1. David Grant USAF Medical Center VA Northern California Health Care System 2010 VA/DoD Joint Venture Conference David Grant USAF Medical Center VA Northern California Health Care System

2. David Grant USAF Medical Center VA Northern California Health Care System 2 New Initiatives – Projects Closed IDENTIFY ALL NEW INITIATIVES OVER THE PAST YEAR: 1. Joint Cardiovascular Program (Oct 2010) 2. Joint Inpatient Mental Health (Oct 2009) 3. Disability Evaluation System (DES) Pilot Program 4. Oral Maxillofacial Surgery Residency Training 5. Joint Hemodialysis Unit expansion from 10 to 16 chairs (June 2010) IDENTIFY ANY PROJECTS OR EFFORTS THAT WERE CLOSED OR FAILED IN THE LAST YEAR: None

3. David Grant USAF Medical Center VA Northern California Health Care System 3 Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Have access standards been met? 2. Have new consults increased to X per month? 3. Have out of system referrals for VA and DoD decreased? 4. Has the Agreement moved to the level of more highly integrated model? 5. Are Patient / Employee satisfaction surveys analyzed and reported? DATA SOURCES USED FOR THE PMs: 1. ProClarity Data Cube (Fee and referral workload) 2. CHCS, M2, locally produced clinic data bases 3. VA Survey of Healthcare Experiences of Patients (SHEP), and DoD Patient Surveys OUTCOMES FOR EACH PM LISTED: 1. Access within standards or reduced wait list 2. Consults less than predicted but procedures on target 3. May not have decreased as projected but no increase in referrals 4. Integration varies by longevity of program 5. Excellent patient / employee satisfaction surveys

4. David Grant USAF Medical Center VA Northern California Health Care System 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 EMPLOYEE DVA VA PATIENT VICX VA PATIENT ESCORT State, Ins, Reg X (patient) X VA PATIENT VISITOR State, Ins, Reg X (patient) X * Enter Type of ID Required: (DoD, DVA, GOVT, State, Post or Base)

5. David Grant USAF Medical Center VA Northern California Health Care System 5 Access to Care and Referral Management ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. VA tracks Access to Care standards but has no mechanism to refer besides Fee or electronic wait list 2. Inappropriate or incomplete referrals 3. Dual Electronic Medical Records – Referrals/Results process 4. Impact to VA Network RESOLUTIONS TO ISSUES RELATED TO ACCESS TO CARE & REFERRAL MANAGEMENT: 1. Track those areas that are most deficient and develop programs (JIFs) to relieve the backlogs 2. Referral Management must ensure there are clearly defined business rules in place, provider led education processes 3. Process improved over past years although remains manpower intensive, but usable work-a-round. 4. Ensure good coordination within network as to local VA medical center individual capability & capacity

6. David Grant USAF Medical Center VA Northern California Health Care System 6 Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. Joint Sleep Lab (4 beds at DGMC) 2. Endovascular Surgery Center (Expands current cardiovascular JIF) 3. Hematology/Oncology Infusion Center (Expands on current program) LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Joint CBOC with Ambulatory Surgery (Alameda Point, CA) 2. Research 3. Exploring construction of second Fisher House on site 4. Exploring possibility of orthopedic surgery