lot of business acumen. So I’m working every day in two cultures. And today, with the standup of the new Defense Health Agency, there’s even more complexity.

My role essentially is to act as the advisor to the Commandant and the Assistant Commandant on any and all issues related to the health care of the force. I represent the Marine Corps to BUMED and to the DHA. I assist in developing policies related to the provision of care for the operating forces. I oversee the very skilled action officers in the Health Services department here at Marine Corps Headquarters as they deal with daily issues and with the long-term projects we’re working.

We’re trying to develop robust military-civilian partnerships to ensure Marines and sailors receive not only the best care but also experience the best quality of life during their treatment, regardless of whether it resides inside or out of the DoD healthcare system.

C&CC: Please discuss USMC Health Services’ background, mission, and role as part of the USMC medical and greater DoD medical community.

RDML Pecha: The Marine Corps is “America’s Expeditionary Force in Readiness.” Health Service Support to this expeditionary force is made up of: Corpsmen (5,735), Medical Corps (315), Medical Service Corps (248), and Nurse Corps (20). We provide organic health service support and force health protection to Marines wherever they’re engaged. Whether in garrison, forward-deployed, or forward-engaged, Navy medical profession[al]s, officer and enlisted, are directly involved in supporting the warfighters as they respond to all manner of crises and contingencies.

Our primary focus is on ensuring world-class care to Marines and sailors, no matter where they may be. That entails providing the best trained and equipped medical personnel to Marine units in increasingly complex environments, finding and retaining men and women with diverse backgrounds, cultures, and skills while implementing new capabilities that enhance our effectiveness.

C&CC: What are some of the primary advances that are helping USMC HQ HS address the needs of Marine Corps patients at home and in facilities worldwide?

RDML Pecha: Our biggest initiative from the individual warfighter’s perspective is the rollout of Marine-Centered Medical Home (MCMH). This is a joint BUMED/USMC effort to improve the delivery of care to the operational forces in garrison and was launched in January 2013 in a pilot program. Following a patient-centered concept, the program has already demonstrably improved access to and quality of care delivered by the organic Health Service Support assets of the USMC. For example, the 5th Marine Regiment was able to decrease the number of Marines on [limited duty] by 70 percent through the improved coordination provided by their robust medical home capabilities.

The program delivers enhanced staffing, for example adding billets for clinical nurses, clerks, care coordinators, and embedded behavioral health providers. At the same time, we’re improving the environment of care, to get out of the old battalion aid station model and into modern clinical facilities. Marines enrolled in one of our MCMH’s can now access medical care from their aid station 24/7 via phone, secure email messaging, or in person. We’re looking to expand MCMH over the next five years to the entirety of Marine Corps operational forces; this year we’re working to open sixteen more sites.

C&CC: How is USMC HQ HS working to promote partnering with industry in delivering more effective and efficient know-how to the DoD medical community?

RDML Pecha: “Keeping faith” with healthy Marines, Wounded Warriors, and their families is of paramount importance to both Marine Corps and Navy Medicine leadership. In order to provide the finest care and support for them today and in the future, we need to leverage cutting edge medical research. Health Services and Navy Medicine have partnered with top educational institutions such as UCLA, Johns Hopkins University, Wake Forest, Cleveland Clinic, Rutgers, and the University of Pittsburgh. Together, we’re looking for ways to provide today’s Wounded Warriors with the best care possible, while ensuring tomorrow’s injured receive better care—and faster care—before and after injury.

We live in austere fiscal times for the DoD. Caring for catastrophic injuries like amputations, burns, and genitourinary trauma is not only costly, it can be highly specialized. So we’re trying to develop robust military-civilian partnerships to ensure Marines and sailors receive not only the best care but also experience the best quality of life during their treatment, regardless of whether it resides inside or out of the DoD healthcare system. Creating lines of communication with the business and academic worlds is essential.

C&CC: How are you addressing challenges regarding lessons learned on today’s asymmetric battlefields?

RDML Pecha: You’re right that the battlefield of today is different in many ways from those of previous conflicts. We’ve had to adapt to different injury patterns and we’ve worked to incorporate advances in trauma care right up to the point of injury.

The signature injury of these conflicts, mild Traumatic Brain Injury (mTBI) associated with IEDs, has required new ways to integrate medical knowledge with mission readiness and follow on care and rehabilitation. In addition, this kind of cooperation is leading to major advances in [protective equipment]—for example, Kevlar undergarments. So the whole way we deliver medical care in the operational setting needs to adapt, and the Pivot to the Pacific is going to require new ways of looking at this as well. Most of the knowledge gained is a capability that will be invaluable regardless of whether the threat is asymmetric or conventional.

It’s critical to preserve the lessons learned throughout these conflicts, but it’s equally important to keep the processes of extracting those lessons quickly and disseminating them to the field. It’s a daunting task, but we’re convinced that pushing the bar higher will save lives.

What USMC Health Services Does

New HS Logo

While not all-inclusive, Health Services currently supports deployments worldwide for Medical Contingency/Stability Operations (MCO/MSO), Stability, Security, Transition, and Reconstruction Operations (SSTRO), Humanitarian Assistance/Disaster Relief (HA/DR), Detainee operations, and Homeland Defense/Homeland Security  (HLD/HLS). In addition to enhancing interoperability with naval, joint and coalition partners, Health Services is also engaged in leveraging the capabilities of government agencies and non-governmental organizations (NGOs)/private voluntary organizations (PVOs). USMC Health Services is also involved in informing Congressional & DoD requirements to improve force protection, health surveillance, and casualty care through the Quadrennial Defense Review (QDR) and its Medical Readiness Review (MRR), as well as in the drafting of Service-specific guidance and instructions

C&CC: Feel free to discuss any accomplishments or objectives USMC HQ HS has achieved or is working to bring to fruition.

RDML Pecha: In 2013, we conducted a comprehensive Poly- Pharmacy Quality Assurance initiative to look at the care provided to Marines on three or more chronic medications. We focused on narcotic and psychotropic medications. We learned that less than 0.65 percent of the force are on three or more of these medications, and that the affected patients’ unit Medical Officers were aware of the individuals and were tracking them appropriately. For 2014, we’re going to be focusing on referral tracking from the deployment health assessment program.

We’re working with the Naval Health Research Center to use their Expeditionary Medical Encounter Database to enhance patient care, inform and improve services, and to allow for a ready database for research. For similar reasons, DoD is partnering with the [Department of Veterans Affairs] to develop a registry of all military personnel diagnosed with TBI and/or PTSD, in order to hopefully better inform care from diagnosis through separation/retirement and beyond.

We’ve worked closely with the Navy’s Bureau of Medicine and with the Intrepid Fallen Heroes Foundation to establish satellite National Institute Center of Excellence for TBI and Psychological Health on Camp Pendleton and Camp Lejeune. These centers provide state-of-the-art comprehensive diagnostic and rehabilitative care capabilities for Marines with chronic TBI or PTSD. These satellites also provide resource information and real time support to Marine Corps Health Service Support assets in theater or garrison.