VA/DoD Joint Venture VA/DoD Joint Venture between Tripler Army between Tripler Army Medical Center and VA Medical Center and VA

Pacific Island Health Care Pacific Island Health Care SystemSystem

““Caring and Working Caring and Working TogetherTogether””

• 1991 - Undersecretary of the Army and Deputy Secretary of Veterans Affairs approve the Joint Venture for Hawaii

• 1993 – Established Tripler ward staffed by VA primarily for VA patients (Ward 3B2)

1988 TAMC Upgrade & Addition

VA Medical & Regional Office Center

1999

Matsunaga AmbulatoryCare Center

2000

Free-Standing5-Level Parking Facility

1997

60-Bed Center for Aging

1997

DoD/VA Joint VentureDoD/VA Joint VentureHistoryHistory

DoD/VA Joint VentureMission, Vision & Committees

$17.51M

* As developed at the September 6, 2002 Joint Strategic Planning Conference

Mission statement

“Caring and Working Together…Pacific Regional Medical Command and the VA Pacific are committed to providing our beneficiaries the finest health care

in the Pacific.” 

Vision statement

“To be the model DoD/VA integrated comprehensive health care system in the 21st Century.”

DoD/VA Joint VentureDoD/VA Joint VentureJoint Venture Governance StructureJoint Venture Governance Structure

Executive Management Team (meets quarterly or as required) Charter

• provide strategic directions for the Joint Venture• serve as a forum to provide updates to the TAMC Cdr and VAPIHCS Director from subordinate committees on an as needed basis, final level for dispute resolution prior to elevating issues to the regional level• Strategic Planning (as required)

Joint Venture Steering Group (meets monthly) Charter

• provide operational directions for subcommittees and staff• serve as forum to provide updates fro subordinate committees• on an as needed basis, interim level for dispute resolution prior to elevating issues to the EMT

Subordinate Groups (meet bi-monthly/weekly)Joint Business Working Group (JBWG) (reimbursement)JV Demo Site Group (execution of the business plan)Joint Referral Group (authorization & referral)

Charter• identification & evaluation of processes related to their particular areas of emphasis• provide feedback and input into the JVSG• development of metrics

DoD/VA Joint VentureDoD/VA Joint VentureIntent of the Pacific Joint VentureIntent of the Pacific Joint Venture

• Designated in July 1991 as a Joint Venture

• Benefits of this designation:• Support for the TAMC Graduate Medical Education Program

• Support to veterans for inpatient acute care, outpatient medical specialty care and ancillary services

• Cost avoidance for a separate VA inpatient facility

• Amount reimbursed to DoD is less than VA reasonable costs paid to civilian entities

• Supports the Presidential Management Agenda initiative on VA/DoD Sharing, the Presidential Task Force recommendations, and the VA/DoD Joint Strategic Plan

VA agreement to house inpatient svcs in E-Wing; changed to form JV

DoD/VA Joint VentureDoD/VA Joint VentureJoint Venture AgreementJoint Venture Agreement

• Initial agreement signed in March 1992

• Relationship with VA has continued to evolve

• Current Joint Venture agreement, signed in December 2002, consists of a master sharing agreement with 27 separate annexes and reimbursement methodology

• Current agreement will continue through December 2007

1992 2000 2002

VA agreement evolved IP support through TAMC; new OP clinic built and admin svcs housed in E-Wing; workload at TAMC increased; major shift from Space Available care to staff increases to support add’l wkld

VA agreement revised to reflect additional support; Master Sharing Agreement, plus 27 annexes and reimbursement methodology developed; development of joint strategic goals; demo project; incentive fund proposals

DoD/VA Joint VentureDoD/VA Joint VentureOverview of Current AgreementOverview of Current Agreement

• Clinical Services including inpatient medical, surgical and psychiatry and outpatient specialty clinic services

• Neuropsychology testing• Ancillary support (laboratory

(including autopsy & morgue), pharmacy & radiology)

• Hospitalist Support• Emergency Services• Oral Surgery• Joint Policies/Committees• Health Education & Training

• Center for Aging Meals• Housekeeping• Security• Medical Maintenance• Agreement Revision

Procedures

Additions:• Joint Separation Physicals

(added in March 2003)• Clinical Investigations• PTSD Residential Treatment

Program

DoD/VA Joint VentureDoD/VA Joint VentureFacility Responsibilities and Facility Responsibilities and

WorkloadWorkload• Tripler provides primary and tertiary care for active duty, retirees, and their dependents and referred veterans throughout the Pacific basin.

An average day at Tripler results in 34 admissions, 137 beds occupied, 6 births, 2154 clinic visits, 27 ambulatory procedures, 5175 prescriptions being filled & 3177 laboratory tests*

• VAPIHCS provides primary and mental health care, limited specialty care, home based primary care, long term care, and inpatient psychiatric care to veterans in Hawaii, Guam, the Commonwealth of Northern Marianas Islands (Saipan, Tinian, Rota), and American Samoa.

On an average day, VA averages 651 clinic visits, 55 occupied beds at the CFA, and 14 occupied beds on 3B2

* Source: MEPRS, FY05

** Source: VAPIHCS, Feb 2006

Pacific Ocean AtlanticOcean

Indian Ocean

Russia

ChinaUSA

SouthAmerica

Australia

Africa

Canada

Pacific Regional Medical Pacific Regional Medical Command “Area of Command “Area of

Interest”Interest”

VA PIHCSVA PIHCS

VA Pacific Islands Health VA Pacific Islands Health Care SystemCare System

DoD/VA Joint VentureVAPIHCS Reimbursements to TAMC

FY05 VA Claims Submitted = $16M

IP

Hskpg

Other

Ancillaries

Psych

OP

IP

OP

Psych

Ancillaries

Housekeeping

Other

Source PAD IBO and RMD P&B

FY2003

• In March 2003, a TAMC Automation Workgroup successfully developed a manual, work-around solution for itemized outpatient billing; this program was recognized at the TRICARE conference in January 2004 with a 1st place award in the financial category

FY2004

• Incentive Fund proposals (CAD/CAM) funded

• In June 2004, TAMC and VA Pacific Island Health Care System submitted the Business Plan for their demonstration site proposal

• Our JV served as one of three sites for the Mitretek market assessment; joint workload database was reviewed at Health Affairs and has been provided for implementation

FY2005

•Two additional Incentive Fund proposals (Pain Management and Dialysis) funded

DoD/VA Joint DoD/VA Joint VentureVenture

Recent AccomplishmentsRecent Accomplishments

DoD/VA Joint VentureDoD/VA Joint VentureJoint Venture Demonstration ProjectJoint Venture Demonstration Project

Project Managers

Rosemary Kyte (TAMC)

Dr. Enrico Camara (VAPIHCS)

• Joint Chargemaster Based Billing System (JCMBB)

• Health Care Forecasting, Demand Management & Resource Tracking Database (ResTrk)

• Referral Management & Fee Authorization System (RefMgt)

• Document Management System (DocMgt)

• TriWest Study (TriWest)

• Community Based Outpatient Clinics Study (CBOCs)

DoD/VA Joint DoD/VA Joint VentureVenture

Demonstration ProjectDemonstration Project

NDAA 03

GAO

HEC

DSS Oversight (VHA/MHS)

Hawaii Collaborative

(EMT/JVSG)

MHS Program Offices

VHA Program Offices

(given studies outcomes)

Local Process OwnersLocal Process Owners

(VHA and MHS Systems)(VHA and MHS Systems)

TAMC

(System / Processes)

• CHCS II

• CMBB

VAPIHCS

(Systems / Processes)

JVSG Work Groups

DoD/VA Joint DoD/VA Joint VentureVenture

Demonstration Project OversightDemonstration Project Oversight

Racquel LosMgmt. Analyst

PROJECT TEAM

Alexander SetoProject Manager

EMTVAPIHCS/TAMC

DoD/VA-LocalLeadership

Project Leads

Ctrs-VA

ConsultantsEnrico Camara,

MD VAPIHCS

Craig OswaldVAPIHCS

Rosemary KyteTAMCCOLLABORATIVE

Brenda HornerTAMC

As of: 12/15/05

Charlotte SandMgmt. Analyst

Ctrs-DoD

JVSG

ConsultantCBOCStudy

FirstConsulting

Group Res. Trckg.

FirstConsulting

GroupDoc. Mgmt.

3M/RITPOJCMBB

FirstConsulting

Group

Ref. Auth.

ConsultantTriWestStudy

Document Mgmt

Interim Solution

DoD/VA Joint DoD/VA Joint VentureVenture

Demonstration Project Demonstration Project OrganizationOrganization

DoD/VA Joint VentureDoD/VA Joint VentureJoint Venture Incentive Fund ProposalsJoint Venture Incentive Fund Proposals

Project Managers

Brenda Horner (TAMC)

Dr. Enrico Camara (VAPIHCS)

Dr. Richard Girton (VAPIHCS)

• FY2003 National Defense Authorization Act, Public Law 107-314 directed DoD and VA to implement a DoD/VA Health Care Sharing Fund

• Each Department is to contribute $15M to the fund each year (FY04 through FY07)

• FY2004: Five proposals were approved by the JV Steering Group for submission

• Delta Systems II Cad/Cam -- FUNDED

• Common Data View for VA/DoD Patient Information

• Integrative Medicine Research, Education & Clin Cntr

• Bi-Directional Pharmacy

• VA Chronic Dialysis Center

• FY2005: Two proposals were approved by the JV Steering Group for submission

• Pain Management -- FUNDED

• Dialysis Center -- FUNDED

DoD/VA Joint VentureDoD/VA Joint VentureIncentive Fund Background & Incentive Fund Background &

SubmissionsSubmissions

• Dedicated hard work by both departments• Determination to succeed• Taking a global view – the intent is to save

“federal” healthcare dollars• Putting patients first• Communication• Communication• Communication

DoD/VA Joint VentureDoD/VA Joint VentureKeys to SuccessKeys to Success