Evaluation of the Lovell Federal Health Care Center Merger Findings, Conclusions, and Recommendations (2012) / Chapter Skim
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6 Findings, Conclusions, and Recommendations
6 Findings, Conclusions, and Recommendations
Pages 165-178
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medical center in North Chicago into a federal health care center (FHCC) in terms of its benefit to the Department of Defense (DoD)
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Determine if success criteria would be different if the partner DoD health care facility was supporting operational units instead of basic/ advanced training units, such as the Navy Health Center Great Lakes.
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, cost savings or cost avoidance, increased market share among eligible beneficiaries, greater patient satisfaction, greater provider satisfaction, improved clinical proficiency of active duty providers, improved training programs, and better research opportunities. Operational measures for each of these outcomes need to be identified and adopted.
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The committee notes that most of the performance measures are specific to the VA or to the DoD rather than to the integrated performance of the FHCC, which is why the committee concluded that these alone do not constitute the basis for an adequate evaluation of the Lovell FHCC's success at achieving integration. The main purpose of the performance benchmarks was to address the concerns of the respective departments that the Lovell FHCC experiment might fail badly before the end of the 5-year demonstration period.
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The review of the private-sector merger literature appears in Appendix D, "Collaboration Among Health Care Organizations: A Review of Outcomes and Best Practices for Effective Performance," and is summarized in Chapter 5. The lessons learned from the VA/DoD joint ventures reported at the annual joint venture conferences are also summarized in Chapter 5, and short profiles of each joint venture and the lessons learned they have reported are in Appendix C, "Department of Veterans Affairs/Department of Defense Joint Ventures: Brief Histories and Lessons Learned." Task 4: Stakeholder Concerns The committee was not able to conduct a statistically valid survey of the most important stakeholders, the patients.
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The concern was whether independent duty corpsmen (IDCs) and active duty advanced practice nurses (APNs)
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RECOMMENDATIONS Develop Uniform Policies, Procedures, and Business Practices for Federal Health Care Centers Findings The Lovell FHCC model is distinguished from other VA/DoD collaborative initiatives primarily by being a single organization rather than a partnership. The concept is that a health center that is operationally unified will be more cost effective and better positioned to provide high-quality health care.
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RECOMMENDATION 1. Before establishing additional federal health care centers, the Department of Veterans Affairs and the Department of Defense should agree on a governance plan and common policies and procedures for joint health care delivery functions.
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RECOMMENDATION 2. Additional federal health care centers should not be implemented until an interoperable or joint Department of Defense/Department of Veterans Affairs electronic health record system becomes available.
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Develop Criteria for Selecting Future Federal Health Care Center Sites Findings The VA and the DoD have developed criteria for identifying "joint market areas" for increased health care sharing. They are health care markets with large DoD and VA beneficiary populations where shared facilities and services would provide access to services or infrastructure not available in one or the other organization; improve efficiency through economies of scale; reduce duplication of services, infrastructure, or both; and mitigate the impact of deployment on access.
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Only when firm cri teria based on cost savings and the expectation of enhanced health care service delivery are met should the concept of a future FHCC be considered. Analyze and Promulgate Lessons Learned from the Lovell Federal Health Care Center Experience Findings The leadership of the Lovell FHCC encountered numerous issues that had to be resolved to achieve an integrated organization and uniform policies and procedures.
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Lovell Federal Health Care Center merger experience, including both what and what not to do, and disseminate them through onsite consultation, webinars, technical assistance, and other means to other federal health care center sites considering joint ventures and related collaborative arrangements. Conduct a Comprehensive Evaluation of the Lovell Federal Health Care Center Demonstration Findings The Lovell FHCC has been in operation for less than 2 years and is still implementing parts of the integration plan.
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Lovell Federal Health Care Center merger and future collaborative arrange ments, the Department of Veterans Affairs and the Department of Defense should develop a comprehensive evaluation framework with defined and measurable criteria for assessing performance that take into account local and national contexts, organizational capabilities and readiness, implementation plans, intermediate outcomes, and likely long-term impact. The committee offers a comprehensive evaluation framework in Appendix B
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Lovell Federal Health Care Center IT informational brief. Presenta tion by the director of the DoD/VA Interagency Program Office to the IOM Committee on Evaluation of the Lovell Federal Health Care Center Merger at its first meeting, Washington, DC, February 25.
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