1. El Paso Joint Venture 2011 VA/DoD Joint Venture Conference El Paso Joint Venture Wm Beaumont Army Medical Center El Paso VA Health Care System

2. Agreement: WBAMC provides Inpatient Care for eligible Veterans. Baseline and Current Status: WBAMC will accept all VAB medical-surgical inpatient cases, only referring the VAB to the community if services are not available at the time of patient presentation. Example: WBAMC has only one neurosurgeon at this time. If an EMS call comes in that requires the service it is referred to the community. Quantitative Results from the Agreement: Approximately 77% of all inpatient care requirements for Veteran patients is provided by WBAMC. While authorized community care is 22% Qualitative Value of the Agreement: 1.Closest VA tertiary facility is 263 miles away. Not conducive to family involvement in care planning. 2.VAB patients tend to have higher acuity which provides an excellent GME training milieu and supprots WBAMC staff competency. 3.Increased patient satisfaction, provider satisfaction (close proximity allows for better communication) 4.Conservancy of funding resources. El Paso JV abides by the VA-DoD Billing Guidelines. Reporting Facility Names: William Beaumont Army MC El Paso VA Health Care System Service Provided: Inpatient Care

3. Agreement: WBAMC provides emergency services and specialty care for eligible Veterans. Baseline and Current Status: WBAMC and EPVAHCS have a standing agreement that all VABs who present to the WBAMC Emergency Department will be seen and EPVAHCS will reimburse them for the encounters. EPVAHCS does its own Primary care. Specialty care is provided to VABs where not available at the EPVAHCS as WBAMC workload allows. Quantitative Results from the Agreement: 100% access: Surgery,ENT, Urology, and Orthopedics. OB care is available. Areas of limited access: Neurosurgery, neurology, pulmonary Areas of association: Endocrinology, Hematology-Oncology, Ophthalmology, Qualitative Value of the Agreement: 1.Closest VA tertiary facility is 263 miles away. Not conducive to family involvement in care planning. 2.VAB patients tend to have higher acuity which provides an excellent GME training milieu and provider competency 3.Increased patient satisfaction, provider satisfaction (close proximity allows for better communication) 4.Conservancy of funding resources. El Paso JV abides by the VA-DoD Billing Guidelines. Reporting Facility Names: William Beaumont Army MC El Paso VA Health Care System Service Provided: Outpatient Care

4. El Paso Joint Venture Joint Venture Performance Measures PMs USED TO TRACK JV SUCCESS: 1. Number of VAB encounters 2. Access to Care Standards compliance 3. Costs DATA SOURCES USED FOR THE PMs: 1. CHCS - DHCP 2. M2 - VSSC 3. UBO OUTCOMES FOR EACH PM LISTED: 1. Decrease in community (fee-based), increase in-house (JV) 2, Decrease travel costs for VBAs. 3. Continuity of care, decreased waiting times. 4. Decreased Fixed Cost ratio (cost/unit) 5. Increased workload credit for both agencies. 4

5. El Paso Joint Venture Future Initiatives and/or Proposals NEAR TERM (1-2 YEARS) INITIATIVES: 1. JIF Proposal – Joint Endoscopy Center 2. Joint Infusion Center 3. Joint Strategic Planning 4. Joint Education Services (BCLS, ACLS, SIMS) LONG TERM (>2 YEARS) GOALS / INITIATIVES / STRATEGIES: 1. Joint Laboratory Services 2. Joint Radiology Services 5

6. El Paso Joint Venture Best Practices – Lessons Learned Best Practices: Joint CMS/SPD operation Cardio Thoracic Surgery (JIF, O&M dollars now) Mammography Services (soup to nuts) Joint committees (Clinical, Administrative, Reimbursement) Middle management collaboration Atmosphere of Trust – leadership driven Cooperation of staff – guiding patients to the right resource, at the right time Referral management team VAB Discharge Planning Reviewing Process Lessons Learned: Burying the hatchet (and not into your partner) Retraining the elephant 6

7. El Paso Joint Venture IDES –Collocated staffs (DoD, VBA, VHA) –Staffs have access to all required IT systems NEW CAMPUS Current Issues (other than IM/IT) 7