1. Installation Name: Joint Venture Review 2011 VA/DoD Joint Venture Conference Alaska Joint Venture Alaska DoD/VA Joint Venture Hospital

2. Baseline and Current Status (FY11):  VA IP Admissions: 749  VA IP Surgeries: 205  VA Same Day Surgeries: 187  VA ER Visits: 3334  VA Specialty Clinic Visits: 1829  VA Pathology: 2631  VA Lab: 1654  VA MRI: 1440  VA CT:2337 Service Provided:  Inpatient  Inpatient Surgeries & Procedures  Emergency Room  Same Day Surgery & Specialty Clinic  Ancillary Services  Central Sterile Supply  Logistics 2011 Joint Venture Conference 673d Medical Group & Alaska VA Agreement:  The 673d Medical Group is a DoD/VA Joint Venture Hospital  VA Anchorage Clinic resides outside the gate  The Air Force manages the hospital  VA provides70 FTEs  The VA Manages the ICU  The DoD VA Joint Venture Hospital is the preferred provider for Inpatient & ER visits for Anchorage Veterans

3. Quantitative Results from the Agreement:  Estimated Cost Avoidance $7M+ annually  Used FY11 Data  VA & Medicare fee schedule used for estimated Private Sector Care (PSC)* 2011 Joint Venture Conference 673d Medical Group & Alaska VA Qualitative Value of the Agreement:  Increased beneficiary access  Continuity of care  Patient satisfaction  One stop shopping  Clinical currency for AF  Federal money comes back to federal facility

4. Installation Name: Joint Venture Review Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. VA workload in JV hospital FY 10 to FY 11 – admissions, surgeries, outpatient visits, ER visits 2. Collaborative Referral Management, prospective review of PSC/Fee referrals, ROFR 3. Number of GI cases done at VA clinic by 673 MDG physicians, collaborative initiative 4. VA establishment of collocated warehouse service in JV hospital; integrated logistics service 5. Delivery of central sterile supply instruments/supplies from JV hospital to VA clinic, integrated initiative DATA SOURCES USED FOR THE PMs: 1. Essentris, CHCS, AHLTA, S-3, CPRS 2. CHCS, M2, ProClarity, Fee Basis Claims System 3. CPRS, CHCS, feedback from VA and 673 MDG 4. VA end-user surveys, inspections, feedback from VA and 673 MDG 5. VA end-user surveys, inspections, feedback from VA and 673 MDG OUTCOMES FOR EACH PM LISTED: 1. VA admissions 735 to 749 (+2%), ER visits 3,264 to 3,334 (+2%)same day surgeries 238 to 187 (-28%), outpatient visits 2,390 to 1,829 (-31%) 2. Increased JIF opportunities, clinical currency, enhanced access, reduction in PSC/Fee 3. Cost avoidance, clinical currency, optimizing OR utilization; 28 GI procedures performed at VA clinic 4. Collocated warehouse; pursue opportunities to share/collaborate; logistics/standardization 5. Integrated staff and processes to achieve a seamless operation, one standard of care 4 Alaska DoD/VA Joint Venture Hospital

5. Installation Name: Joint Venture Review Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Non-invasive cardiology services – 2012 JIF 2. Surgical Quality Workload Management (SQWM) – 2012 JIF 3. Level IV Trauma Center 4. Joint Venture governance organizational relook 5. Fisher House LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Invasive Cardiology 2. Level III Trauma Center 3. Integrate duplicate services 4. Expanded partnerships (AFHCP, Tri-JIFs) 5 Alaska DoD/VA Joint Venture Hospital

6. Installation Name: Joint Venture Review Best Practices – Lessons Learned Best Practices: Process Improvement Initiatives Referral management Discharge planning & follow up care MRI access Surgical services Credentialing, Orientation &Training Lessons Learned: What makes the JV successful One Team One Fight, ETHOS Cradle to Grave The philosophy of finding ways to “safely” say yes Seeking out and creating win-win opportunities 6 Alaska DoD/VA Joint Venture Hospital

7. Installation Name: Joint Venture Review Lack of shared electronic medical record Security access to base Human Resource challenges Cyclical turnover of staff, deployments Lack of specialty providers in Alaska Standardization & agency restrictions Lack of sustainment funding tail for JIFs; operating on the margins Accounting for shared workload Differing due dates for VA and DOD for various taskings Challenges to JV 7 Alaska DoD/VA Joint Venture Hospital

8. Installation Name: Joint Venture Review One Team! One Fight! Sharing resources: staff and equipment Revenue enhancer Federal money comes back to federal facility’s Systematic organizational approach to communication Commitment of senior leaders Access for Veterans, clinical currency for AF Joint strategic planning Strong documentation codifying joint agreements Branding JV philosophy with all new staff Strengths of the JV 8 Alaska DoD/VA Joint Venture Hospital