1. Patient Movement Panel Discussion CAPT James Marron, MC, USN Medical Director, TAO-Pacific CDR Carla Thorson, NC, USN Clinical Operations, TAO-Pacific CDR David Byman, MSC, USN Health Care Operations, NH Oki Major Scott Tonko, NC, AF Deputy Director, TPMRC Major Domingo Bicaldo, MC, AF Flight Surgeon, TPMRC Ms. Marsha Graham, RN Chief Managed Care, TAMC

2. TRICARE Pacific 2 Patient Movement Main Issues Pacific Referral System – Juniper Commercial Air Evacuation Brief and Checklist Overflight Programs for NH Okinawa and TAMC Military Air Evacuation

3. TRICARE Pacific 3 Patient Movement Algorithm Patient Referral for Specialty Appointment CM/AE requests appointment using Juniper TAMC schedules appt. send dates through Juniper NH Oki schedules appt. dates sends through Juniper Pt accepts or declines CM/AE completes Comm Air Brief Pt travels for appt.

4. TRICARE Pacific 4 Patient Referrals - Juniper New system replaced Persona Feb/Mar 08 Pacific facilities must have remote access to TAMC’s system to input referrals Many MTFs have limited access  Firewalls  Local IT connections  Lack of training and system knowledge

5. TRICARE Pacific 5 Patient Referrals - Juniper Referral workload now moved to TAMC and other MTFs to input  Faxes and emails between MTFs  Connected MTFs input into system Creating havoc in specialty care clinics  No shows  Cancellations  Patient miscommunications

6. TRICARE Pacific 6 Comm Air Evac Brief & Checklist ISSUES Commercial AE lacked standardization throughout the Pacific Inadequate patient preparation for referral appointments Negative impact on specialty care availability at TAMC Increased TDY time/costs to parent command

7. TRICARE Pacific 7 Comm Air Evac Brief & Checklist SOLUTION Process Action Team created to address issues - comprehensive representation of Pacific MTFs Created a standardized briefing for the Pacific approved by TAMC and JPLO Improved patient preparation for referral appointments Increased specialty care availability at TAMC Decreased TDY time/costs to parent command – SAVE $$$

8. TRICARE Pacific 8 Commercial Air Evacuation Brief

9. TRICARE Pacific 9 Commercial Air Evacuation Checklist

10. TRICARE Pacific 10 Overflight Program NH Okinawa No expansion of services, better utilization of existing services Negligible impact on TAMC’s GME program primarily specialty services Email communication from originating MTF to COMMANDER If approved follow normal process NO involvement of TAO-P

11. TRICARE Pacific 11 Overflight Program Tripler Army Medical Center Benefits TAMC GME program Email communication from originating MTF to TAMC DCCS – CAPT David Lane Approval then to TPRMC for commercial ticketing NO involvement of TAO-P

12. TRICARE Pacific 12 QUESTIONS?