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March News From MOAA

Dateline: 3/15/2017

New VA Secretary Hits the Ground Running

Dr. David Shulkin was sworn in as the ninth secretary of Department of Veterans Affairs after receiving unanimous approval from the Senate.

MOAA was pleased to see Shulkin installed and ready to get on with the major business at hand, including continued implementation of many of the initiatives he pursued as the former undersecretary of the Veterans Health Administration (VHA).

“It's comforting to see that even in a highly politicized environment like we're currently in, the Senate can put aside partisan differences to focus on veterans and their needs,” said Cmdr. René Campos, USN (Ret), director of veterans and wounded warrior care for MOAA's Government Relations Department.


The new secretary has a tough road ahead of him, though, balancing the often competing priorities of Congress, the White House, his own agency, and the American public as well as the veterans he is committed to serving.


His first major action must be to work with lawmakers to extend the Choice Act, legislation allowing qualified veterans to receive care in the private sector. Under current law, the program is set to expire this August.


Extending the Veterans Choice Program (VCP) would also allow the VA time to put in place a new program to meet the rising demand for veterans' health care brought about since the VCP was established in 2014.


The Choice Act was Congress' answer to the reports of secret wait lists in the Phoenix VA Health Care system in Arizona. With only 90 days to implement what was initially a temporary program, the VHA had to establish a massive contracting effort to expand delivery of health care to veterans through an integrated network of civilian providers until the VA could address the demand within its own system.


Though initially plagued with problems, over time the VA and Congress implemented laws and adjusted policies to make it easier for veterans to access care through the VCP.


Today, more than 1 million veterans have been able to access care thanks to the Choice Act.


While Congress determines the next steps for the VCP, the VA also has taken lessons from implementing the program to create a new community care program.


MOAA and other veterans service organizations (VSOs) have worked closely with the VA over the years to ensure the veteran's perspective is considered during the VA's transformation.


On Friday, VSOs received another quarterly update from the VA's community care team, this time on how the VA will deliver pharmacy benefits, manage appointments, and pay civilian providers under a new community care contract.


MOAA will provide more details on the new program once the contract has been announced.


Secretary Shulkin also will appear before the House Veterans' Affairs Committee on March 8 to give an update on the Choice Act and to share with Congress what he is doing to improve access and quality of health care to veterans.


Commissary Savings Redefined to 20%

Year after year, the Defense Commissary Agency (DeCA) told Congress and store patrons that commissary shoppers saved an average of at least 30 percent on brand-name groceries over prices in commercial stores and supermarkets.


The claim lost some credibility over time with the rise of big box discounters and retail supercenters. Also, DeCA's price-tracking methodology lost support in Congress and at the Pentagon amid a push to transform commissaries into more business-like operations, using commercial tools such as variable pricing and private-label brands to try to reduce DeCA's $1.3 billion annual appropriation.


DeCA officials now concede the 30-percent savings figure didn't include price comparisons at Walmart Supercenters. Nor did it consider the popularity of private-label goods that outside grocers find so profitable. Nor did DeCA adjust its own estimates to give greater weight to products in highest demand with lower savings.


On Monday, in response to a congressional mandate, DeCA released a new set of “baseline” estimates of commissary savings that reflect these factors and more.


Without reducing the value of the shopping benefit, DeCA says, it has redefined how it measures savings. Global savings across all 238 commissaries are calculated now at 23.7 percent and savings stateside at 20.2 percent. At 61 overseas commissaries, average savings are 44.2 percent against local food prices.


To be able to shift to variable pricing, DeCA also is publishing average savings by seven U.S. commissary regions. The 36 commissaries operating on New England bases, for instance, provide average savings of 21.4 percent. Across 30 commissaries in the South Atlantic states, savings average 19.9 percent.


The combined region of Alaska/Hawaii, with nine commissaries, offers the highest savings for patrons at 32.6 percent. Twenty commissaries in the Rocky Mountain region, which runs south from the Canadian border through Arizona and New Mexico, had the lowest savings - 17.6 percent compared to prices off base.


The Pacific coastline states, with 31 commissaries, provide average savings of 20.9 percent, while 18 military grocery stores in North Central states save shoppers an average of 20.2 percent.


“This enhanced way of calculating savings doesn't change the actual dollars that patrons save, but it will give patrons a better understanding of price comparisons in their local area,” said DeCA Director Joseph H. Jeu in a press release Monday unveiling revised savings estimates.


A day later Jeu announced that, effective June 3, he will retire after six-and-a-half years at DeCA's helm and more than 38 years' total federal service.


“The transformation is well on its way and the right people are in place to see it through,” Jeu's statement on Tuesday said.


Military exchange executives, said industry sources, were surprised and upset by DeCA's announcement on the new baseline savings. Exchange directors have argued for years that their own store traffic and sales performance are linked to the popularity of commissaries, and commissary sales are falling.


Since last October, start of fiscal 2017, DeCA sales are down 7.6 percent and by more than 10.5 percent in January compared to January 2016.


“It's just really bleak,” said one representative for manufacturers serving the military resale system. “If your sales are down, the last thing you want to do is send out a press release saying that people are saving 10-percent less than they thought they were. That's just going to drive sales way down.”


Some might challenge Jeu's timing, but he was on the clock. Congress first ordered DeCA to produce more realistic baseline savings, including across regions, in 2015. The due date to report was March 2016, so DeCA was 11 months late.


Brooke Goldberg, director of family policy and spouse programs for Military Officers Association of America, said senior defense officials have given assurances if the revised savings rate “drops even 1 percent, DeCA will begin evaluating a corrective measure.” The hope is that a more granular approach to tracking savings will “be good for patrons, as it provides a more definitive benchmark on a regional basis rather than national scale,” Goldberg said.


Some advocates for military families fear that the mere perception of lower savings could put commissaries at greater risk, despite DeCA's vow that it only has clarified current savings in order to preserve them through the changes ahead.


“I do think it means less certainty for families moving forward,” said Eileen Huck, government relations deputy director for National Military Family Association. “Families have always been told they could expect a certain level of savings when shopping at the commissary, regardless of where they happened to be stationed.


“Now the rules of the game have changed somewhat. Although DeCA has stated its commitment to preserving this new level of savings, there are many more factors in play,” including variable pricing of products and introduction of DeCA-branded products later this year. So, said Huck, “it is fair for families to question what this will mean for the value of the commissary benefit in the long run.”


For years, DeCA measured shopper savings by comparing a 26-week average of brand-name prices, always set at cost, against average market prices across the country. It used Nielsen price data and filled in any gaps -- for Alaska, Hawaii, and overseas -- with limited manual price comparisons in those locales.


That method of calculating savings for 38,000 branded items at the national level has been replaced by a new method more suited to the transformation.


“We are adding more geographic specificity, since cost of living varies by region,” said a DeCA official. “Adding a regional savings level will provide a better sense for how much our patrons save by shopping at their local commissary, compared to retailers in their particular region.”


DeCA has also updated the products it uses for our price comparisons, emphasizing “the most common patron purchases” within sales categories like produce or meat. The new savings benchmark also take into consideration patron purchases at local commercial grocers, as manually gathered in every region.


Critics have raised concerns about how DeCA is relying more heavily now on “clipboard” pricing methods rather than Nielsen data to benchmark local savings across regions. But the greater worry is how patrons will react to the results.


“It certainly has the potential to adversely affect patronage,” said Tom Gordy, president of the Armed Forces Marketing Council. “But what I think people have to fully understand is the prices have not changed. It's just the way the savings are calculated has changed.”


Another industry analyst was more skeptical, suggesting new baseline savings leave headroom for Defense officials or Congress to slash DeCA's $1.3 billion budget while still claiming to preserve customer savings. He also pointed to a new Government Accountability Office report on DoD construction projects that showed DeCA surcharge dollars were used to fund only one construction project in fiscal 2015.


“Construction is the best manifestation of the health of the resale system,” he said. “This report indicates that the system might already be faltering.”


12 Apps to Improve Heart Health

Every 40 seconds someone dies from heart disease in the U.S, according to the American Heart Association. And cardiovascular disease is the leading cause of preventable deaths in the U.S.


To gain a better understanding of your heart health, reduce the risk factors of developing cardiovascular disease (like obesity, high cholesterol, and high blood pressure), and make daily changes that will go a long way toward living a heart healthier lifestyle, check out these 12 apps. (Search for them in the iTunes App Store of Google Play on your smart device.)   


ASCVD Risk Estimator (American College of Cardiology): The ASCVD's free app helps you understand the risks of developing cardiovascular disease, as well as which risk factors are most relevant to you. As part of this highly individualized app, users can enter basic information - like their age and whether or not they smoke - and then further customize the app's tips by including their history of conditions like high blood pressure and diabetes. After entering this health data, the app provides a lifetime risk assessment for developing heart disease along with detailed information about individual risk factors and how to avoid them.  


Blood Pressure Companion (Maxwell Software): Blood Pressure Companion (free) illustrates the correlation between blood pressure and weight. As you track your blood pressure and weight through this app, you get data that shows how fluctuations in pounds can affect your blood pressure readings. In addition, the app reminds you to test your blood pressure, which helps to keep the data as accurate as possible.  


Blood Pressure Log - MyDiary (Zlamaniec): While this free app does not include a blood pressure monitor, it does keep detailed records to analyze trends. By entering data such as blood pressure readings, body posture, and cuff location, users create detailed graphs that can be sent to a doctor via email or used to generate reports in Excel spreadsheets or MS Word documents. Users can also track their glucose levels, weight, and oxygen saturation with this app. 


Blood Pressure Monitor (Taconic System LLC): This app allows users to monitor their blood sugar and blood pressure levels, as well as their weight. You can enter the medications you use and your daily diet in order to get statistical reports on vital functions. In addition, the free app allows you to easily email health data to your physician.


Cardiio (Cardiio Inc.): Cardiio (free) helps users determine their ideal heart rate and, as they monitor their progress, lets them know when they're experiencing abnormalities. In addition, Cardiio shows how your heart rate measures up against others, like an Olympic athlete or someone living on an island. The app also has a seven-minute workout routine.   


Cardiograph (MacroPinch Ltd.): Cardiograph ($1.99) makes heart health a family affair. By using the same type of technology found in a doctor's office, this app allows multiple users to track their heart rhythm by taking a picture of their fingertip. In addition, the app includes fun facts and trivia to help you learn about heart health in an entertaining way.    


Health Mate (Withings): Users can find out their blood pressure trends and real-time data through Health Mate, which includes a health pressure monitor. The app is free, but the blood pressure monitor can be purchased for $129.95.   


Healthy Heart 2 (Ringful LLC): If you are at high risk for developing heart disease, you can track your blood pressure, glucose, potassium, and cholesterol levels with this free app. In addition, you can enter information about your medications and behavioral factors that might contribute to the possibility of developing heart disease.


Instant Heart Rate (Azumio Inc.): Through Instant Heart Rate ($2.99), you can monitor your heart rate as you exercise, while avoiding putting too much stress on your heart. In addition, this app allows you to make comparisons about your heart rate during different activities. From running to resting and everything in between, Instant Heart Rate provides data that gives you an idea of when you're making your target heart rate - and when you're not.   


Kardia Mobile (AliveCor Inc.): Kardia Mobile is a $99 product, which can be used with Android and Apple devices, designed for those who already have a history of cardiovascular problems. This compact tool allows users to record a medical-grade EKG in less than a minute and send data to a doctor to diagnose possible atrial fibrillation. In addition, Kardia Mobile tracks sleep, exercise, and dietary habits, as well as shortness of breath.  


MotionX 24/7 (MotionX): Those who want to monitor their heart health while they're awake and asleep use MotionX 24/7 ($0.99). For daily monitoring, you can compile data on weekly and monthly heart-rate highs and lows, as well as get information on heart rates during exercise and rest. In addition, MotionX 24/7 has a motion sensor that tracks sleep habits, a microphone to detect snoring, and a smart alarm. This app also has a pedometer function to help users track heart health data on multiple fronts.   


Smart Blood Pressure (SmartBP) BP Tracker (Evolve Medical Systems LLC): This free app is particularly helpful for those who either have heart disease or are at high risk of developing it. Through SmartBP, patients can record their systolic and diastolic blood pressure, as well as their pulse, and easily share that data with their doctor. It also has a feature that tracks body mass index, helping those who want to lose weight meet their goals.


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