Future of federal health care through our unique partnership and combined focus of “Readying Warrios and Caring for Heroes.” Active duty on Monday and a Veteran on Tuesday Geriatrics to pediatrics Total Facilities: West Campus: 48 buildings on 107-acres of land between Green Bay Rd. and Buckley Rd. in North Chicago, Illinois. East Campus: Four medical facilities on Naval Station Great Lakes, Illinois. Community Based Outpatient Clinics : Two facilities in Evanston and McHenry, Illinois, and one in Kenosha, Wisconsin Total Enrolled Patients (FY 2011): 56,416 Military Veterans: 42,102 Active Duty Military: 4,366 Active Duty Family Member: 5,230 Non-Active Duty Family Member and Retirees: 4,718 Staffing (FY 2011) Total fulltime equivalent (FTE) positions: 2,610 Civilians: 1,882 Active Duty military: 728 Volunteers: 1,197
The Quadruple Aim Readiness Ensuring that the total military force is medically ready to deploy and that the medical force is ready to deliver health care anytime, anywhere in support of the full range of military operations, including humanitarian missions. Experience of Care Providing a care experience that is patient and family centered, compassionate, convenient, equitable, safe and always of the highest quality. Population Health Improving the health of a population by encouraging healthy behaviors and reducing the likelihood of illness through focused prevention and the development of increased resilience. Per Capita Cost Creating value by focusing on quality, eliminating waste, and reducing unwarranted variation; considering the total cost of care over time, not just the cost of an individual health care activity.
Future of federal health care through our unique partnership • 118,000 eligible patients • Military veterans • Active duty military 40,000 Navy recruits that pass through NSGL annually • Military family members • Military retirees (TRICARE) • Serving at 5 locations in Northern Illinois and Southern Wisconsin : • West Campus: 48 buildings on 107-acres in North Chicago. • East Campus: Five medical facilities on Naval Station Great Lakes • Community Based Outpatient Clinics: Two facilities in Evanston and McHenry, Illinois, and one in Kenosha, Wisconsin. Active duty on Monday and a Veteran on Tuesday Geriatrics to pediatrics
FY 2011 ____total pharmacy prescriptions ____DoD outpatient prescriptions = 598,061 ____Veteran outpatient prescriptions = 80,709 (window) 473,509 (mail , includes scripts sent to cmop) ____inpatient unit doses produced and administered = 1,108,139 So Far FY2012 ____total pharmacy prescriptions ____DoD outpatient prescriptions = 391,194 (through June) ____Veteran outpatient prescriptions = 60,764 (window) 350,090 (mail, includes scripts sent to cmop) (through June) ____inpatient unit doses produced and administered = 911,768 (through June)
42,000 Recruits 20,000 DoD beneficiaries 48,000 veterans 110,000 Total from 12/10 thru 2/12 Discussed with Patrick Tiderman last week and again today. In short, he’s engaging with both the VA national Fisher House rep and the Fisher House in an effort to facilitate community outreach and support. We’re going to need a champion (committee) to raise funds/support on our behalf. He’s gathering information now and will brief the Senator shortly. In the end, we hope to have a group of community stakeholders formed to continue the process (I envision community influencers, corporate leaders, VSOs, military committees, etc., but this will clearly be up to the committee). The conversation is open and frequent -- but, it’s very important that we are not in the middle of the support/fund raising. Will have updates frequently. Thanks! Jonathan
THE GREEN HOUSE® model is a “de-institutionalization” of skilled nursing care. What this means is that Veterans will enjoy living in a small home with private rooms and private bathrooms, and will continue receiving the same quality of personal and clinical care provided in our Community Living Center. Furthermore, this intimate environment affords Veterans and their care partners greater choices in their daily activities and care planning. Together, they will create “home” and decide what is most meaningful to them. Veterans will still have access to the rest of the Lovell FHCC facility, including the Canteen and other campus activities.
Both Linear and Cyclical projection models were calculated. The Cyclical projection model was used as it should more accurately reflect the cyclical workload patterns we experience. Compared to the Feb projection, the May outpatient projection has decreased about 2% from 836k to 812k. Breaking this down, the CHCS projection is stable (833k to 829k) while the VISTA projection fell (403k to 383k). Inpatient projections remained stable.
1038 FHCC Staff Participated in Jan 11 Climate Survey (1038/2758 = 37.6%) Plan Determined FHCC staff composition according to rank/wage grade Randomly selected pools of individuals from each rank/wage grade Selected potential focus group participants from each pool maintaining equivalent percent composition to that of the FHCC workforce that each rank/wage grade group composed Wanted 150 FHCC staff to participate 14 groups of 15 people Excluded ESC Leadership Stratify groups based on rank and wage grade Extended initial offer to 211 randomly selected FHCC Staff 29 staff accepted (182 did not respond or responded “No”) Extended a second offer to an additional 216 randomly selected FHCC staff 23 staff accepted (193 did not respond or responded “No”) Total number of participants: 70 (including 31 CAT Members) 39/427 = 9.1% 70/427 = 16.4%
Incorporating Changes into the Culture
Incorporating Changes into the Culture Articulate the connections between the new behaviors and organizational success Develop the means to ensure leadership development and succession
Scope includes beneficiaries enrolled to any FHCC DMIS. Outpatient includes ambulatory surgery, institutional, non-institutional categories. Inpatient includes institutional and non-institutional. Data capture on claims is for all claims paid through 31 Dec 2011 HNFS Claims Mart, Financials by DMIS report was the data source. Beneficiary scope includes all those enrolled to any of the three FHCC DMIS’s. Paid dollars (Paid $) was the cost metric used; this is the actual amount of costs paid for care by the Military Health System (excludes co-pays, co-insurance, deductibles, etc). Timeline on claims: this report includes all claims paid through 31 Dec 2011. December data was excluded. Inpatient paid dollars includes institutional and non-institutional claims. Outpatient paid dollars includes institutional and non-institutional claims. Paid dollars were normalized to exclude North Chicago VAMC.
RDML Wagner's desk for signature. Expect to get it tomorrow when she returns from TAD. I provided you and Renee a copy yesterday of the 3 minor edits BUMED legal, Jeff Sherman, suggested when he did an initial review.
Va dod joint chicago
Captain James A. Lovell Federal Health Care Center Mr. Paul Grundy August 08, 2012Patrick L. Sullivan, FACHE David J. Beardsley CAPT, MC, USN Lovell FHCC Director Lovell FHCC Deputy Director V8
OverviewAbout the Lovell FHCCCommand DemographicsFactors Driving IntegrationReview: Since IntegrationHighlights: Since IntegrationThe FHCC Demonstration People-Centric FHCC Score Card Summary (FY ‘12)Information Management/Information Technology(IM/IT)ChallengesQuestions 2
Overview• First-of-its kind integration: • Former North Chicago VA Medical Center and Naval Health Clinic Great Lakes• Unique combined mission:“Readying Warriors and Caring forHeroes.”• Larger than a single facility: • West Campus: 107-acres at former Campus North Chicago VA Medical Center campus • East Campus: USS Osborne, USS Campus Tranquillity, USS Red Rover and Fisher Branch Medical Clinics; Bldg 200H. • Community-Based Outpatient Clinics: Kenosha, McHenry and Clinics
VA Navy Civilian Employees: 1,352 Arm Civilian y Active Duty: 1 Employees: 530 Contract: 42 Active Duty: 728 Total 1,394 Contract : 261 Total: 1,519 Combined Staff Total: 2,914 5
VA Core Values Navy Core Values Integrity, Commitment Honor, Courage , Commitment Advocacy, Respect , Excellence Lovell FHCC Mission Lovell FHCC VisionLeading the way for Federal Creating the future of federalHealth Care by providing a healthcare quality, patient-centered Lovell FHCC Promise Kept experience, and ensuring Readying Warriors and the highest level of Caring for Heroes operational readiness. Lovell FHCC Values Respect, Integrity, Trust, Accountability , Teamwork/ Camaraderie 6
FHCC Reporting Structure Joint Executive Council (JEC) Health Executive Council (HEC) Advisory Board VA Director (SES) Navy Deputy (O6) Command MasterStakeholders Chief (E9) Advisory Council Patient Facility Dental Fleet Patient Care Resources Services Support Services Medicine Mgmt. Auth. From Executive Agreement (EA) Communication and EA Compliance Operational Line of Authority Military Reporting Relationship & Accountability 7
Factors Driving Integration Historic Base Realignment and Closure (BRAC) Committee 1995 Presidential Priority Capital Asset Realignment for Enhanced Services (CARES) Study Center for Naval Analysis 2002 Recommendations Direction and leadership from the Health Executive Council and Joint Executive Council Base Realignment and Closure (BRAC) Committee 2005 Recommendations Congressional Interest Current Two legacy EHR systems - Four applications – 3 Networks Joint VA / DoD Programs Disability evaluation system Electronic health records - iEHR Transition programs Joint pharmacy initiatives Recovery coordination for the wounded, ill, and injured. 8
Legislation to IntegrateNational Defense Authorization Act (NDAA) 2010Sec. 1702 Transfer of Property: Permission to transfer DoD real andrelated personal property.Sec. 1703 Transfer of Civilian Personnel to the VA: Permission for DoDcivilian personnel to move to the VA personnel system.Sec. 1704 Establishment of Joint Medical Facility DemonstrationFund: Establishment of a Treasury Fund with a reconciliation process.Sec. 1705 Health Care Eligibility for Services at the Captain James A.Lovell Federal Health Care Center: Obtain designation as UniformedTreatment Facility for beneficiary purposes.
Executive Agreement SummarySigned by SECVA / SECDEF on 23 April 2010 The formal agreement between the DoD and the VA regarding the standup and operation of the FHCC located in North Chicago, Illinois, and Great Lakes, Illinois. Active Duty members and Active Duty dependents enrolled in TRICARE Prime pay no co-payments for inpatient or outpatient health care services. 9 specific areas directed by NDAA 2009 5 specific areas directed by NDAA 2010
DoD/VA - Way Ahead“The vision Secretary Panetta and I share is to provide an integrated, seamless experience to our people across their lifetime — from when they raise their hand to take the oath, to when they leave active service and join the veteran ranks, to when they are laid to rest with final honors . . .February 27, 2012 "When DoD and VA health care providers begin accessing a common set of health records, iEHR will enhance quality, safety and accessibility of health care" Department of Veterans Affairs Secretary Eric Shinseki Senate Armed Services Military Construction and Veterans Subcommittee. March 15, 2012 11
Strategic Objective Strategic InitiativePatient-Centered Care 1. Good to Great: Transformational Leadership Model 2. Patient-Centered Care Council 3. Pain Management Program 4. Outreach 5. Kenosha CBOC Relocation/Expansion 6. Room Service Style Dining 7. Tele-Audiology 8. Expand GI, Surgery and Oncology Services 9. Construct New Dental Facility 10. Renovate/Expand Rehab Gym and Pool (Bldg. 132)Lean 1. Conduct Facility Assessment 2. Implement LSS/SR Program 3. Reduce Medical Indeterminate RateTalent Management 1. Staff Development •Succession Planning; Retention, Recruitment, Rewarding; HR Process Improvement; Special-Emphasis RecruitmentInnovation 1. Increase Number of Correlated Records 2. Center of Health Care Education Excellence 3. Expand Imaging Services
Review: Readying Warriors and Caring for Heroes• Deployed 112 Lovell FHCC Sailors throughout the world to support various Department of Defense missions • Thirty four currently deployed in support of global missions • Twenty one deployed in support of Operation Continuing Promise 2011• USS Red Rover processed more than 38,000 U.S. Navy Recruits. • Delivered more than 178,000 immunizations 14
FY 2011 – Readying Warriors and Caring for Heroes •86, 617 Unique Patients •25,003 Veterans •59,224 DoD Beneficiaries (inc Recruits) • 2,390 Employee/Humanitarian/Other non-Veteran •816,639 outpatient visits (Includes Dental) •186,007 dental visits • 19,451 emergency room visits •10,345 DoD / 9,106 Veteran•1,870,170 total pharmacy prescriptions •565,560 DoD outpatient prescriptions •575,088 Veteran outpatient prescriptions •729,522 inpatient unit doses produced and administered 15
Highlights: Since Integration• Standup of the Lovell FHCC • Successful Civilian Transfer of Function•From 1,500 staff to more than 3,000 • Implemented PIV / ANACI • Enhanced clinical services•Building Green House® Homes A transformational approach for skillednursing emphasizing de-institutionalization• Enhancing Patient-Centered Care /Planetree® Healing Environment•Approval for Fisher House• Over 130, 000 medical records integrated since December 2010 18
The Green House Project Elder centric Staff engaged in meaningful relationships built on Ribbon Cutting Quality of life andequality, empowerment, and mutual respect 01 Oct 2012 care focused Each house •Capability •10 Beds •Staffing • 2.5 RN •10 Shahbazim
People Centric – Staff Satisfaction FY11 Command Climate Survey “I think the overall level of “My overall level of trust in the FHCC has…” communication at the FHCC has…” Gotten Better Stayed the Same Gotten Worse 1038 FHCC Staff Participated in Jan 11 Climate Survey (1038/2758 = 37.6%) 21
Captain James A. Lovell Federal Health Care Center= Organizational Strength = Slight Organizational Concern = Moderate Organizational Concern = High Organizational Concern 22
Lovell FHCC: Results DrivenPhase I• Combining the Behavioral Health Units of NHGL and NCVAMC - Net Cost Savings of FY03 to FY07 $5,400,262• DoD Blood Processing Center (one-time cost avoidance) - Net Cost Savings of $3,130,000Phase II• Combining the Inpatient Medicine, Emergency Room, ICU/CCU, and Surgery Departments - Net Reduction of 51.04 FTEE - Net Cost Savings $5,800,000 in FY05 to FY07Phase III• MILCON Construction - One time cost savings of $67M• Recurring annual operating cost savings of $19M• Projected recurring cost savings of $3.3M• Center for Naval Analysis (CNA) Full & comprehensive assessment of costs (Aug 11 – Jul 12) Source: CBA by NHCGL/NCVAMC - Feb 06, 2009 24
Thirteen Year Cumulative Percent Change in Cost VHA Cost Per Patient Total Medical Care Obligations per Total UniquePatients (including non-Veterans)Average Medicare Payment Per EnrolleeMedicare Program Benefits per EnrolleeConsumer Price IndexBureau of Labor Statistics All Urban Consumers 25
FHCC Economic Model Health Care inflation MHS Direct Care hospital reductions 70 (2004) to 59 (2009) have opportunity to be reversed through VA/DOD integration and return of hospital based opportunities for DOD providers/patients . Increasing Utilization Integrated systems (FHCC) have more incentives consistent with ACO (HMO) or health systems approach found in VISN (includes long term care) and large DOD MTF. Think whole life care (newborn to grave, in/outpatient medical home concept). Current strategies of Joint Ventures, Med Home and Network (PPO) relations have fewer incentives to contain utilization. Efficiencies of scale and continuity More Beneficiaries - FHCC integration adds more capacity (both infrastructure and super med home)
Source: HNFS Claims Mart Financials by DMIS report Purchased Care for FHCC DMIS EnrolleesOutpatient, Inpatient, and Total Paid Dollars Jan 2010 - Nov 2011 Move Merger Date Completion Date 28
$100M JIF IM/IT Solutions Identified MSSO W/ Context Mgmt (Single Desk Top) - Sentillion Evaluate and CareFXScheduling Single Clinic RegistrationAppointment Consults Order Portability AHLTA<>VistA Business Rad – Lab - Intelligence Pharmacy 29
FHCC Enterprise Service Bus (ESB)About 100K messagesacross the bridge in last VistAnine days includingweekends.AHLTA
FHCC Enterprise Service Bus (ESB)• Legacy constraints• Use of Pix Stub / Error Exception handling• Supports failure of ID Management and standard terminology issue• Model for iEHR 32
IM/IT: Current Status Single Patient Registration: Operational Medical Single Sign On with Context Management: Operational iEHR Presentation Layer (GUI) – Powered by JANUS Phased Rollout starting December 2011 Enhancements / Issues for contract award Expand to all users by May 2012 Orders Portability Radiology: Deployed June 14, 2011 Laboratory: 3-phased approach Phase I Deployed - January 6, 2012 Phase II Deployed - February 27, 2012 Full Deployment - March 20, 2012 Consults : Business requirements – January 2012 Contract Kick-off – March 2012 Orders deployed – August 2012 Referrals/notes deployed – February 2013 Target for Completion – February 2013 Pharmacy/Allergies: Interim plan in place Final capability part of iEHR? 33
IM/IT: Way AheadNetwork Services Data Sharing / Non-Clinical IT IssuesReconciliation & BillingSchedulingAudit Mechanism for Exchange of MH Notes Across BHIECareFX at Lovell FHCCLogistics Support (DMLSS)Surgery Quality Workflow Manager (SQWM) as Beta SiteVA Enterprise Real Time Location System (RTLS)Joint Wi-Fi RolloutDisaster Recovery (DR)Continuous Readiness in Information Security Prgm (CRISP)Reciprocity -Information Security Computer training VA/DoDPharmacy iEHRPresentation Layer - JANUS 34
Presentation Layer (JANUS)Current Status Currently accessible on every desktop on both the VA and Navy Medicine Network Limited training during initial start up and over the shoulder as requestedChallenges Managing capability expectations Need document identifying current full capabilities, partial capabilities, and near-term future enhancements No formal issue reporting/tracking mechanismPlanned way ahead Address identified challenges and incorporate into training plan for expectation management of the end users Add as part of current AHLTA/CPRS training Provide road-show training to departments Add to existing training schedule and continue over-the-shoulder as required 35
Status & Accomplishments: North Chicago Non-IT IssuesISSUE Status Remarks UpdateCombining VA Police 3/12/12 EDM submitted to Mr. Riojas raised specific questions in 4/11/12 – Questions from VACOand the Naval Asst Sec for Security and the operational organization of the Security and Preparedness office toSecurity Forces at Preparedness for review. proposed combined security plan. FHCC response due 05/07/12.the JALFHCC Response to Dr. Petzel 3/21 Answers to be provided by RC, 4.25.12 – NME – positively endorsed BUMED Legal and FHCC staff by 4/26. concerns of jurisdictions, by NME and BUMED, and was sent to Review of response at 5/2 Advisory training, logistics, and Board. HA on April 17. administration. Dir, 6.18.12 – FHCC Advisory Board Security and Law minutes: VA and DoD lawyers (Mr. Enforcement to do fact Pope and Mr. Sherman) will review finding on rules, regs, and with Navy and VA SME’s to complete jurisdiction by 4/10. position requirements, training and Response to questions experience crosswalk. Corey Joles, raised due by 4/26. NME Civ as POC. June 26, 2012 charge letter attached. Report due July 16, 2012 to Dr. Murawsky.Use of the VA Request disapproved by HA, Presented to HEC, issue reframed 4/23/12 – Draft CMOP rewrite to addressConsolidated Mail as part of interim solution pending t VISN12 & NME questions. Submitted toOrder Pharmacy iEHR pharmacy package. FHCC to h NME & VISN12 on 04/27/12. On FHCC(CMOP) at the redraft for HA. Due 3/30. Received e Advisory Board Agenda for 05/02/12. by Advisory Board Co-Chairs on 4/5. 7/23/12-This topic has moved past NMEJALFHCC (narrowed Sent back to FHCC for further work on to BUMED and is now on schedule forto demonstration d the business case. discussion at HEC.period). o c u m 36 e
Status & Accomplishments: North Chicago Non-IT IssuesISSUE Status Remarks FHCC StatusFHCC to be designated as an IM FHCC will be an iEHR It was agreed at the HEC that the FHCC will not be POM –FY14.IT alpha test site alpha test site for an independent alpha site. Inefficiencies exist in Pharmacy module the current model that slows down progress and the FHCC Budget needs to reflect this. To be discussed at Advisory Board 05/02/12.Request amendment of the EDM in coordination EDM in coordination process. 4.25.12 – NME -positively endorsed byAcquisition & Contracting EDM process. NME and BUMED and was sent to HA on(JUL 2008) to allow flexibility 17 April.to use Great Lakes Center 7.12-13.12 – FHCC, VISN, VHA, DMLSS,(GLAC)/VA , Navy Medical met and work plan drafted for pilotingLogistics Command DMLSS at FHCC.(NAVMEDLOGCOM)or Navy 7.30.12 – DMLSS Work Group charterFacilities Midwest (NAVFAC) forwarded to NME/VISN/FHCC Advisory Board for approval. 7.31.12 – EDM still in coordination at HA and VACO.Change the executive 1. Hospital Corpsmen 1. Determined by Legal (Navy and VA Regional) Utilization of Navy Corpsmen privileges onagreement to allow Navy policy is in that local policy is all that is necessary. Due the West Campus: Resolved - Since MayHospital Corpsman privileges coordination for USH to Advisory Board 5/3/12. 14, 2012, the corpsmen work under theon the West Campus signature. VISN 12 2. Independent Duty Corpsman issue still under license of their civilian preceptor nurse and NME have review by Legal (VA RC and Navy) for who has direct responsibility for the concurred. malpractice coverage issues. Due to Advisory patient care. Per the Executive Agreement, 2. Independent Duty Board 5/3/12. an active duty Division Officer Nurse Corpsmen practice is position is responsible for the admin, consistent with training, and over site of the program. practice in Navy MTFs. Not changes required. 37
Status & Accomplishments: North Chicago Non-IT IssuesISSUEC Status Remarks FHCC StatusAmend 10 U.S.C. 1091 to The proposal will be included in There is currently a process in place with FHCC standing by until FY14designate the federal the DoD FY14 Legislative NAVMEDLOGCOM doing the personalhealth care facility in program. services contracting.North Chicago as anorganization eligible foruse of personal servicescontracts authorityFinancial Issues: 1. NME and VISN12 working 1. VA standards have been provided to 1. The legal review is expected to be1.Construction with CFOs to plan. the Navy to review. Legal review by completed by July 13, 2012.2.Atrium mitigation 2. FHCC contracted with RFI VA Regional Counsel and DoD 2. At NME /BUMED (3rd floor approved).3.CBOC expansion for architectural risk Counsel continues to evaluate if Atrium and parking garage to be mitigation plans for the variations from Navy standards can discussed at FHCC Advisory Board Atrium and Garage. 90% be accomplished under the auspices 05/02/12. submittal information for the of the FHCC Executive Agreement. 7.27.12 – BUMED approval received to Lovell FHCC Atrium 2. NAVFAC has funds to execute Atrium proceed with garage and stairwell; Mitigation project was mitigation in FY 12. Plans to be funding from FHCC. received from the A/E firm. developed for FY13/14 for Garage. 3. Request for DMIS IDs - not 3. Request denied as complexity of 1. Resubmit FY14 without resources required. expansion of Kenosha CBOC to DoD required. is still under review in BUMED. VA concurred. Submit FY14Joint Incentive Fund October 10 EDM signed by Dr. CFO at Navy and VHA to develop parallel CFO’s Formed “Capital Purchasing Research(JIF) Authority Taylor (DoD) and Dr. Petzel (VA) process for requesting funding for project Team” to develop recommendations forAlternative to exclude the “totally / equipment that supplements Treasury handling capital procurement at the FHCC. integrated” facility from Fund. Due 5/3/12 Team development & funded options for CFO participating in the JIF. review. EDM & white paper was signed on 25 July. 38