2. Highlight 1997 and selected 3rd Quarter 1998 accomplishments Reaffirm the strategic direction articulated in “Vision for Change” and “Prescription for Change” Review 1998-2003 strategic targets

3. Strategic Management Framework Healthcare Delivery Customer Service and Patient Satisfaction Special Emphasis Programs Enrollment and Improved Access to Care Medical Education and Research Resource Management Information Management Emergency Preparedness Leadership in the Delivery of Healthcare Value Contents

5. VHA Strategic Framework for Quality Management

6. Every VISN increased implementation of interventions from the Chronic Disease Index (14 nationally recognized clinical interventions for ischemic heart disease, hypertension, COPD, diabetes, & obesity). Every VISN increased implementation of interventions from the Prevention Index (9 nationally recognized guidelines for immunizations, cancer screening, tobacco consumption, and alcohol consumption.

7. One year survival rates improved for congestive heart failure, COPD, pneumonia, & chronic renal failure, and remained stable for 5 other high volume conditions. Enrollment in primary care increased and the proportion of patients who knew one provider or team was in charge of their care increased. Surgical mortality rates within 15 surgical specialties decreased or remained stable in 12 specialties, while increasing only slightly in 3 specialties. VHA Developed and implemented the Palliative Care Index to track efforts to provide end-of-life planning for terminally ill patients. VHA’s work is aimed at minimizing physical and psychological suffering and optimizing the quality of life for these patients.

8. STAFF COURTESY TIMELINESS ONE PROVIDER DECISIONS PHYSICAL COMFORT EMOTIONAL NEEDS PATIENT EDUCATION TRANSITION FAMILY INVOLVEMENT COORDINATION OF CARE

9. GOALS 1996 1997 1998 1999 2002 By 2002, increase to 90% the 65% 65% 75% 79% 95% proportion of patients reporting VA inpatient healthcare as very good or excellent. By 2002, increase to 90% the 61% 63% 75% 79% 95% proportion of patients reporting VA outpatient healthcare as very good or excellent. Increase to 90% the proportion 78% 79% 85% 87% 90% of patient who rate the quality of VHA healthcare as equivalent to or better than what they would receive from others.

10. Special emphasis programs are clinical services that address illnesses specific to the service-connected veteran population, constitute areas of special VA expertise, or are unique programs addressing the psycho-social needs of certain identified veterans. Addictive Disorders Blind Rehabilitation Geriatrics and Long-Term Care Gulf War Veterans Homelessness Post Traumatic Stress Disorder

11. Rural Access for Readjustment Counseling Services …. Several Vet Center outstations have been opened on Native American Indian reservation lands. The centers provide a broad base of outreach and case management, as well as counseling, and serve as points of referral into the VA healthcare system. They are staffed by Native American service providers, who maintain sensitivity to the local culture and collaborate with native healing philosophies and practices. Outpatient Model Program for SCI Evaluations…. VAMC Augusta began providing comprehensive outpatient annual SCI evaluations. Veterans who receive an average of 16 clinical services in 2 - 3 days. Due to veteran travel distances, VA contracted with an SCI residential care home for lodging and personal care assistance. In its first year, the program provided evaluations for 349 veterans, and a minimum of 1047 bed days of care were avoided. Patients are pleased with the efficient scheduling, comprehensive services, lodging arrangements, and the staff assistance.

12. ELIGIBILITY REFORM enables VHA: to provide needed healthcare in the most appropriate setting to include preventive and primary care services to expand sharing authority to enroll veterans in the VHA healthcare system. RIGHT SERVICE PLACE TIME

14. 1000 2000 3000 4000 5000 6000 7000 8000 9000 A O LLTHER P C RIMARYARE M R P C T EDICALESIDENTSINRIMARYARERAINING S: VHA O A A OURCEFFICEOFCADEMICFFAIRS 38.6% 1 9 9 6 1 9 9 7 1 9 9 8 1 9 9 9 2 0 0 0 M I E D C A L R I E S D E N T S 48.4%45.9% 41.0% 39.3% F Y ISCALEAR VHA supports 10% of nations graduate medical education positions annually. VHA supports training for 54,000 people in over 40 allied health professions. Increasing generalist residencies by 750 positions Reducing specialty residencies by 1000 positions: - 25 % in AY 97/98, - 50% in AY 98/99 - 25% in AY 99/00.

15. The purpose of VA’s research program is to discover knowledge and create innovations that advance the health and care of veterans and the nation. Both the number of R&D projects and the number of projects specifically relevant to VA’s healthcare mission will increase substantially by 2003.

16. Decrease the systemwide average cost per patient by 30%. FY96 FY97 F&03 decrease bed days of care 2500 1782 1300per 1000 unique users increase percent of 50% 54% 75%healthcare budget expended on outpatient care 46% 69% NAincrease the proportion of surgeries and procedures done in an ambulatory care setting

17. Increase the percent of the operating budget obtained from non-appropriated sources to 10% of the total. Increase the percent of patients identified with insurance. Increase the number of VA medical centers with DoD managed care support contracts (Tricare). Increase the number of Enhanced Use Leasing projects. Obtain Congressional authorization for a Medicare pilot.

18. Refine the Resource Allocation Methodology

19. Provide seamlessly integrated care, continuous reliable and flexible communications and information transmission, and timely readily accessible management systems. Improve VHA’s technology infrastructure Telecommunications Infrastructure Project (TIP) Microsoft Exchange Internet/Intranet Functionality Project Expand support for clinical operations Clinical Information Resources Network (CIRN) Computerized Patient Record System (CPRS) Government Computer-Based Patient Record (G-CPR) Imaging Project Expand support fo r administrative decision making Decision Support System (DSS) Enrollment system Project Non-VA Patient Care Project

20. Provide seamlessly integrated..... (cont’d) Improve the interface with VBA Automated Medical Information Exchange (AMIE) Phase II

21. VHA will preserve the capability to respond to any kind of incident, from a local event -- such as a small fire in a healthcare facility, to a major disaster -- such as floods, hurricanes, terrorism.

22. Provides medical care to 3.6 million veterans. Serves as the largest single provider of health professions training in the world. One of the largest and most productive research organizations in the country. Becoming the principal Federal asset for medical assistance in large-scale disasters. Largest direct care provider for homeless persons in the country.

23. A strong decentralized national network of healthcare providers a full continuum of care clinical services grounded in clinical care guidelines VHA today faces the issues and trends of the changing healthcare marketplace of tomorrow with a number of distinct advantages. a 10 dimension quality management accountability program a strong and well qualified staff a wealth of experience in education, research, chronic care and geriatric care

24. A strong decentralized national network of healthcare providers a full continuum of care clinical services grounded in clinical care guidelines VHA will focus on five areas where it may assume a leadership role over the next several years. To set the national standard for healthcare quality management. To have a compassionate and high quality workforce that is nationally regarded as being in the vanguard of innovation, teamwork, quality and service. To generate new knowledge at the forefront of national healthcare and that facilitates improved clinical outcomes. To build education programs reflecting its experience base and to be in the vanguard of integrating medical education and service delivery in organized or managed care settings. To be a national leader in providing exceptional information technology and services to support delivery of the best healthcare to veterans.