1. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Low Country Federal Healthcare Executive Council FY 10 Review

2. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Low Country Federal Healthcare Executive Council (LFHEC) Governing Body for management of joint healthcare services Chartered Oct 06 based on local Navy/Air Force/VA collaboration Meets monthly Annual Strategic Planning Off-Site: August 2010 Representation: Commanding Officer, Naval Health Clinic Charleston (NHCC)-Chair Director, Ralph H. Johnson VA Medical Center (RHJVAMC) Commander, 628th Medical Group (628 MDG) Commanding Officer, Naval Hospital, Beaufort South Carolina Market TRICARE Director Healthcare Business, Fiscal, Planning & Clinical/Ancillary Staff Chiefs of Medical Staff, Senior Nurse Executives

3. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review LFHEC Mission: Enhancing delivery of quality, patient-centered health care through collaborative Federal and community partnerships LFHEC Vision: Blazing the trail in seamless Federal healthcare…for you!

4. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review 2. Quality of Care Committee Medical Staff Issues/Credentialing, Privileging, Joint Commission Issues JACC Emergency Response Team & AED standards at VA/DoD clinic Shared Training 1. Market Opportunities Resource Sharing Committee Explore sharing opportunities Develop sharing agreements Identify/evaluate future Joint Incentive Funds (JIF) Projects Coordinate Interface with other LFHEC Standing Committees LFHEC Standing Committees

5. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review 3. Information Management/Information Technology Evaluate/assess IM/IT Sharing capabilities for market application i.e. “Single Desktop” and Laboratory Data Sharing Interoperability Support interoperability components of JIF projects and sharing agreements Carolina e-Health Alliance JIF Submission ($2.3M under review) partnership between LFHEC and four major health systems 4. Integrated Disability Evaluation System Newly formed committee to coordinate plans for the nationally mandated VA/DOD Integrated Disability Evaluation System (IDES) LFHEC Standing Committees

6. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review 1. Begin the process to establish the Charleston commuting area as a DoD/VA Joint Venture (JV) site 2. Share Best Practices regarding the Implementation of Patient and Family Centered Care/Patient Centered Medical Home 3. Extend Stakeholder Relationships 4. Promote Interoperability of Electronic Medical Records/Information Technology 5. Decrease Costs through Recapture of Fee Basis/TRICARE Network services FY-11 LFHEC Strategic Goals

7. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review New Initiatives – Projects Implemented IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Opened the CAPT John G. Feder Joint Ambulatory Care Clinic, Joint Base Charleston (JB-CHS) Sep 2010 a. VA Community Based Outpatient Clinic (CBOC) is co-located, One of Three Wings b. Shared Phlebotomy Services c. Waiver – NHCC provides 10 day prescription for VA patients requiring immediate medications d. NHCC performs Stat laboratory tests for Veterans seen at the CBOC e. Laboratory Data Sharing Initiative IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: None

8. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review New Initiatives – Projects Implemented IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Initiation of Joint Outpatient Orthopedics Services (Resource Sharing Agreement (RSA) - NHCC Nov 09 2. Initiation of Joint Cardiology Clinic (RSA) - NHCC Dec 09 3. Initiation of Consulting Pathology Services (RSA) (RHJVAMC staff) at both NHCC and 628 MDG (3 rd & 4 th Qtr 2009) 4. Initiation of Market-Wide Education and Training Initiatives – Jun 09 5. 628 MDG/NHCC/RHJVAMC MOU Readiness Skills Verification Training Program - Dec 08 *FY-10 18 Trainees with favorable comments post-completion IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: None

9. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Quarterly workload statistics for MRI, Orthopedics & Cardiology 2. Man-Hours Worked (DMHRSi used for “DoD” days in Joint Clinics, and in VISTA for VA Days) DATA SOURCES USED FOR THE PMs: 1. CHCS/M2/DMHRSi 2. VISTA/DSS/VSSC OUTCOMES FOR EACH PM LISTED: 1. MRI – JIF Funds $2,467,890 – Value of Services provided exceeded JIF investment in two years FY10 Orthopedics: 689 encounters; 36 surgeries FY10 Outpatient Cardiology: 641 encounters; DoD TRICARE Outpatient Cardiology network costs decreased 45% Dec 09 – Jul 10 ($79,000) 2. DMHRSi Data: Orthopedics: 558 hours Cardiology: 344 hours

10. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Access to Military Installation Procedures REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES TYPE OF VISITOR ID BADGE* PRIOR COORDINATIONVA APPOINTMENT DOCUMENTATION / VERIFICATION VISITOR CENTER VA EMPLOYEE DVA MOU with JB-CHS RHJVAMC conducts National Agency Check with Inquiries – Sends letter to JBC If outside of normal criteria VA PATIENT Base 1 Year First visit allowed with VIC or Appt Letter or on Daily Appointment list JB-CHS conducts SLED/ NCIC Checks. VA Security Clerks at JACC assist in processing requests “ VA PATIENT FAMILY MEMBER Spouse, Children or Parents (> age 16) Base 1 Year First visit allowed with VIC or Appt Letter Must accompany Veteran Same as Above“ VA PATIENT GUEST/ESCORT Drives and or Assist Veteran (> age 16) Base 1 Year First visit allowed with VIC or Appt Letter Must accompany Veteran Same as above after being issued a letter from RHJVAMC – only two escorts allowed “

11. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Durable Equipment approval for Orthopedics Patients 2. 628 Access to Care/Continuity of Care/Patient Satisfaction RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. All DME processed through NHCC Referral Management Center for DoD beneficiaries 2. The recent implementation of the Air Force Family Health Initiative at the 628 MDG, modeled on the Patient-Centered Medical Home concept, has enhanced access to care, continuity of care and quality of care

12. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Joint Optometry Clinic – Joint Incentive Fund Project 2. Stakeholder Relations Program – Educational seminars regarding Patient and Family Centered Care- Medical Home Implementation 3. Obtain Authority and Implement Sharing of Radiological Images 4. Awaiting Results of Carolina E-Health Alliance JIF Submission for FY11 5. Five FY11 LFHEC Strategic Goals 6. Co-Located IDES services and resources on JB-CHS

13. Charleston SC RHJVAMC/NHCC/628 MDG Joint Venture Review Future Initiatives and/or Proposals LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Participation of all LFHEC members in the Carolina e-Health Alliance, a local health information exchange 2. Mobile Pharmacy (Sharing or possible JIF project) 3. Additional VA/DOD Initiatives (JIF and/or Sharing Agreements) with Naval Hospital Beaufort and/or Winn Army Community Hospital, in Ft. Stewart, GA

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