DoD VA Joint Business Case Analysis(BCA)/Planning

1. DoD VA Joint Business Case Analysis(BCA)/Planning Integrated Healthcare Market Planning Mike Brock, VA Debra Irwin, AF

2. Overview • Business Case Analysis Planning • Project Proposals (JIF) • Project BCA Tool • Key Elements for a Successful Project Proposal and BCA • Project Proposal and BCA Lessons Learned

3. Business Case Analysis and VA/DoD Sharing • Purpose “The Secretary of Veterans Affairs and the Secretary of Defense shall enter into agreements for the mutually beneficial coordination, use, or exchange of use of the health care resources of VA and DoD. The goal is to improve the access, quality, and cost effectiveness of the health care provided by the Veterans Health Administration and the Military Health System to the beneficiaries of both Departments.” *MEMORANDUM OF UNDERSTANDING BETWEEN THE DEPARTMENT OF VETERANS AFFAIRS AND THE DEPARTMENT OF DEFENSE HEALTH CARE RESOURCES SHARING GUIDELINES October 31, 2008

4. Opportunities for VA-DoD Sharing • Purchased Care/Non-VA Care Recapture • Combining or Complementary Services to GME • Combining Other VA and DoD Services in one location – economies of scale • Joint training sessions – reduced training costs; increased training opportunities (non-GME) • Increased patient mix and complexity – enhanced clinical currency

5. Methods for Identifying Sharing Opportunities • Key: Routine Meetings of Local Leadership and Work Group (s) • Data Mining for Potential Projects • Enrollment • Staffing • Direct Care • Purchased Care • Business Case Analysis • Project Proposals

6. Elements of Successful Joint Incentive Fund Projects • Leadership Driven Process • VA/DoD Governance • Vision and Local Focus are a Critical Component • Jointly Defining Value of Services • Clinical Champion • GME Support • Input on clinical capabilities and availability • Data and Analysis - Defining Factor of Success • Must Meet JIF Criteria for Success (Quantitative and Qualitative; i.e. Self-Sustainingwithin Two-Years, Support GME )

7. Evaluation of Projects - Joint Incentive Fund • The Financial Management Workgroup meets to evaluate and score each proposal using the following criteria: • Improves Quality of Care & Access to Care • Mission Priority / Corporate Direction • Return on Investment • Measurable Performance Data Identified • Supports VA/DoD Joint Strategic Plan • Other Intangible Benefits • Size & Scope of Impact

8. Proposal Format (JIF) • Addresses three areas: • Descriptive Information on Project • Financial Information • Other Supporting Information

9. Proposal Format (JIF) Descriptive Information • Summary of the Project • Describe Project’s Goals and Objectives • Describe Outcomes • Tangible/Economic Benefits • Intangible Benefits • Any Waivers or Certificates Required? • Any Special Approval Required? (i.e. equipment) • Exportable?

10. Proposal Format (JIF) Descriptive Information • # of VA and DoD Beneficiaries Impacted • IT Interoperability • Prioritize (if more than one component) • Alternative Solutions Considered • Other Unique Circumstances • Contract Management/Oversight • Leadership Oversight (Meetings, minutes, etc) • “Show Stoppers” • How Supports Joint Strategic Plan?

11. Proposal Format (JIF)Financial Information • Level of Funding for each VA and DoD • Financial Benefit to VA and DoD • Plan for Reoccurring Costs after JIF is Used

12. Proposal Format (JIF)Other Supporting Information • Impact on waiting times or access • Impact on quality of care • Impact on Capital Asset Realignment for Enhanced Services (CARES) Study recommendations or Base Realignment and Closure (BRAC) decisions • Performance Criteria? Outcome Measures?

13. Components of the BCA Tool • Introduction and Instructions • Investment and Sustainment Costs • Personnel Costs • Total Costs • JIF Funding • Direct Benefits • Indirect Benefits • Summary (ROI, Payback Period) • Summary of all Components

14. BCA Standardized DoD and VA Data • Historical: Locally Applied/Bottom Up Approach • Future: Top Down/Market Based Perspective • Reports Produced Nationally • Analysis Done Locally • Development of Tools for Standardizing DoD and VA Data • AF/VA Datamart and Expansion to Army/Navy • Product/Service Line Crosswalk Maps VA Care Codes to MEPRS • Downloads to Microsoft Excel for Pivot Tables Relatively Easy to Manipulate and Present Relevant Cost, Supply and Demand Data; Require Analysis for Use by Leadership Decision Making

15. Lessons Learned – JIF Projects • Gain Leadership’s Approval Early • Intermediate Service Commands • VISNs • Difficulty recruiting in the following areas: • Rural markets • Part-time staff • MRI Technicians (GS versus Contract) • Hiring versus Contracting for Radiology • Realistic Cost Estimating • Salaries (Determine most appropriate: GS or Contract • Equipment • Minor Construction (i.e. MRIs, etc.)

16. Lessons Learned – JIF Projects (Cont.) • One Initiative Per Proposal (Support with Data) • IM/IT • Must be Congruent with Corporate Direction • Cannot Duplicate Existing Systems (Stovepipe) • Factor in long lead times for contract support • Project Funding • For JIF Projects, plan early for funding after two-year funds expended • Use Examples of Successful BCAs • http://www.tricare.osd.mil/DVPCO/default.cfm • Contact your Service Liaison or the VHA Medical Sharing Office for other examples

17. Lessons Learned – Business Case Analysis (Cont.) • Contingency Plan for Military Deployments • Honest Discourse and Developing Trusting Relationships Critical • Initial Time and Effort is High but Decreases as the Process and Project develops/matures