1. Installation Name: Joint Venture Review 2011 VA/DoD Joint Venture Conference New Mexico VA Health Care System 377th Medical Group, Kirtland AFB Albuquerque, NM

2. Albuquerque 2008 & 2010 JIF: Promote the timely delivery of quality emergency medical care to beneficiaries of the NMVAHCS ED. 50% reduction in long ED stays and a 20% reduction of avoidable inpatient hospitalization through ED observation. Expected annual cost savings through enhanced observation capability in the VA ED verses inpatient admissions $164,000. Decrease percentage of left without being seen to >2%. Initiative: Renovation of 2000 square feet to streamline the triage process in the NMVAHCS ED and to allow for better patient flow. ABQ VA ED Renovation JIF 2008 & 2010 Joint Incentive Funds

3. Baseline and Status prior to JIF: 2008: 11% of patients left without being seen; 31% of patients spent greater than 6 hours in ED; Average patient wait time was 1.28 hours and the average length of stay was 4.57 hours. Quantitative Results from this JIF: 2011: Even though the JIF project is not 100% complete we have already started to see an improvement in the ED patient services as evidenced by an 3% decrease in patients leaving without being seen, 8% decrease in the number of patients who spent greater than 6 hours in ED, 18% decrease in patient wait times, 10% decrease in the patients length of stay. Once the JIF project is complete we anticipate a continued decrease in the above mentioned areas. Qualitative Value of the Agreement: Since 2008 there has been a DoD Cost Avoidance of $254K. DoD patients utilization of the NMVAHC ED gives MTF providers better and faster access to encounter results, enhancing continuity of care and provides better patient care. The decrease in wait time and length of stay has resulted in an increase of patient satisfaction and a decrease in patients leaving without being seen resulting in a decrease in missed opportunities. ABQ VA ED Renovation JIF

4. Agreement: The 377 MDG Agrees to allow NMVAHCS to occupy the 377 MDG Ambulatory Surgery Space and the NMVAHCS agrees to provide 30 Same Day Surgeries per month free of charge for eligible MDG beneficiaries. Service Provided: Same Day Surgeries NMVAHCS/377 MDG Same Day Surgery Unit (SDSU) Sharing Agreement

5. Baseline and Current Status: Currently, the 377 MDG sends all MDG beneficiaries to the network for Same Day Surgeries. During the NMVAHCS Operating Room renovation the NMVAHCS will be down 2 operating rooms and may need to send SDS to fee basis. The $2.5M SDSU renovation is complete. New SDSU equipment has arrived. Sharing Agreement is currently being fine tuned to address issues such as emergency notification and inspection/exercise requirements of VA staff working in the 377 MDG space. An additional 332 has been submitted to order added renovation to ensure 377 MDG building security. Estimated activation date January 2012. Quantitative Results from the Agreement: NMVAHCS cost avoidance in the first year will be $1.1M. Each year to follow will be a $2.3M+ NMVAHCS cost avoidance. DoD Cost avoidance will start after month 41 and it will be $74K per month/$896K annually. DoD paid $2.9M for space renovation. Return on Investment for the DoD starts in month 42. The SDSU will have a capacity of up to 2496 procedures annually (2136 VA/360 DoD) Qualitative Value of the Agreement: Care is provided in-house providing faster service and giving MTF and VAMC providers better and faster access to SDS results. Ensuring continuity of care and improved patient convenience. NMVAHCS/377 MDG Same Day Surgery Unit (SDSU) Sharing Agreement

6. Albuquerque 2011 JIF: The new sleep laboratory and clinic will accommodate 31,383 DoD Prime beneficiaries and 56,520 VA beneficiaries (2009). The NMVAHCS covers all 33 counties in the state of New Mexico, 4 counties in southern Colorado. Additionally, VA also cared for 638 Veterans from Eastern Arizona and 1,463 Veterans from West Texas in 2009. Initiative: To establish a new Sleep Disorder Center comprised of an 8 bed Sleep Laboratory and clinic unit at the Raymond G. Murphy VA Medical Center to serve the ever expanding needs of VHA and DoD beneficiaries in New Mexico. ABQ VA Sleep Disorder Clinic JIF 2011 Joint Incentive Funds

7. Baseline and Status prior to JIF: In 2009, DoD purchased care for 309 unique patients for a cost of $676,613.92; and the VA purchased fee based care of 375 sleep studies for a cost of $602,596.86 (Sleep Study & Pulmonology related claims), with a backlog of 1321 sleep studies at the VA. Population demand in the region for sleep studies is expected to grow conservatively at 10% per year. Quantitative Results from this JIF: It is projected that collectively both agencies will save $11,211,368 over 4 years in future network costs. Qualitative Value of the Agreement: Improved patient satisfaction with timely diagnosis and treatment of sleep disorders. Improved patient satisfaction with convenience of testing site and improved access and scheduling. Improved quality of life and improved health status of patients as a result of improved access and accomplishment of the needed testing. ABQ VA Sleep Disorder Clinic JIF

8. Installation Name: Joint Venture Review Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. 377 MDG quarterly expenditures to the NMVAHCS. 2. 377 MDG quarterly encounters at the NMVAHCS. 3. Quarterly Joint Venture Working Group (JVWG). 4. Quarterly Joint Executive Committee (JEC). DATA SOURCES USED FOR THE PMs: 1. 377 MDG Resource Management Office billing received from NMVAHCS for services. 2. 377 MDG Resource Management Office billing received from NMVAHCS for services. 3. JVWG Core Members and Subject Matter Experts. 4. JEC Core Members and JVWG Minutes. OUTCOMES FOR EACH PM LISTED: 1. Helps determine if a need exists for requesting additional funding for Joint Venture Clinical s services. 2. Identifies specific areas of change in Joint Venture Sharing. 3. Creation of sub working groups and tracking/closing of JVWG minute items. 4. Items referred to JVWG and tracking/closing of JEC minute items. 8

9. Installation Name: Joint Venture Review Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. VA to perform surgical procedures in 377 MDG Ambulatory Surgery Unit space. 2. 2011 JIF - Renovation of space to construct 8 bed Sleep Study Laboratory. Projected expense $4.9M. 3. VA Security Police to work MDG front desk and to enforce security in MDG patient/staff parking lot. 4. Training MOU. Active duty personnel to work at VA to stay current on War Skills. 5. VA to provide MDG with notice of VA Key note speakers. 6. Review benefits of establishing joint logistics, contracting, and civilian hiring practices 7. Explore options for continued high referrals with poor access in local area; i.e. dermatology LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. 377 MDG Oral Surgery space – Possibility exists for the VA to use 377 MDG Oral Surgery space. 2. 3. 4. 5. 9

10. Installation Name: Joint Venture Review Best Practices – Lessons Learned Best Practices: Joint Decontamination Team Training MOU Lessons Learned: Sharing Agreements require a lot of planning and time to implement. 10

11. Installation Name: Joint Venture Review Security during Increase Force Protections on the MDG side. Duplication of training. 11 Current Issues (other than IM/IT)

12. Installation Name: Joint Venture Review MDG provides VA with blood credits from USB drives = $60,000 - $80,000 VA annual savings. VA hired 1 Oral Surgeon -.50 FTE for MDG referrals. Patient Convenience and Continuity of care. 12 Additional Information as Desired