In his final week as assistant secretary of defense for health affairs, Dr. Jonathan Woodson achieved, in part, an objective he'd sought for more than five years: a softening in Congress to the prospect of on raising health care fees for military families and retirees.
Woodson didn’t propose Tricare fee hikes every single budget cycle he was in office just to dig into the troops' wallets or make retirees angry, he told Military Times earlier this month. He did it, he said during an interview on April 13, to preserve a the military's health care system and position it to that would meet the challenges of war while "pivoting to the future."
"Sometimes," Woodson said, "when you create a vision that is over the horizon, people think you are crazy," Woodson said. "The key is to present that vision in increments so you can achieve your goals."
When Woodson steps down, effective Sunday, May 1, he will leave a military health system that looks largely the same as it did in 2010 — at least to the average patient. Military personnel continue to provide care to troops and beneficiaries in military facilities, and Tricare pays for community care.
But the system actually is vastly different. A new Defense Health Agency provides support services for the military medical commands. Health facilities in the largest military markets fall under regional umbrella organizations. And this year, Tricare will be consolidated into two regions, with more patients being reassigned to military hospitals and clinics for primary care.
Through the transformation, the private, soft-spoken Woodson, was a fierce change agent, colleagues say.
"The He is such a humble person, he’d just like to slip away to Boston, but the truth is, he ... helped guide us through some really challenging situations, helped us stand up this new military health system. He is an impactful leader," said Defense Health Agency director Navy Vice Adm. Raquel Bono April 12.
Some of Woodson's proposals — such as pushing military retirees under age 65 out of Tricare Prime and implementing rank-based fees for Tricare for Life users — collapsed under largely from pressure from by patients and military support organizations who wanted pushed for system improvements rather than higher costs.
Of his inability to get proposed Tricare fee hikes through Congress, Woodson said they were needed attempts to improve the overall system.
"Many years it was just about a budget drill and numbers," he admitted. "What I have been trying to do lately is add value. The Tricare patient pays one tenth of what the average family pays in the commercial market. It's a good product and now we want people to feel good about it."
In addition to standing up the 1,700-employee Defense Health Agency, which manages Tricare, pharmacy operations, medical training, education and other functions,Woodson reduced the geographic areas served by Tricare Prime, expanded the department's mail order pharmacy benefit to reduce prescription costs and oversaw the contract award for the Defense Department's electronic health record system after a decade-long effort to create a joint record with the Veterans Affairs Department.
He also helped hone the structure of the military medical system, steering away direction from the large combat field hospital system and to an expeditionary system that can deliver care to troops and civilians anywhere in the world.
"I needed to create a framework so that the talented men and women of the military health system could do their best work and pivot to the future so they are stronger, better and relevant in the future," Woodson said.
Responsible for a budget of $47.8 billion, Woodson said a top priority in office was to ensure that the top line didn't balloon to $70 billion by 2025 as predicted by budget watchers.
Woodson said he was able to contain costs through management controls and "getting lucky."
"We have moderated and worked very hard to put in management controls to rein in costs, and we still need to work hard to manage [them]," Woodson said.
Woodson leaves as Congress debates changes to the military health system in the fiscal 2017 defense policy bill.
After spending more than seven months studying Tricare reform, the House Armed Services Committee has proposed introducing health enrollment fees on new active duty troops and families after 2018 and raising rates for current personnel and retirees starting in 2020.
Making any of these changes, Woodson said, has not been easy.
"Really important jobs you feel good about come with great challenges. If it were easy, anybody could do it," he said.
He is expected to return to the private sector, where he previously served as associate dean for student diversity and multicultural affairs and associate professor of surgery at Boston University School of Medicine, and senior attending vascular surgeon at the Boston Medical Center.
He also plans to continue serving in the Army Reserve, where he holds the rank of brigadier general.
Army Surgeon General Lt. Gen. Nadja West said she looks forward to seeing Woodson continue to serve, in the Army, and as a private physician, helping the country and the "global community."
"I truly appreciate the opportunity to have served with Dr. Woodson and thank him for his years of dedicated service to our service members and their families. I know he will continue to do great things to advance healthcare," West said.
Air Force Surgeon General Lt. Gen. Mark Edger called Woodson's leadership in wartime and throughout the health system transformation "extraordinary."
"Under his leadership, new knowledge and innovation advanced our care for wounded, ill and injured service members. He led us to unprecedented collaboration in our health services that produced impressive efficiencies and a coordinated, productive system of performance management. We will miss Dr. Woodson," Edger said.
Patricia Kime covers military and veterans health care and medicine for Military Times. She can be reached at pkime@militarytimes.com.
Patricia Kime is a senior writer covering military and veterans health care, medicine and personnel issues.
