Installation Name: Joint Venture Review 2010 VA/DoD Joint Venture Conference Hawaii Collaborative - Tripler Army Medical Center and VA Pacific Island Health Care System

Installation Name: Joint Venture Review 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Sleep Lab Joint Incentive Funded Project completion 2. Enhanced Document and Referral Management (eDR) 3. Referral and authorization process improvements 4. Ambulatory Surgical/Endoscopy Center 5. Embedding VA physicians into TAMC IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: 1. Organizations failed to reach agreement on FY11 Joint Incentive Fund projects for submission.

Installation Name: Joint Venture Review 3 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Timeliness of billing and paying 2. Percentage of consults appointed within 5 business days, within 10 business days 3. Timeliness of VA response for transfer to TAMC 4. No show rates for veterans 5. Re-admissions within 30 days DATA SOURCES USED FOR THE PMs: 1. TAMC Patient Administrative Division manual billing spreadsheets; eDR for FY Manual tracking for FY 2010 through adhoc reporting from VistA and CHCS; eDR for FY Manual tracking for FY 2010 based on UBO generated claims spreadsheets; item has been stable for the year so is now monitored only through exceptions reported through Joint Referral Committee 4. Manual tracking for FY 2010 through CHCS adhoc reports; eDR for FY Manual tracking through CHCS adhoc reports OUTCOMES FOR EACH PM LISTED: 1. Claims processed (from TAMC to VAPIHCS) and payments received (from VAPIHCS to TAMC) were negatively impacted with lack of electronic tools; average claim time often exceeded days; payments for FY10 are beginning to be processed in September eDR will decrease those times to 14 days for outpatient services and approximately 45 days for inpatient services 2. 80% or greater of all consults are appointed with 5 business days; % within 10 business days 3. 90% of dispositions are made within 30 minutes 4. Goal is <5%; top three clinics each quarter that exceed the goal are evaluated to determine intervention that can be put into place 5. Strive for no readmissions within 30 days for same/similar diagnosis

Installation Name: Joint Venture Review 4 Access to Military Installation Procedures REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES TYPE OF VISITOR ID BADGE* PRIOR COORDINATION VA APPOINTMENT DOCUMENTATION / VERIFICATION VISITOR CENTER VA EMPLOYEEDVA ID Vehicle decal VA PATIENT DVA (VA Photo ID card) or older VA ID without a photo if accompanied by another ID with photo or VA appt documentation supported by a form of picture ID, (i.e. state issued ID or drivers license). VA appt documentation supported by a form of picture ID, (i.e. state ID or drivers license); if patient does not posses VA appt documentation, the patient will be directed to the Visitor Control Center to have their appointment verified and will be given a temporary visitor pass when validated. Vehicle decal VA PATIENT ESCORTValid picture ID Employees with a authorized VA issued badge are granted escort authority. Vehicle decal VA PATIENT VISITORValid picture ID Prior coordination through VAPIHCS and/or the TAMC Joint Venture Office Guests must go to the Visitor Control Center (VCC )and request a visitors pass to the installation. The VCC will also provided directions and parking locations. Proof of a valid state drivers license, proper vehicle registration and insurance (or a rental agreement) for vehicles operated on the base. Vehicle decal * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

Installation Name: Joint Venture Review 5 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Dual eligibles accepting beneficiary travel as VA but change to retired status (Conflicting national policies…awaiting policy clarification) 2. Frequent users of Emergency Room services 3. Patient no-show rates 4. VA patient access to TAMC campus can cause significant late appointments 5. High rate of homelessness on islands RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Remains problematic and must be resolved case by case 2. Case management—TAMC hired 5 social workers 3. Automatic telephone reminders put into place; PCM notification for patient education; evaluation of reasons for no shows (i.e., social impacts, transportation, etc) 4. Patient education on campus access

Installation Name: Joint Venture Review 6 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Construction of Post Traumatic Stress Residential Rehabilitation Program Building 2.Construction of the Ambulatory Surgical/Endoscopy Center 3. Initiation of the Disability Evaluation System 4. Linkage of eDR through FBCS to IPAC 5. Development of a Joint Strategic Planning Working Group LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Development of a joint outpatient center at Barber’s Point 2. Creation of a shared Joint Venture Office 3. Creation of a sub-acute unit 4. Development of new inpatient tower