DoD/VA Joint Facilities & Markets Ken Cox Director, DoD/VA Program Coordination Office OASD(HA) 1
VA/DoD Joint Executive Council Organizational Structure TITLE 38 U.SC. 8111(c) DOD/VA Health Executive Council t 2003 National Defense Authorization Act (PL 107-314) VA/DoD JOINT EXECUTIVE COUNCIL (JEC) Construction Planning Committee (CPC) Communications Working Group (WG) Joint Strategic Planning Committee (JSPC) VA/DoD HEALTH EXECUTIVE COUNCIL (HEC) VA/DoD BENEFITS EXECUTIVE COUNCIL (BEC) VA/DoD INTERAGENCY PROGRAM OFFICE (IPO) Acquisition & Medical Materiel Management WG Contingency Response WG Continuing Education & Training WG Credentialing Policy Ad Hoc WG Deployment Health WG Health Professions Education WG Information Management Information Technology WG Interagency Clinical Informatics Board Joint Facility Utilization & Resource Sharing WG Benefits Delivery at Discharge WG Benefits & Services WG Information Sharing / Information Technology WG Medical Records WG Evidence-Based Clinical Practice Guidelines WG Financial Management WG Pain Management WG Mental Health WG Patient Safety WG Pharmacy Ad Hoc WG Last updated 10/6/10
VA/DoD Joint Market Opportunities Assignment Goal Assess current DoD/VA joint ventures (Phase I) and next future possible joint markets/joint ventures (Phase II). Co-locate/Co-manage Selected DoD/VA Facilities Where Demand and Economies of Scale Can Be Optimized Objectives: Increased access for patients; Improved efficiency; Reduced duplication of services; Reduced infrastructure, where possible; and Mitigating the effect of deployment on access to healthcare. 3
Assessment Status Eight joint venture sites, Data on clinical and business operations, identified markets, the demand and opportunities in those markets, governance, and the management models in place Joint Markets Initial assessments eleven markets - Scheduling five new markets. 4
Joint Ventures Studied North Chicago North Chicago VA Medical Center/Naval Health Clinic Great Lakes Las Vegas Michael O Callaghan Federal Hospital: VA Southern Nevada Health Care System/99th Medical Group, Nellis AFB Anchorage Alaska VA Health Care System/3rd Medical Group, Elmendorf AFB Honolulu VA Pacific Islands Health Care System (Spark M. Matsunaga Medical Center)/Tripler Army Medical Center Albuquerque New Mexico VA Health Care System/377th Medical Group, Kirtland AFB Key West Miami VA Health Care System (Community Based Outpatient Clinic)/Naval Medical Clinic Key West El Paso El Paso VA Health Care System/William Beaumont Army Medical Center Fairfield Northern California VA Health Care System/David Grant Medical Center, 60th Medical Group, Travis AFB Biloxi Biloxi VA Medical Center/81st Medical Group, Keesler AFB 5
Domain-Based Interview Tool Separate Coordinated Connected Integrative Consolidated Clinical Services Insignificant referrals Regular communications High numbers of referrals Significant number of referrals as one Protocol-driven placement of all patients Facilities Distant Some sharing where duplica tion exists Projects & facilities come from master planning Many departments share space One facility or set of facilities Staffing Distinct Support in peaks and valleys Joint staff planning Multiple examples of single/joint staffing Single staffing Business Processes Different Reduce barriers Work flows understood & acted on Transparent Single system Management/ Governance No Relation Joint planning sessions Overlap of key functions Overlap of key functions One governance & management structure IM/IT Separate systems Evidence of E exchange of info Moving toward systems interface Complete interoperability One system Logistics Little if any exchange Borrowing, bartering and contractual exchange Mutual examination of best pricing and service Selective joint contracting of major areas of procurement One supply chain Education & Training Distinct Selective exchange of methods Frequent use of joint programs and curriculum Most programs and curriculum are same/similar Unified program Research Distinct Selective exchange of protocols Joint planning and review of many studies Significant overlap of protocols and review Unified program 6
Key Accomplishments Fully integrated staffing in some patient care areas Use of Joint Incentive Fund process Joint committee structures Patient care applied equally regardless of type of beneficiary Shared training, orientation, and contingency planning exercises 7
Key Accomplishments Joint Referral/Business Office streamlined access to care, workload accounting and itemized billing Access to military base for veterans Local workaround solutions for IT and billing Hiring temporary staff for other Departments 8
Key Challenges IM/IT Lack of a single integrated view of patient information Lack of training/knowledge of available applications Staffing Shortages Deployment Hiring Limited use of Title 38 benefits for DoD 9
Key Challenges Leadership Lack of/or unclear Department-level guidance and expectations on: Joint Venture Requirements-Goals/Objectives Training on Joint Ventures for senior leaders Financial Management Bartering Lack of incentives to share 10
Conclusion Can joint ventures/markets: Maintain or increase access to care? Reduce infrastructure? Improve efficiency? Strengthen provider practices and quality? Mitigate impact of deployment? Answer = Yes, if: There is high-level commitment Major issues are resolved 11