1. Installation Name: Joint Venture Review 2011 VA/DoD Joint Venture Conference David Grant USAF Medical Center VA Northern California Health Care System

2. Reporting Facility Names: VA Northern California Health Care System (VANCHCS) and David Grant USAF Medical Center (DGMC) Agreement: Overall Master Sharing Agreement provides for services at 75% CMAC plus per diem, pharmacy, etc. JIF funded proposals provide for salary offsets in the sustainment years. Other proposals based on excess capacity or currency requirements on a limited time basis (general surgery 0% CMAC thru end of calendar year 2011). Services provided to the DoD at McClellan are billed at VA costs. Baseline and Current Status: Maintain inpatient access for Veterans at DGMC. Average daily census of Veterans @ 20. Dialysis maximized at 60 patients. Neurosurgery targets maintained at >100 surgeries a year. Radiation therapy maximum throughput 60 patients/month currently at 50. Inpatient Mental Health underutilized by 2,500 bed days of care a year. Other JIF service lines have their own unique metrics. Quantitative Results from the Agreement: Overall goal is to increase access and reduce Non VA Care Costs by 25% and DoD Purchased Care. Individual JIF service lines have their own unique metrics. Qualitative Value of the Agreement: DGMC is a third access point for VANCHCS Veterans. Its location is ideally situated mid way between East Bay and Sacramento on the I-80 corridor. Increases access and proximity. VANCHCS Director refers to DGMC as an extension of the VA healthcare system. Complexity and comorbidities of Veterans provides clinical currency for military staff and training/residency programs. Service Provided: Services provided for Veterans at DGMC: ED, inpatient, outpatient, inpatient mental health, dialysis, neurosurgery, radiation therapy, cardiovascular and endovascular surgery services. Services provided for DoD beneficiaries at McClellan VA OPC: lab, radiology and pharmacy and leased clinical space. Leased space at Fairfield VA OPC for AF chiropractic and joint neuro surgery clinic. JEC Mandate Reporting Format Template

3. Cost Benefit Performance between (DGMC/VANCHCS) Service Provided: Joint Radiation Oncology Center (JROC) Joint Radiation Oncology Center JROC - Performance MeasuresStatus Bring state-of-the-art Radiation Oncology technology to the VA/DoD joint venture at DGMC Increase access to radiation oncology services for VA and DoD patients Decrease the amount of outsourcing of VA/DoD Radiation Oncology care Reduce fee costs for high dollar, highly specialized services for both agencies Move sharing agreement to the level of a highly integrated joint venture Increase utilization of DGMC AF Radiation Oncology providers Increased opportunity for participation in joint research protocols Provide redundancy to ensure continuity of care during maintenance & repair Create center for state-of-the-art care for VA and DoD patients

4. Joint Radiation Oncology Center JIF Goal: 100 additional VA patients to the existing 150 annual patients (baseline FY08). Over 300 total VA patients seen in FY11 (thru Aug 11)

5. Cost Benefit Performance between (DGMC/VANCHCS) Service Provided: Joint Inpatient Mental Health Unit (JIMHU) Joint Inpatient Mental Health Unit JIMHU - Performance MeasuresStatus Has access to inpatient mental health care increased in Northern California by 10 beds? Have 5150/5250 patients been successfully admitted to the new unit? Has the workload generated more complex cases to support enhanced GME for DGMC? Has the amount of outsourcing of DoD inpatient MH care decreased by 85%? Have MH referrals to the community and other VAMCs decreased by 85%? Was a patient satisfaction survey developed for both agencies? Are the results of the patient satisfaction surveys analyzed and being reported?

6. Joint Inpatient Mental Health Unit JIF Goal: 4,900 Bed Days of Care (DoD 1,800/VA 3,100) Annual 12 month avg: DoD 1,000/VA 1,200

7. Cost Benefit Performance between (DGMC/VANCHCS) Service Provided: Joint Cardiovascular Care Center (JCVCC) Joint Cardiovascular Care Center JCVCC - Performance MeasuresStatus OR RN and technician staffing is adequate to permit opening of a dedicated operating room at DGMC seven days per week. This OR would be dedicated to cardiothoracic and vascular cases Enhanced inpatient ICU and ward staffing at DGMC to accommodate the added inpatient demand Has the workload generated more complex cases to support enhanced GME for DGMC? Equitable allocation of cost and workload credit to make this joint service a win-win, sustainable program Have the access to care standards been met (28 days for DGMC and 30 days for VA)? Have VA cardiology/interventional cardiology/cardiothoracic surgery consultations increased at DGMC by 5 per month? Have VA cardiothoracic surgery procedures at DGMC increased to 2 per month? Have out-of-system referrals for VA and DoD significantly decreased? Have VA and DoD purchased care costs decreased? Are we measuring the following: Mortality, CICSP, Impact on existing programs, VANCHCS leadership currently reviews all admissions to DGMC and the community on a daily basis to ensure admission to a VA medical center was considered, Patient and employee satisfaction

8. Joint Cardiovascular Care Center 8 JIF Goal: Increase the number of VA cardiothoracic surgery procedures by 25/yr and like DoD procedures by 100/yr Annual Target Yr 1 (FY11): 50 Yr 2 (FY12): 100 Yr 3 (FY13):150

9. Installation Name: Joint Venture Review 9 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Have access standards been met? 2. Have new consults increased to X per month? 3. Have out of system referrals for VA and DoD decreased? 4. Has the Agreement moved to the level of a more highly integrated model? 5. Are Patient / Employee satisfaction surveys analyzed and reported? DATA SOURCES USED FOR THE PMs: 1. ProClarity Data Cube (Fee and referral workload) 2. CHCS, M2, locally produced clinic data bases 3. VA Survey of Healthcare Experiences of Patients (SHEP), and DoD Patient Surveys OUTCOMES FOR EACH PM LISTED: 1. Access within standards or reduced wait list 2. Consults less than predicted but procedures on target 3. May not have decreased as projected but no increase in referrals 4. Integration varies by longevity and strong “champions” of the program 5. Excellent patient / employee satisfaction surveys

10. Installation Name: Joint Venture Review 10 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Implement Joint Hospitalist program without JIF funding 2. Extremity and Restorative Medicine FY13 JIF (Orthopedics, Podiatry, Prosthetics, Physical Medicine and Rehab (PM&R)) 3. American College of Radiology Certification for Radiation Therapy 4. Incorporate Hematology Oncology and Radiation Oncology into a Cancer Center LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Joint Ambulatory Surgery Building at Fairfield/DGMC Campus 2. Research

11. Installation Name: Joint Venture Review Best Practices – Lessons Learned Best Practices: 1. Governance: Joint Venture Oversight Committee (monthly) and Executive Management Team (quarterly) 2. Joint Strategic Planning Session: Brings all corps disciplines together to discuss and think for the long term; out of the box thinking 3. Joint Venture Business Office: Collocated (VA/DoD) personnel provides for streamlined communication and unity of effort. Lessons Learned: 1. Need strong leadership and champions early on in the process 2. Need an “Operations Guide” and org chart early; preferably before the hiring of staff 11

12. Installation Name: Joint Venture Review Gate Access Organization Structure Issues –Union/EEO –Alternative Dispute Resolution –Supervision Meeting suspense for Qtrly IPRs Current Issues (other than IM/IT) 12

13. Installation Name: Joint Venture Review Share Point Gate Access To access the share point simply type the following URL in your internet search bar. https://eim.amc.af.mil/org/60sfs/Visitorcontrolcenter/default.aspx Once your have entered the home page this is what you will see: You have four options to choose from when sponsoring a person on base. -1-14 Days -15-180 Days (Requires signed letter) -181-365 Days (Requires signed letter) -Special Guest (Requires signed letter)

14. Installation Name: Joint Venture Review Sponsor Guest 1-14 Days This page is pretty self explanatory, all you need is to fill out the appropriate areas with the correct information Once completed its as simply as click The “ok” button at the bottom of the screen. Once you click “ok” the person’s name will automatically be added to a list that is computer generated and is accessible to all the employees at the visitors center. All the guest must do is proceed to the visitor’s center with a valid driver’s license, registration and proof of insurance the base pass will then be generated.

15. Installation Name: Joint Venture Review Reimbursement Methodology Workload Credit –VA Fee basis credit versus “count” clinics –Complexity designation Second Fisher House –8 Room House Additional Information as Desired 15