Department of Defense, Assistant Secretary of Defense (Health Affairs)

Department/Agency: Department of Defense

Position:

Assistant Secretary of Defense for Health Affairs

Executive Schedule: Executive Level IV - Presidential Appointment with Senate Confirmation

Major Responsibilities:

• The Pentagon’s top medical doctor
• Runs the Tricare program, which covers 9.2 million military and family members
• Sets medical health standards for enlistment and deployments
• Also oversees the Armed Forces Institute of Pathology and the Uniformed Services University of the Health Sciences.
• Develops Pentagon policies for health and medical programs, including clinical investigations, patient movement, quality assurance and training health professionals

Key Competencies and Preferred Qualifications:

• Physician 
• Broad experience in public health, pandemic and disaster medicine, and management 
• Familiarity with Pentagon budgeting procedures 
• Assistant Secretary of Defense for Health Affairs

Insight:

Problems with outpatient neglect and poor maintenance at Walter Reed Army Medical Center prompted a major shake-up in the office of the Assistant Secretary of Defense for Health Affairs in 2007. The Washington Post won a Pulitzer Prize for breaking the Walter Reed story.

Dr. S. Ward Casscells was appointed in the wake of the scandal. The U.S. Army Reserve colonel said during his confirmation hearing that his frustrating personal experience as a patient in the army’s health care system — he suffered an infected elbow wound during his tour in Iraq — would inform his strategy as assistant secretary. “If it's frustrating for a colonel, you can imagine how frustrating it is for a sergeant or corporal, particularly if they've had a head injury or their family is 1,000 miles away and can't be advocates for them….” he said. “We've got to fix that and make it fair and fast.”
He pledged to the Senate Armed Services Committee to streamline a military health care system bogged down by bureaucracy.

Cascells’ predecessor, Dr. William Winkenwerder, Jr.,  held the top health post at the Pentagon for nearly six years and presided over the decision to close Walter Reed Army Medical Center in Washington, D.C., and merge its operations into the National Naval Medical Center in Bethesda, Maryland, by 2011. A contract was let to build a $640 million hospital on the existing site in Bethesda, across from the National Institutes of Health, in March 2008. Cascells said then that the new Walter Reed National Military Medical Center “will be the crown jewel in an already illustrious military medical system.” Casscells has been applauded for his efforts to increase transparency within Pentagon health affairs, opening his office to more dialogue with armed services members and their families as well as the media. The DOD launched a resource line for “wounded warriors” in September 2008 to further facilitate communication. The next assistant secretary will also face the challenge of meeting the health needs of the growing numbers of soldiers returning from Iraq and Afghanistan with physical and mental traumas.

In addition to casualty care, the assistant secretary for health affairs oversees basic health care for the military and family members through TRICARE, the military’s HMO. Keeping this program affordable is key, Casscells told senators, because raising co-pays and deductibles “runs the risk of making it harder for us to recruit and retain the very best …. [P]eople value enormously the health care given in the military.”

Emphasis has shifted recently toward preventive care. Casscells said that promoting healthy habits not only saves money but ensures a pool of fit men and women for the armed services. The assistant secretary also has a voice in advocating for medical research, improved quality of care, and humanitarian aid efforts designed to lessen the possibility of international conflict.

Key Relationships – Within the Department or Agency:

Under Secretary of Defense for Personnel and Readiness
Director, TRICARE Management Activity
Defense Medical Standardization Board
Under Secretary of Defense (Comptroller)
Under Secretary of Defense for Policy
Under Secretary of Defense for Acquisition, Technology and Logistics
Chairman, Joint Chiefs of Staff

Key Relationships – Within the Government:

Congressional appropriations committees

Key Relationships – Outside the Government:

Medical educators and research community
Health care providers
Veterans groups Military families

Nomination Referred to:

Senate Committee on Armed Services

Current Position Profile:

1. Jonathan Woodson (Nominated: April 22, 2010). Woodson holds the rank of Brigadier General, United States Army, Reserve and has supported several Army Medical Department missions including Advanced Trauma Life Support Training (for active and reserve forces), military-civilian medical programs in Central America, and air medical evacuation missions in Central America.

Recent Position Profiles:

2. S. Ward Casscells III, M.D. (2007-    ). Cardiologist, former professor and vice president for biotechnology at the University of Texas Health Science Center in Houston. Former director of clinical research at the Texas Heart Institute. U.S. Army Reserve colonel who suffered a minor wound while on assignment in Iraq. 

3. William Winkenwerder, Jr., M.D. (2001-2007). Former senior executive for Blue Cross Blue Shield of Massachusetts and Prudential Healthcare.

4. J. Jarrett Clinton, M.D., M.P.H. (Acting Assistant Secretary, 2000-2001). Rear admiral in the Commissioned Corps of the U.S. Public Health Service. Former administrator, U.S. Agency for Health Care Policy and Research.