Mr. Paul Grundy

Captain James A. LovellCaptain James A. LovellFederal Health Care CenterFederal Health Care Center

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Patrick L. Sullivan, FACHELovell FHCC Director

David J. Beardsley CAPT, MC, USNLovell FHCC Deputy Director

August 08, 2012August 08, 2012

OverviewOverviewAbout the Lovell FHCCCommand DemographicsFactors Driving IntegrationReview: Since IntegrationHighlights: Since IntegrationThe FHCC Demonstration

People-CentricFHCC Score Card Summary (FY ‘12)

Information Management/Information Technology(IM/IT)ChallengesQuestions

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OverviewOverview• First-of-its kind integration:

• Former North Chicago VA Medical Center and Naval Health Clinic Great Lakes

• Unique combined mission: “Readying Warriors and Caring for Heroes.”

• Larger than a single facility: • West CampusWest Campus: 107-acres at former North Chicago VA Medical Center campus• East CampusEast Campus: USS Osborne, USS Tranquillity, USS Red Rover and Fisher Branch Medical Clinics; Bldg 200H. • Community-Based Outpatient Community-Based Outpatient ClinicsClinics: Kenosha, McHenry and Evanston Community Based Outpatient Clinics

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Combined Staff Total: 2,914Combined Staff Total: 2,914

Civilian Employees: 1,352

Contract: 42

Total 1,394Total 1,394

Civilian Employees: 530

Active Duty: 728

Contract : 261Total: 1,519Total: 1,519

VAVA NavyNavy

ArmArmy y Active Duty: 1

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VA Core ValuesVA Core ValuesIntegrity, Commitment

Advocacy, Respect , Excellence

Navy Core ValuesNavy Core ValuesHonor, Courage , Commitment

Lovell FHCC MissionLovell FHCC MissionLeading the way for Federal Health Care by providing a

quality, patient-centered experience, and ensuring

the highest level of operational readiness.

Lovell FHCC VisionLovell FHCC Vision Creating the future of federal

healthcareLovell FHCC Promise Kept Lovell FHCC Promise Kept

Readying Warriors and Caring for Heroes

Lovell FHCC ValuesLovell FHCC ValuesRespect, Integrity, Trust,

Accountability , Teamwork/ Camaraderie

VA Director (SES)VA Director (SES)Navy Deputy (O6)Navy Deputy (O6)Command Master Command Master

Chief (E9)Chief (E9)

Joint Executive Council (JEC)Joint Executive Council (JEC) Health Executive Council (HEC)Health Executive Council (HEC)

Advisory BoardAdvisory Board

Stakeholders Stakeholders Advisory Advisory

CouncilCouncil

Dental Services

Patient Services

Patient CareFacility Support

ResourcesFleet

Medicine

Mgmt. Auth. From Executive Agreement (EA) Communication and EA Compliance Operational Line of Authority Military Reporting Relationship & Accountability

FHCC Reporting Structure FHCC Reporting Structure

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Factors Driving Integration Historic

Base Realignment and Closure (BRAC) Committee 1995

Presidential Priority Capital Asset Realignment for Enhanced Services (CARES) Study Center for Naval Analysis 2002 Recommendations Direction and leadership from the Health Executive Council and

Joint Executive Council Base Realignment and Closure (BRAC) Committee

2005 Recommendations Congressional Interest

Current Two legacy EHR systems - Four applications – 3

Networks Joint VA / DoD Programs

Disability evaluation system Electronic health records - iEHR Transition programs Joint pharmacy initiatives Recovery coordination for the wounded, ill, and injured.

Legislation to IntegrateLegislation to Integrate National Defense Authorization Act (NDAA) 2010 National Defense Authorization Act (NDAA) 2010

Sec. 1702 Transfer of Property: Sec. 1702 Transfer of Property: Permission to transfer DoD real and related personal property.

Sec. 1703 Transfer of Civilian Personnel to the VA: Sec. 1703 Transfer of Civilian Personnel to the VA: Permission for DoD civilian personnel to move to the VA personnel system.

Sec. 1704 Establishment of Joint Medical Facility Demonstration Sec. 1704 Establishment of Joint Medical Facility Demonstration Fund: Fund: Establishment of a Treasury Fund with a reconciliation process.

Sec. 1705 Health Care Eligibility for Services at the Captain James A. Sec. 1705 Health Care Eligibility for Services at the Captain James A. Lovell Federal Health Care Center: Lovell Federal Health Care Center: Obtain designation as Uniformed Treatment Facility for beneficiary purposes.

Signed by SECVA / SECDEF on 23 April 2010 The formal agreement between the DoD and the

VA regarding the standup and operation of the FHCC located in North Chicago, Illinois, and Great Lakes, Illinois. Active Duty members and Active Duty dependents enrolled in TRICARE Prime pay no co-payments for inpatient or outpatient health care services.

9 specific areas directed by NDAA 2009 5 specific areas directed by NDAA 2010

Executive Agreement SummaryExecutive Agreement Summary

DoD/VA - Way Ahead DoD/VA - Way Ahead “The vision Secretary Panetta and I share is to provide an

integrated, seamless experience to our people across their lifetime — from when they raise their hand to take the oath, to when they leave active service and join the veteran ranks, to when they are laid to rest with final honors . . .February 27, 2012

"When DoD and VA health care providers begin accessing a common set of health records, iEHR will enhance quality, safety and accessibility of health care" Department of Veterans Affairs Secretary Eric Shinseki Senate Armed Services Military Construction and Veterans Subcommittee. March 15, 2012

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Strategic Objective Strategic Initiative

Patient-Centered Care 1. Good to Great: Transformational Leadership Model2. Patient-Centered Care Council3. Pain Management Program4. Outreach5. Kenosha CBOC Relocation/Expansion6. Room Service Style Dining7. Tele-Audiology8. Expand GI, Surgery and Oncology Services9. Construct New Dental Facility10. Renovate/Expand Rehab Gym and Pool (Bldg. 132)

Lean 1. Conduct Facility Assessment2. Implement LSS/SR Program 3. Reduce Medical Indeterminate Rate

Talent Management 1. Staff Development•Succession Planning; Retention, Recruitment, Rewarding; HR Process Improvement; Special-Emphasis Recruitment

Innovation 1. Increase Number of Correlated Records2. Center of Health Care Education Excellence3. Expand Imaging Services

Review: Readying Warriors and Caring for Review: Readying Warriors and Caring for Heroes Heroes

• Deployed 112 Lovell FHCC Sailors throughout the world to support various Department of Defense missions

•Thirty four currently deployed in support of global missions

• Twenty one deployed in support of Operation Continuing Promise 2011

• USS Red Rover processed more than 38,000 U.S. Navy Recruits.

• Delivered more than 178,000 immunizations

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FY 2011 – Readying Warriors and Caring for FY 2011 – Readying Warriors and Caring for HeroesHeroes•86, 617 Unique Patients

•25,003 Veterans•59,224 DoD Beneficiaries (inc Recruits)• 2,390 Employee/Humanitarian/Other

non-Veteran

•816,639 outpatient visits (Includes Dental)•186,007 dental visits

• 19,451 emergency room visits •10,345 DoD / 9,106 Veteran

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•1,870,170 total pharmacy prescriptions•565,560 DoD outpatient prescriptions•575,088 Veteran outpatient prescriptions•729,522 inpatient unit doses produced and administered

Highlights: Improving on ExcellenceHighlights: Improving on Excellence

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Highlights: Improving on ExcellenceHighlights: Improving on Excellence

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Highlights: Since IntegrationHighlights: Since Integration

•From 1,500 staff to more than 3,000

• Implemented PIV / ANACI• Enhanced clinical services

•Building Green House® Homes A transformational approach for skilled nursing emphasizing de-institutionalization

• Enhancing Patient-Centered Care /Planetree® Healing Environment

•Approval for Fisher House

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• Standup of the Lovell FHCC• Successful Civilian Transfer of Function

• Over 130, 000 medical records integrated since December 2010

The Green House ProjectThe Green House Project

Staff engaged in Staff engaged in meaningful meaningful

relationships built on relationships built on equality, empowerment, equality, empowerment,

and mutual respect and mutual respect

Ribbon Cutting Ribbon Cutting 01 Oct 201201 Oct 2012

Quality of life and Quality of life and care focusedcare focused

Elder centric Elder centric

Each houseEach house•CapabilityCapability

•10 Beds10 Beds•StaffingStaffing

• 2.5 RN 2.5 RN •10 Shahbazim10 Shahbazim

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Workload Review – Thru May 2012Workload Review – Thru May 2012

AdmissionsAdmissions Outpatient VisitsOutpatient Visits

3,122

4,7244,4894,463

839K 816K

511K

812K

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People Centric – Staff SatisfactionPeople Centric – Staff Satisfaction

“I think the overall level of communication at the FHCC has…”

“My overall level of trust in the FHCC has…”

FY11 Command Climate SurveyFY11 Command Climate Survey

Gotten Better Stayed the Same Gotten Worse 1038 FHCC Staff Participated in Jan 11 Climate Survey (1038/2758 = 37.6%)

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Captain James A. LovellFederal Health Care Center

= Organizational Strength = Slight Organizational Concern = Moderate Organizational Concern = High Organizational Concern

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People Centric – Staff SatisfactionPeople Centric – Staff SatisfactionFY12 Command Climate SurveyFY12 Command Climate Survey

Phase I• Combining the Behavioral Health Units of NHGL and NCVAMC - Net Cost Savings of FY03 to FY07 $5,400,262• DoD Blood Processing Center (one-time cost avoidance) - Net Cost Savings of $3,130,000Phase II• Combining the Inpatient Medicine, Emergency Room, ICU/CCU,

and Surgery Departments - Net Reduction of 51.04 FTEE - Net Cost Savings $5,800,000 in FY05 to FY07Phase III• MILCON Construction - One time cost savings of $67M• Recurring annual operating cost savings of $19M• Projected recurring cost savings of $3.3M • Center for Naval Analysis (CNA)

Full & comprehensive assessment of costs (Aug 11 – Jul 12)

Lovell FHCC: Results DrivenLovell FHCC: Results Driven

24Source: CBA by NHCGL/NCVAMC - Feb 06, 2009

VHA Cost Per Patient Total Medical Care

Obligations per Total Unique

Patients (including non-Veterans)

Average Medicare Payment Per

EnrolleeMedicare Program

Benefits per Enrollee

Consumer Price Index

Bureau of Labor Statistics All Urban

Consumers

Thirteen Year Cumulative Percent Change in Cost

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Health Care inflationMHS Direct Care hospital reductions 70 (2004) to 59 (2009) have

opportunity to be reversed through VA/DOD integration and return of hospital based opportunities for DOD providers/patients .

Increasing Utilization Integrated systems (FHCC) have more incentives consistent with ACO

(HMO) or health systems approach found in VISN (includes long term care) and large DOD MTF.

Think whole life care (newborn to grave, in/outpatient medical home concept). Current strategies of Joint Ventures, Med Home and Network (PPO) relations have fewer incentives to contain utilization.

Efficiencies of scale and continuityMore Beneficiaries

- FHCC integration adds more capacity (both infrastructure and super med home)

FHCC Economic Model FHCC Economic Model

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Source: HNFS Claims Mart Financials by DMIS report

Merger DateMove

Completion Date

Purchased Care for FHCC DMIS EnrolleesPurchased Care for FHCC DMIS EnrolleesOutpatient, Inpatient, and Total Paid DollarsOutpatient, Inpatient, and Total Paid Dollars

Jan 2010 - Nov 2011Jan 2010 - Nov 2011

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$100M JIF IM/IT Solutions Identified$100M JIF IM/IT Solutions Identified

Evaluate Scheduling

Clinic Appointment

MSSO W/ Context Mgmt (Single Desk

Top) - Sentillion and CareFX

Single Registration

Business Intelligence

Order PortabilityAHLTA<>VistA

Rad – Lab - Pharmacy

Consults

30Spiral model (Boehm, 1988)

VistA

AHLTA

FHCC Enterprise Service Bus (ESB)FHCC Enterprise Service Bus (ESB)

About 100K messages across the bridge in last nine days including weekends.

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FHCC Enterprise Service Bus (ESB)FHCC Enterprise Service Bus (ESB)

• Legacy constraints• Use of Pix Stub / Error Exception

handling• Supports failure of ID Management and

standard terminology issue• Model for iEHR

IM/IT: Current StatusIM/IT: Current Status Single Patient Registration: Operational Medical Single Sign On with Context Management: Operational iEHR Presentation Layer (GUI) – Powered by JANUS

Phased Rollout starting December 2011 Enhancements / Issues for contract award Expand to all users by May 2012

Orders Portability Radiology: Deployed June 14, 2011 Laboratory: 3-phased approach

Phase I Deployed - January 6, 2012 Phase II Deployed - February 27, 2012 Full Deployment - March 20, 2012

Consults : Business requirements – January 2012 Contract Kick-off – March 2012 Orders deployed – August 2012 Referrals/notes deployed – February 2013 Target for Completion – February 2013

Pharmacy/Allergies: Interim plan in place Final capability part of iEHR?

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IM/IT: Way Ahead IM/IT: Way Ahead Network Services Data Sharing / Non-Clinical IT IssuesReconciliation & BillingSchedulingAudit Mechanism for Exchange of MH Notes Across BHIE CareFX at Lovell FHCC Logistics Support (DMLSS)Surgery Quality Workflow Manager (SQWM) as Beta SiteVA Enterprise Real Time Location System (RTLS)Joint Wi-Fi RolloutDisaster Recovery (DR) Continuous Readiness in Information Security Prgm (CRISP)Reciprocity -Information Security Computer training VA/DoDPharmacy iEHRPresentation Layer - JANUS

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Presentation Layer (JANUS) Presentation Layer (JANUS) Current Status

Currently accessible on every desktop on both the VA and Navy Medicine Network

Limited training during initial start up and over the shoulder as requested

ChallengesManaging capability expectations

Need document identifying current full capabilities, partial capabilities, and near-term future enhancements

No formal issue reporting/tracking mechanismPlanned way ahead

Address identified challenges and incorporate into training plan for expectation management of the end users

Add as part of current AHLTA/CPRS trainingProvide road-show training to departments Add to existing training schedule and continue over-the-shoulder as

required

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Status & Accomplishments: North Chicago Non-IT IssuesStatus & Accomplishments: North Chicago Non-IT IssuesISSUE Status Remarks Update

Combining VA Police and the Naval Security Forces at the JALFHCC

3/12/12 EDM submitted to Asst Sec for Security and Preparedness for review. Response to Dr. Petzel 3/21 concerns of jurisdictions, training, logistics, and administration. Dir, Security and Law Enforcement to do fact finding on rules, regs, and jurisdiction by 4/10. Response to questions raised due by 4/26.

Mr. Riojas raised specific questions in the operational organization of the proposed combined security plan. Answers to be provided by RC, BUMED Legal and FHCC staff by 4/26. Review of response at 5/2 Advisory Board.

4/11/12 – Questions from VACO Security and Preparedness office to FHCC response due 05/07/12. 4.25.12 – NME – positively endorsed by NME and BUMED, and was sent to HA on April 17.6.18.12 – FHCC Advisory Board minutes: VA and DoD lawyers (Mr. Pope and Mr. Sherman) will review with Navy and VA SME’s to complete position requirements, training and experience crosswalk. Corey Joles, NME Civ as POC. June 26, 2012 charge letter attached. Report due July 16, 2012 to Dr. Murawsky.

Use of the VA Consolidated Mail Order Pharmacy (CMOP) at the JALFHCC (narrowed to demonstration period).

Request disapproved by HA, the document is being prepared for return to the FHCC requesting they resubmit the request with the additional information needed to make a decision as listed in the OASD/HA letter.

Presented to HEC, issue reframed as part of interim solution pending iEHR pharmacy package. FHCC to redraft for HA. Due 3/30. Received by Advisory Board Co-Chairs on 4/5.  Sent back to FHCC for further work on the business case.

4/23/12 – Draft CMOP rewrite to address VISN12 & NME questions. Submitted to NME & VISN12 on 04/27/12. On FHCC Advisory Board Agenda for 05/02/12.7/23/12-This topic has moved past NME to BUMED and is now on schedule for discussion at HEC.

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Status & Accomplishments: North Chicago Non-IT IssuStatus & Accomplishments: North Chicago Non-IT IssuesesISSUE Status Remarks FHCC Status

FHCC to be designated as an IM IT alpha test site

FHCC will be an iEHR alpha test site for Pharmacy module

It was agreed at the HEC that the FHCC will not be an independent alpha site. Inefficiencies exist in the current model that slows down progress and the FHCC Budget needs to reflect this. To be discussed at Advisory Board 05/02/12.

POM –FY14.

Request amendment of the Acquisition & Contracting EDM (JUL 2008) to allow flexibility to use Great Lakes Center (GLAC)/VA , Navy Medical Logistics Command (NAVMEDLOGCOM)or Navy Facilities Midwest (NAVFAC)

EDM in coordination process.

EDM in coordination process. 4.25.12 – NME -positively endorsed by NME and BUMED and was sent to HA on 17 April.7.12-13.12 – FHCC, VISN, VHA, DMLSS, met and work plan drafted for piloting DMLSS at FHCC.7.30.12 – DMLSS Work Group charter forwarded to NME/VISN/FHCC Advisory Board for approval.7.31.12 – EDM still in coordination at HA and VACO.

Change the executive agreement to allow Navy Hospital Corpsman privileges on the West Campus

1. Hospital Corpsmen policy is in coordination for USH signature. VISN 12 and NME have concurred. 

2. Independent Duty Corpsmen practice is consistent with practice in Navy MTFs. Not changes required.

1. Determined by Legal (Navy and VA Regional) that local policy is all that is necessary. Due to Advisory Board 5/3/12.

2. Independent Duty Corpsman issue still under review by Legal (VA RC and Navy) for malpractice coverage issues. Due to Advisory Board 5/3/12.

Utilization of Navy Corpsmen privileges on the West Campus: Resolved - Since May 14, 2012, the corpsmen work under the license of their civilian preceptor nurse who has direct responsibility for the patient care. Per the Executive Agreement, an active duty Division Officer Nurse position is responsible for the admin, training, and over site of the program.

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Status & Accomplishments: North Chicago Non-IT IssuesStatus & Accomplishments: North Chicago Non-IT Issues

ISSUEC Status Remarks FHCC Status

Amend 10 U.S.C. 1091 to designate the federal health care facility in North Chicago as an organization eligible for use of personal services contracts authority

The proposal will be included in the DoD FY14 Legislative program.

There is currently a process in place with NAVMEDLOGCOM doing the personal services contracting.

FHCC standing by until FY14

Financial Issues: 1.Construction2.Atrium mitigation3.CBOC expansion

1. NME and VISN12 working with CFOs to plan.

2. FHCC contracted with RFI for architectural risk mitigation plans for the Atrium and Garage. 90% submittal information for the Lovell FHCC Atrium Mitigation project was received from the A/E firm.

3. Request for DMIS IDs - not required.

1. VA standards have been provided to the Navy to review. Legal review by VA Regional Counsel and DoD Counsel continues to evaluate if variations from Navy standards can be accomplished under the auspices of the FHCC Executive Agreement.

2. NAVFAC has funds to execute Atrium mitigation in FY 12. Plans to be developed for FY13/14 for Garage.

3. Request denied as complexity of expansion of Kenosha CBOC to DoD is still under review in BUMED. VA concurred. Submit FY14

1. The legal review is expected to be completed by July 13, 2012.

2. At NME /BUMED (3rd floor approved). Atrium and parking garage to be discussed at FHCC Advisory Board 05/02/12.

7.27.12 – BUMED approval received to proceed with garage and stairwell; funding from FHCC.

1. Resubmit FY14 without resources required.

Joint Incentive Fund (JIF) Authority Alternative

October 10 EDM signed by Dr. Taylor (DoD) and Dr. Petzel (VA) to exclude the “totally integrated” facility from participating in the JIF.

CFO at Navy and VHA to develop parallel process for requesting funding for project / equipment that supplements Treasury Fund. Due 5/3/12

CFO’s Formed “Capital Purchasing Research Team” to develop recommendations for handling capital procurement at the FHCC. Team development & funded options for CFO review. EDM & white paper was signed on 25 July.

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It takes all of us to achieve the mission

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http://www.lovell.fhcc.va.govhttp://www.lovell.fhcc.va.gov

Questions?Questions?

Readying Warriors and Caring for Heroes