1. Naval Branch Health Clinic & VA Outpatient Clinic Key West 2010 VA/DoD Joint Venture Conference Naval Branch Health Clinic Key West & VA Outpatient Clinic Key West CAPT Julie Miavez, OIC, NBHC Key West Dr. Hector Ramirez, ACOS, Ambulatory Care VA Miami Dr. Douglas Eaton, CMO, VA Key West

2. Naval Branch Health Clinic & VA Outpatient Clinic Key West 2

3. Naval Branch Health Clinic & VA Outpatient Clinic Key West 3 New Initiatives – Projects Closed NEW INITIATIVES OVER THE PAST YEAR: Rural Health Care Community Based Outpatient Clinic Interactive education and training Collaborative information exchange PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: Computerized patient record systems do not interact (CPRS/Vista versus (AHLTA)

4. Naval Branch Health Clinic & VA Outpatient Clinic Key West 4 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: Revenue generated Access to care and missed opportunities DATA SOURCES USED FOR THE PMs: Reimbursable amounts to the VA and DoD Rates –Psychiatry OUTCOMES FOR EACH PM LISTED: FY 2010 –$1,346,354 DVAMC – Miami –$ 194,161 Key West 12% missed opportunities and 97% utilization

5. Naval Branch Health Clinic & VA Outpatient Clinic Key West 5

6. Naval Branch Health Clinic & VA Outpatient Clinic Key West 6 Access to Military Installation Procedures REQUIRED ACCESS PROCESS and POLICIES FOR VA BENEFICIARIES and/or EMPLOYEES TYPE OF VISITOR ID BADGE* PRIOR COORDINATION VA APPOINTMENT DOCUMENTATION / VERIFICATION VISITOR CENTER VA EMPLOYEE DVA VA PATIENT DVA VA PATIENT ESCORT STATE X VA PATIENT VISITOR STATEX * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

7. Naval Branch Health Clinic & VA Outpatient Clinic Key West 7 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: AHLTA does not communicate with VA VISTA/CPRS Separate standards for Audiology/Spirometry testing Limited Physical Therapy services at VA for DoD RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: Not resolved Access is through network physical therapy

8. Naval Branch Health Clinic & VA Outpatient Clinic Key West 8 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: Propose amending sharing agreement –Data collection for inclusion of Teledermatology Increase Psychiatry active duty referrals to VA LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: Using DoD/VA Joint Venture Key West as a model for future sites –Homestead Air Reserve Base