1. 1 DoD-VA Partnership Status 1 September, 2005

2. 2 DoD/VA Partnership How does MEPRS relate to this? Let’s see……

3. 3 VA/DoD Executive Council Structure Work Groups and Task Forces Construction Planning Committee Construction Planning Committee Strategic Planning Committee Strategic Planning Committee Health Executive Council (HEC) Health Executive Council (HEC) Benefits Executive Council (BEC) Benefits Executive Council (BEC) Joint Executive Council (JEC) Joint Executive Council (JEC)

4. 4 HEC Work Groups Contingency Response Deployment Health Evidence-Based Guidelines Financial Management Geriatric Care GME IM/IT Joint Facility Utilization Medical Education and Training Medical Material Management Patient Safety Pharmacy

5. 5 Joint Strategic Plan Joint Strategic Plan Revised for FY2005 –Aligned and Tightened Objectives –Performance Metrics Joint Strategic Plan objectives and measures tracked by the work groups –Status Reported to the Councils –Plan progress and revisions included in the annual report to the Secretaries and Congress

6. 6 Joint Incentive Fund (JIF) Intent is to fund creative sharing initiatives at facility, regional and national levels VA will administer the fund under the HEC Minimum VA and DoD contributions are $15 million each from each Department between FY 2004 – FY 2007 ($30M/year $120M total) GAO will review projects National Defense Authorization Act 2003, Section 721, authorizes DoD-VA Health Care Sharing Incentive Fund

7. 7 JIF – FY 2004 Process In FY 2004, 58 proposals initially submitted, 29 proposals selected for further consideration, 12 selected All projects received their first year funding ($29.9M; $7.5M required in year 2) Although some projects have had some delays, most are on track

8. 8 Criteria for Proposals  Improves access to beneficiaries*  Improves quality of care*  Number of beneficiaries impacted by initiative  National, Regional or Local initiatives  New initiative or sustain ongoing initiative  Supports VA/DoD Joint Strategic Plan  Develop in-house capability for services now obtained by contract  Congruent with corporate direction  Exportable to other facilities  Positive Return on Investment*  Measurable Performance Data*  Project is sustainable after conclusion of JIF*

9. 9 Examples of Initiatives Submitted Shared MRI procurement and service Shared staffing Telemedicine Projects Cardiac Cath Lab Outpatient Clinics Sleep Studies Women’s Health Clinics IM/IT Projects Research – Not appropriate for JIF

10. 10 JIF Results from FY 2004 Federal Shared Third Party Obligation Program – TMA and VACO Enhanced Outpatient Diagnostic Services – VA Alaska & Elmendorf AFB Expansion of MRI Services – Dorn VAMC, Moncrief Army Community Hospital and Shaw AFB Joint Telemental Health System – Fargo VAMC & Grand Forks AFB Joint Dialysis Unit – VA Northern California & Travis AFB Mammography Services – North Chicago VA & Naval Hospital, Great Lakes

11. 11 JIF Results from FY 2004 Women’s Health Clinic – North Chicago VA & Naval Hospital, Great Lakes Orthotics/Prosthetics – VA Pacific Islands & Tripler AMC Telepsychiatry Services – Syracuse VAMC & Ft. Drum North Central San Antonio Clinic – South Texas HCS/Wilford Hall Medical Center Teleradiology – VAMC Spokane & Fairchild AFB Cardiac Catheterization Laboratory – Dole VAMC & McConnell AFB*

12. 12 JIF – FY 2005 Issued call for proposals November 2, 2004; due January 12, 2005 Financial Mgt Working Group scored round one in February and March Projects selected to continue will submit financial analysis format and certification by resource managers Financial analysis format was provided Final submissions under review

13. 13 Lessons Learned DoD experienced delay in fund allocation sites due to problems setting up new accounts and establishing new processes – now resolved Sites should begin recruitment of professional staff as early as possible Sites attempting to hire Radiologists should anticipate higher costs Details of operations need to be developed early in the process; document in Memorandums of Understanding Cost increases between proposal submission and award creates need to establish process to increase funding for sites where original estimates were insufficient

14. 14 Demonstration Projects Eight Projects –Budget and Financial Management: 2 –Staffing and Assignment: 2 –Medical Information/Information Technology: 4 Oct 2004 Through October 2007 Evaluated by GAO Status: Satisfactory –Projects overseen by joint work group –Progress tracked/reported monthly –Developing lessons learned for exportability –Forum is in E-Room

15. 15 Great Lakes/North Chicago MILCON project to replace NH Great Lakes in 2007 –Joint Task Force recommended jointly managed facility Health Executive Council direction –Different approach –Reduce cost –Increased integration over previous joint ventures –Reduction of duplicative staff –Incorporate lessons learned form demonstration sties Decision: Fully Integrated Federal Medical Center

16. 16 How does MEPRS relate to this? MEPRS data quality is critical to Program Management –Articulating to Congress, GAO, OMB true cost benefit of sharing – Fact vs Myth –Rate setting/Budget precision Future? –CARES –BRAC Questions?