1. Installation Name: Joint Venture Review 2010 VA/DoD Joint Venture Conference VA Puget Sound Health Care System Madigan Army Medical Center Naval Hospital Bremerton

2. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. VA Puget Sound Health Care System, Madigan Army Medical Center and University of Washington selected for site of joint National Regional Pain Management Center – currently in planning stages for full program resourcing in response to Army’s Pain Management Task Force Recommendations. 2. Out-of-Cycle Submissions for two Joint Incentive Fund (JIF) Projects - Pain Management (forwarded) and Geriatrics Telehealth (pending). 3. Multi-Service Market Office (MSMO) sponsored JIF Business Case Analysis Training – 30+ VA/DoD staff trained from across Puget Sound. 4. NAVFAC funded $883K Healthcare Requirements Analysis (HCRA) feasibility study of NH Bremerton and its clinics and potential to relocate Bremerton VA Clinic on Naval Hospital Bremerton Property – Expected completion by Sep 2011. 5. American Lake Land Transfer negotiations between VA Puget Sound Health Care System, US Army and Pierce County, WA – support from Washington Department of Veterans Affairs, Western Regional Medical Command and Executive Council Pierce County. Proposal at VACO for action. IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR:

3. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: 3 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Quarterly Joint Executive Council (JEC) Meetings - MAMC 2. Quarterly Puget Sound Tricare Executive Council (PS TEC) – all VA/DoD sites in Puget Sound 3. Renewal of Sharing Agreement - MAMC 4. Finalization of Sharing Agreement – NH Bremerton 5. Review of Sharing Opportunities – NH Oak Harbor 6. Renewal of Brachytherapy Sharing Agreement – National Capital Consortium, Bethesda, MD DATA SOURCES USED FOR THE PMs: 1. Fiscal reports for billing and reimbursements for 20 VA staffing at MAMC. 2. Business Office FEE reports for claims and reimbursements for VA patients treated at MAMC. 3. Resource Management Purchased Care Reports for claims and reimbursements for active duty patients treated at VAPSHCS. 4. PS TEC Optimization Reports for purchased care throughout market area by MSMO. OUTCOMES FOR EACH PM LISTED: 1. JEC Minutes 2. PS TEC Minutes 3. VACO and AMEDD approvals of sharing agreements, amendments, training agreements, JIFs, etc. 4. Sharing agreement with NHB is currently in draft, and initial discussions for HCRA feasibility study with NHB, VAPSHCS and contractors 5. Making contacts for potential sharing options with NHOH (emergency preparedness, physical therapy, etc.)

4. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: 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 EMPLOYEE VA ID / MAMC ID or CAC Initially to Get MAMC ID & Car Sticker Yes Visitor Center 1 st Day VA PATIENT VICYes Appt Slip Have vehicle registration, proof of insurance, and drivers license MAMC or Front Gate VA PATIENT ESCORT VA ID or VIC Yes Appt Slip Have vehicle registration, proof of insurance, and drivers license Visitor Center VA PATIENT VISITOR Gate PassNo Have vehicle registration, proof of insurance, and drivers license Call Inpt Ward for Verification Visitor Center * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

5. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: 5 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: Concept of Operations outlines processes for access to care and referral management. VA patients referred to MAMC through emergency room for inpatient services. Active Duty referrals to VAPSHCS through provider contacts. VA/DoD Strategic Planning Conference will review access to care and referral management issues for Puget Sound market. HCRA feasibility study will help determine potential improvements to access to care and referral management options in Bremerton market as well as Peninsula Region. RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: Security gate access is working at Fort Lewis. Social Work discharge planning working well at MAMC. VA Nurse Liaison onsite at MAMC resolves any staffing or patient transfer issues.

6. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: 6 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Establish Sharing Agreement, Charter and Concept of Operations – NH Bremerton. 2. Establish Sharing Agreement, Charter and Concept of Operations – NH Oak Harbor. 3. Establish Annual VA/DoD Strategic Planning Conference – planned 2 nd Qtr FY 2011. 4. Follow-up visit from Joint Market Opportunity Work Group and follow-up visit(s) from VACO, US Army and other Congressional interests in Joint Pain Management Center program implementation FY 2011. 5. Implementation of Joint Pain Management Center “Providing a Standardized DoD and VHA Vision and Approach to Pain Management to Optimize the Care for Warriors, their Families and Veterans.” LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Review/Establish Emergency Preparedness Support Planning/Agreement – Army and Navy Sites. 2. Potential replacement of Bremerton VA Clinic on NH Bremerton Grounds. 3. Potential for Enhanced Use Lease to build Homeless Housing Project after American Lake Land Transfer resolved. 4. Establish full Community Based Outpatient Clinic in Northern Olympic Peninsula Market – Partner with Indian Tribes*

7. Installation Name: Joint Venture Review VAPSHCS, MAMC, NHB: VAPSHCS/MAMC/UW selected for joint National Regional Pain Management Program; JIF submitted and ongoing model planning. 20 VA nursing staff embedded on MAMC inpatient wards since 2003. Active Duty referrals to American Lake Inpatient Mental Health Wards. Discussions of cardiothoracic cases going to Seattle VAMC while MAMC surgeons on deployment. Shared access to Anderson Simulator Center at MAMC. Potential for NHB residents to work through Bremerton VA Clinic; Potential for VA CBOC patient referrals to NHB for emergency, diagnostic and inpatient services. Working with various sources to identify dual-eligible DoD and IHS Veterans; Veterans Service Support Center database in development. Review/renew/establish ConOps; VA/DoD Strategic Planning Retreat. VA/MAMC/Federal Coordinating Center Emergency Preparedness Exercise – Receive “casualties” at both tertiary centers - Dec 7, 2010. 7 Additional Information as Desired