1. Installation Name: Joint Venture Review 2010 VA/DoD Joint Venture Conference Hawaii Collaborative - Tripler Army Medical Center and VA Pacific Island Health Care System

2. Installation Name: Joint Venture Review 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Sleep Lab Joint Incentive Funded Project completion 2. Enhanced Document and Referral Management (eDR) 3. Referral and authorization process improvements 4. Ambulatory Surgical/Endoscopy Center 5. Embedding VA physicians into TAMC IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: 1. Organizations failed to reach agreement on FY11 Joint Incentive Fund projects for submission.

3. Installation Name: Joint Venture Review 3 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Timeliness of billing and paying 2. Percentage of consults appointed within 5 business days, within 10 business days 3. Timeliness of VA response for transfer to TAMC 4. No show rates for veterans 5. Re-admissions within 30 days DATA SOURCES USED FOR THE PMs: 1. TAMC Patient Administrative Division manual billing spreadsheets; eDR for FY 2011 2. Manual tracking for FY 2010 through adhoc reporting from VistA and CHCS; eDR for FY 2011 3. Manual tracking for FY 2010 based on UBO generated claims spreadsheets; item has been stable for the year so is now monitored only through exceptions reported through Joint Referral Committee 4. Manual tracking for FY 2010 through CHCS adhoc reports; eDR for FY 2011 5. Manual tracking through CHCS adhoc reports OUTCOMES FOR EACH PM LISTED: 1. Claims processed (from TAMC to VAPIHCS) and payments received (from VAPIHCS to TAMC) were negatively impacted with lack of electronic tools; average claim time often exceeded 120 - 180 days; payments for FY10 are beginning to be processed in September 2010. eDR will decrease those times to 14 days for outpatient services and approximately 45 days for inpatient services 2. 80% or greater of all consults are appointed with 5 business days; 99-100% within 10 business days 3. 90% of dispositions are made within 30 minutes 4. Goal is <5%; top three clinics each quarter that exceed the goal are evaluated to determine intervention that can be put into place 5. Strive for no readmissions within 30 days for same/similar diagnosis

4. Installation Name: Joint Venture Review 4 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 EMPLOYEEDVA ID Vehicle decal VA PATIENT DVA (VA Photo ID card) or older VA ID without a photo if accompanied by another ID with photo or VA appt documentation supported by a form of picture ID, (i.e. state issued ID or drivers license). VA appt documentation supported by a form of picture ID, (i.e. state ID or drivers license); if patient does not posses VA appt documentation, the patient will be directed to the Visitor Control Center to have their appointment verified and will be given a temporary visitor pass when validated. Vehicle decal VA PATIENT ESCORTValid picture ID Employees with a authorized VA issued badge are granted escort authority. Vehicle decal VA PATIENT VISITORValid picture ID Prior coordination through VAPIHCS and/or the TAMC Joint Venture Office Guests must go to the Visitor Control Center (VCC )and request a visitors pass to the installation. The VCC will also provided directions and parking locations. Proof of a valid state drivers license, proper vehicle registration and insurance (or a rental agreement) for vehicles operated on the base. Vehicle decal * Enter Type of ID Required: ( DoD, DVA, GOVT, State, Post or Base)

5. Installation Name: Joint Venture Review 5 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Dual eligibles accepting beneficiary travel as VA but change to retired status (Conflicting national policies…awaiting policy clarification) 2. Frequent users of Emergency Room services 3. Patient no-show rates 4. VA patient access to TAMC campus can cause significant late appointments 5. High rate of homelessness on islands RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Remains problematic and must be resolved case by case 2. Case management—TAMC hired 5 social workers 3. Automatic telephone reminders put into place; PCM notification for patient education; evaluation of reasons for no shows (i.e., social impacts, transportation, etc) 4. Patient education on campus access

6. Installation Name: Joint Venture Review 6 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Construction of Post Traumatic Stress Residential Rehabilitation Program Building 2.Construction of the Ambulatory Surgical/Endoscopy Center 3. Initiation of the Disability Evaluation System 4. Linkage of eDR through FBCS to IPAC 5. Development of a Joint Strategic Planning Working Group LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Development of a joint outpatient center at Barber’s Point 2. Creation of a shared Joint Venture Office 3. Creation of a sub-acute unit 4. Development of new inpatient tower