Thinking outside the box can be an overused cliché. It just can. But when the COVID-19 pandemic hit the United States in early 2020 and the President of the United States declared COVID-19 a national emergency on March 23, thinking outside of the box is just what was needed. Planning that originated in January 2020 with the Military Health System and the Defense Health Agency turned to action as the enterprise executed their crisis medical planning for the entire department. Now, it was the MHS and the DHA that became the center of gravity in responding to this attack to provide the best health care services and information to their beneficiaries throughout this crisis.
When a medical crisis hits in the Department of Defense, the Military Health System is called upon to lead the attack and defeat this invisible enemy. There were numerous initiatives developed over the course of the COVID-19 pandemic including expanded capabilities in telehealth and telemedicine, the establishment of a COVID-19 Registry, the consolidation of all Military Medical Treatment Facility websites into a standardized product for consistent messaging, the establishment of the DHA Appointing Tool which allowed beneficiaries to self-book their COVID-19 vaccine appointments, and the establishment and execution of the DHA’s first Operational Planning Team designed to manage, distribute and track the distribution of the COVID-19 vaccine. These are just a sample of the initiatives developed over the course of the pandemic.
The area of Pharmaceutical Operations was no different. On March 31, 2020, all medical and dental facilities across the MHS enterprise postponed their medical and dental elective procedures for an extended period of time for all their beneficiaries. This policy was designed to meet three main objectives during the COVID-19 pandemic: first, to enhance the safety of military medical staff; second, to prolong supplies of personal protective equipment and ensure its availability for emergency use; and finally, to ensure the military medical staff is available to provide care related to the pandemic.
“One of the things that the DHA is really trying to do outside of standardization is to implement leading practices in medicine,” stated Colonel (RET) Marcus Gmehlin, former DHA Chief of Pharmacy who was instrumental in pharmaceutical innovations in the first two years of the COVID-19 pandemic. It was at that moment when the DHA Pharmaceutical team began their own innovations for the MHS. The pharmacy division maintains a $9.7 billion dollar program with 56,000 retail pharmacies in the network, a global multi-billion-dollar mail order contract and 770 brick and mortar dispensing locations within the military treatment facility system. To execute this mission, there must be maximum access to the patients. “Once the pandemic hit, our biggest challenge was ensuring access for beneficiaries to get the pharmaceuticals they needed,” said Gmehlin.
With the dental clinics closed, an idea surfaced to use the dental clinicians to assist with newly established “drive-thru” pharmacy clinics. While not a new practice in the commercial world, this was a new concept for the MTF’s and became a huge success story enabling the beneficiaries to access needed pharmaceutical products and services. While the drive-thru pharmacy system was a success story, in reality it was not resource sustainable once full medical and
dental operations opened back up in the MTF’s. Thus became the birth of the remote pharmacy check-in system. “Instead of physically going to the pharmacy, pulling the ticket, and waiting to be called, now you can enter your DoD ID number and receive a text when your prescription is ready,” said Gmehlin. “This saves the patient time and proves to be efficient and effective. Our goal is to standardize this across the entire DHA worldwide.”
The DHA Pharmacy Division was responsible for other initiatives developed during COVID-19. The establishment of dedicated Script Centers, an Amazon-style locker installed at MTF’s, enables a patient to choose a specific pick-up point for their prescriptions. Plans are in development to have these script centers installed at post and base exchanges in the future. This initiative is beneficiary focused to meet their demanding schedules and avoid waiting in line at a pharmacy.
These examples are just the tip of the iceberg of the numerous innovations and creative programs initiated by the DHA during the pandemic. “As we strive for standardization across all our medical services and programs, we must consistently innovate to ensure we provide the best possible services to our beneficiaries,” said Gmehlin. “They expect it, and quite frankly, that is our charge...to be the best in the business.”
Written by:
Colonel (RET) Richard H. Breen, Jr., United States Army
Colonel (RET) Marcus Gmehlin, United States Air Force