One Size Does Not Fit All Joint Ventures, Issues and Resolutions

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One Size Does Not Fit AllJoint Ventures, Issues
and Resolutions Joint Market Opportunities
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VA/DoD Joint Market Opportunities

• The Joint Market Opportunities Work Group was
  chartered by the Joint Executive Committee to
  assess current and potential DoD/VA joint
  ventures.
• Phase I review current Joint Ventures
• Phase II assess potential for increased sharing

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Objectives of Joint Ventures

• Increased access for patients
• Improved efficiency
• Reduced duplication of services
• Reduced infrastructure, where possible
• Mitigating the effect of deployment on access to
  healthcare

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Joint Ventures Studied

• Anchorage, Alaska3rd Medical Group, Elmendorf
  AFB/Alaska VA Health Care System
• North Chicago, IllinoisNaval Health Clinic-Great
  Lakes/North Chicago VA Medical Center
• Honolulu, HawaiiTripler Army Medical Center/VA
  Pacific Islands Health Care System (Spark M.
  Matsunaga Medical Center)
• Key West, FloridaNaval Branch Health Clinic Key
  West/Miami VA Health Care System (Community Based
  Outpatient Clinic)
• El Paso, TexasWilliam Beaumont Army Medical
  Center/El Paso VA Health Care System
• Fairfield, CaliforniaDavid Grant Medical Center,
  60th Medical Group, Travis AFB/Northern
  California VA Health Care System
• Las Vegas, Nevada99th Medical Group, Nellis
  AFB/VA Southern Nevada Health Care System
  (Michael OCallaghan Federal Hospital)
• Albuquerque, New Mexico377th Medical Group,
  Kirtland AFB/New Mexico VA Health Care System

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Status

• Phase I Completed
• Joint Work Group studied/visited eight sites
• Data was collected and reviewed with respect to
  clinical and business operations, local markets
  and their demand and opportunities, governance
  structures, and the management models in place
• Joint Executive Council briefed on the report in
  November
• Phase II Site visits occur February-May 2008

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Key Accomplishments of Joint Ventures

• 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

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Key Accomplishments of Joint Ventures

• 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

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Key Challenges

• IM/IT
• Lack of a single integrated view of patient
  information
• Lack of training/knowledge of available
  applications
• Staffing
• Competition for scarce human resources
• Deployment
• Hiring differences
• Limited use of Title 38 benefits for DoD

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Key Challenges

• Leadership
• Lack of/or unclear Department-level guidance and
  expectations
• Joint Venture Requirements-Goals/Objectives
• Training on Joint Ventures for senior leaders
• Performance measures
• Financial Management
• Bartering
• Lack of incentives to share

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Key Findings

• Joint Ventures are successful if
• There is high-level commitment
• Major challenges are resolved
• Many issues must be resolved at the local level
• One solution will not fit all
• Every local team will have their own take on a
  solution
• Great Lakes/North Chicago
• David Grant/Northern California VA Health Care
  System

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Great Lakes/North Chicago

• The first Federal Health Care Center
• Unique challenges
• Single IT system
• Single financial system
• Transfer of personnel
• Transfer of property
• Services and pharmacy benefits

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David Grant and Northern California VA Health
Care System

• Unique sharing arrangement with a Health Care
  System, not just an individual partner
• Pre-Separation Program, a consolidated DoD
  Pre-Separation and VA comprehensive and pension
  physical
• Veterans use David Grant for ER, inpatient care,
  radiation therapy, and specified diagnostic
  services
• VA Fairfield Clinic includes joint neurosurgery
  clinic and DoD contract chiropractic clinic
• Fully integrated staff in clinics

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• One Size Does Not Fit AllJoint Ventures, Issues
  and Resolutions

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Captain James A. Lovell Federal Health Care
Center 2010
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(No Transcript)
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Site Comparisons

• Naval Health Clinic Great Lakes
• Established 1911 (Current building dedicated
  1960)
• Current catchment area 67K beneficiaries and 49K
  recruits/students
• 22 Med/Surg/Peds Inpatient beds prior to JUN 06
• More than 600,000 outpatient / 187,000 dental
  visits FY07
• 1,531 employees ( active duty and civilian)
• Annual budget FY 07 103M and 72M military pay
• Redesignated Naval Health Clinic 01 JUN 06 -
  OR/ER/Inpatient services moved to North Chicago
  VAMC

• North Chicago VAMC
• Established 1926
• Current catchment area 79K beneficiaries
• 397 inpatient beds
• 59 Acute
• 195 Nursing Home
• 105 Domiciliary
• 38 Psych Residential Rehab
• 243,000 outpatient visits FY07
• 1,269 employees
• Annual budget FY07 180M
• Recent Construction
• Main Hospital- Major renovations 1992, 1996
• Modernization Acute Psychiatry 1996, 2006
• Construction of (4) new ORs, renovation of
  existing ORs and expansion of existing Emergency
  Room 2006

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Phase II
Phase III
Phase I

• Federal Health Care Center
• FY2007
• Navy construction project began 2 JUL 2007
• Surface parking (staff) completed December 2007
• FY2008
• Begin parking structure
• supporting facilities (electricity, water,
  sewer, etc.)
• Renovate 45,000 square foot existing NCVAMC
  spaces
• Begin 201,000 square foot ambulatory care center
• Fall 2010
• Construction project completed
• FHCC opens

• Network Relationship
• January 2005
• 13M NCVAMC Project
• Construction of 4 new Operating Rooms
• Renovated 4 existing Operating Rooms
• Expansion of existing Emergency Department
• June 2006
• Transfer of inpatient med/surg/pediatric
• Professional services by Navy Physicians for
  Surgery and Pediatrics
• Transfer of operating room
• Transfer of ICU
• Transfer of ER service
• Reimbursement methodology
• Facility charges at TRICARE Network negotiated
  rate.

• Sharing Relationship
• October 2003
• Inpatient Mental Health transferred
• Reimbursement methodology
• As TRICARE Network Provider Status
• Local VA/DoD Working group chartered
• Multi-disciplinary
• December 2004
• DoD Blood Donor Processing
  Center transferred
• Reimbursement methodology
• Navy leases VA laboratory space
• VA purchases blood products
• Avoids 3M construction cost to Taxpayer

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Preliminary Cost Benefit Review

• Phase 1
• Mental Health operations average savings
  1,000,000 annually
• Navy Blood Bank Cost avoidance of 850K to 3.1M
• Phase 2
• ICU/CCU operations reduced total costs by
  920,000
• NCVAMC quality, patient satisfaction, and rate of
  adverse events have stayed the same or improved
  in Phase 1 and 2
• Phase 3
• Determining the cost avoidance/cost savings
  achieved thru FHCC partnership (construction and
  operations)
• Lessons Learned

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Cultural Transformation

• Joint Strategic Planning
• Annual Conferences
• Leadership Management Council
• National and Local Functional Task Groups
• Joint Training Plan
• Develop VA/DoD leaders for the challenge of 2010.
• Identify VA/DoD leadership competencies.
• Develop a comprehensive individualized needs
  based training program.
• National Center for Organizational Development
  (NCOD)
• Pre post Phase II assessment
• Employee/ patient focus groups
• Blending cultures / Off-site retreat
• Communications Plan
• Website
• Newsletter
• All Employees meetings

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VA/DoD Phase 2 Surgical Team
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VA/DoD Phase 2 Emergency Dept. Joint Training
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FHCC Governance
Joint Executive Council (JEC) Health Executive
Council (HEC) Joint Facilities Steering
Group (JFSG)
Advisory Board
VHA
BUMED
VISN 12
NME
FHCC SES VA Director Navy 06 Deputy
Stakeholders Advisory Council

Facility Support
Clinical Care
Patient Services
Dental Services
5/30/07
Navy O6 Dep Director
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FHCC Great Lakes/North Chicago Milestones
Timeline
FHCC EDMs Presented to JFSG
(15 Jan 08) All Critical EDMs Ready for HEC/JEC
May 09 FHCC Advisory Board (Assembled)
April 08 FHCC CONOPS
Nov 09 Executive Sharing Agreement
April 09 FHCC 2010 Business Plan
Fall 2010 FHCC activated
Mar 08 All Policy EDMs completed
May 09 FHCC Implementation Plan
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Federal Health Care Center
Integration Framework
2007
HEC/JEC
Design
Implement
JFSG
VACO/VISN
ASD(HA)/BUMED
Concept Of Operations Organizational
Design Operational Framework Performance Metrics
Business Plan
Leadership TG
EDM
EDM
EDM
Executive Sharing Agreement
EDM
EDM
EDM
Implementation Plan Cut-over Plan Contingency Plan
ning
Policies, Procedures, Instructions,
Processes Facilities and Logistics Planning
Cross Functional Task Groups
Communications TG
Business Rules
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Big Rock Issues
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Big Rock Issues
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Big Rock Issues
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Big Rock Issues
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Naming Ceremony 05 October 2007
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Captain James A. Lovell Federal Health Care
Center 2010