Highlight 1997 and selected 3rd Quarter 1998 accomplishments

Reaffirm the strategic directionarticulated in “Vision for Change”and “Prescription for Change”

Review 1998-2003 strategic targets

• Strategic Management Framework• Healthcare Delivery• Customer Service and Patient Satisfaction• Special Emphasis Programs• Enrollment and Improved Access to Care• Medical Education and Research• Resource Management• Information Management• Emergency Preparedness• Leadership in the Delivery of Healthcare Value

Contents

A A B & S

LL PPROPRIATE

ENEFITS ERVICES

“O -VA ”NE

M C & F NI HM N U PR /E C DI W

EET URRENT UTURE EEDS

MPROVE OVERALL EALTHCARE

EET EEDS OF NIQUE OPULATIONS

ESEARCH DUCATION ONTRIBUTE IRECTLY

MPROVE ORKFORCE

E A -E O -C S -C -R C /I R

ASE OF CCESS FFECTIVE UTREACH

USTOM ER ATISFACTION OURTESY

EDUCE OST M PROVE EVENUES

“10 2002”FORI C S -I A , T & A S -I T , E & S -E P

NCREASE USTOMER ATISFACTION

MPROVE CCURACY IMELINESS

W ARENESS OF ERVICES

NNOVATIVE RAINING DUCATION

UCCESSION

MERGENCY REPAREDNESS

O 300 PG

VER ERFORMANCE

OALS

T Q - C S -F S -A -C /P

ECHNICAL UALITY USTOM ER ATISFACTION

UNCTIONAL TATUS CCESS OST RICE

47 O I /P G (O I/P G)

UTCOM E NDICATORS

ERFORM ANCE OALS

“1 0 200 2”FORD C /P 30%

I U 20%I E R 10%

ECREASE SYSTEMW IDE OST ATIENT BY

NCREASE SERS BY

NCREASE XTERNAL EVENUES TO

E : H - C S -XCELLENCE IN EALTHCARE VALUE USTOMER ERVICE

H VFOR OMELESS ETERANSP M S & SROVIDE EDICAL ERVICES UPPORT

R -EESEARCH DUCATION

B E CE AN MPLOYER OF HOICE

E AXCEPTIONAL CCOUNTABILITY

L E /R P CS I O C

I E RM C

I A E I S

R ME E

INK DUCATION ESEARCH TO ATIENT ARE

HIFT FROM NPATIENT TO UTPATIENT ARE

MPLEMENT LIGIBILITY EFORM

ANAGED ARE

MPROVE CCESS

NHANCE NFORMATION YSTEMS

ESOURCE ANAGEMENT

MPOW ER M PLOYEES

STRATEGY

To attract and retain the bestpeople possible.

To employ clinical careactivities that increase thelikelihood of achievingdesired health outcomes.

To measure and monitorprogress in achieving desiredhealth outcomes.

To engage all levels of theorganization in both routineand event-triggered cyclesof improvement.

To enlist impartial and independent review of care.

I

II

III

IV

V

S T R A T E G Y

T o o p t i m i z e u s e o f t e c h n o l o g yt o a c h i e v e d e s i r e d h e a l t h o u t c o m e s .

T o o p t i m i z e p a t i e n t a n d p a t i e n tf a m i l y i n v o l v e m e n t i n t h e d e s i g n a n d d e l i v e r y o f h e a l t h c a r e s e r v i c e s .

T o p r e p a r e t h e c u r r e n t a n df u t u r e h e a l t h c a r e w o r k f o r c e t od e l i v e r h i g h q u a l i t y h e a t l h c a r ea n d t o a c t i v e l y p a r t i c i p a t e i ni m p r o v i n g c a r e .

T o g e n e r a t e n e w k n o w l e d g e t h a t f a c i l i t a t e s i m p r o v e d h e a l t ho u t c o m e s .

T o e n l i s t i m p a r t i a l a n d i n d e p e n d e n t r e v i e w o f c a r e .

V I

V I I

V I I I

I X

X

VHA Strategic Framework for Quality Management

0%

10%20%30%

40%50%60%

70%80%90%

1 3 5 7 9

P I IREVENTION NDEX N TERVENTION

S - 1997 N P A R O UR CE ETW ORK ER FORMANCE GR EEM EN T EPORT

P I - N I L E IR EVENTION NDEX ATIO N W IDE MPLEMENTA TION EVEL O F ACH NTERVENTIO N

FY 1996

FY 1997

8642

100%I

I

MPLEMENTAT

ON

LEVEL

OF

N 'A

AT LV G

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

I

I

MPLEMENTAT

ON

LEVEL

OF

C D I - N I L E IHRONIC ISEASE NDEX ATIONW ID E MPLEMENTATION EVEL OF ACH NTERVEN TION

C D I IHR ON IC ISEASE N DEX NTER VEN TION

S - 1997 N P A R OUR CE ETW ORK ER FORMANC E GREEM EN T EPORT

FY 1996

FY 1997

1 3 5 7 9 11 13 N 'A

AT LV G

2 4 6 8 10 12 14

Every VISN increased implementation of interventionsfrom the Chronic Disease Index(14 nationally recognized clinicalinterventions for ischemic heart disease, hypertension, COPD,diabetes, & obesity).

Every VISN increased implementationof interventions from the Prevention

Index (9 nationally recognized guidelines for immunizations, cancer

screening, tobacco consumption, and alcohol consumption.

One year survival rates improved for congestive heart failure,COPD, pneumonia, & chronic renal failure, and remained stablefor 5 other high volume conditions.

Enrollment in primary care increased and the proportion of patients who knew one provider or team was in charge of theircare increased.

Surgical mortality rates within 15 surgical specialties decreased or remained stable in 12 specialties, while increasing only slightly in 3 specialties.

VHA Developed and implemented the Palliative Care Index totrack efforts to provide end-of-life planning for terminally ill patients. VHA’s work is aimed at minimizing physical and psychological suffering and optimizing the quality of life for these patients.

STAFF COURTESY TIMELINESS

ONE PROVIDER DECISIONS

PHYSICAL COMFORT EMOTIONAL NEEDS

PATIENT EDUCATION TRANSITION

FAMILY INVOLVEMENT COORDINATION OF CARE

GOALS 1996 1997 1998 1999 2002

By 2002, increase to 90% the 65% 65% 75% 79% 95%proportion of patients reportingVA inpatient healthcare as very good or excellent.

By 2002, increase to 90% the 61% 63% 75% 79% 95%proportion of patients reportingVA outpatient healthcare asvery good or excellent.

Increase to 90% the proportion 78% 79% 85% 87% 90%of patient who rate the quality of VHA healthcare as equivalentto or better than what theywould receive from others.

Special emphasis programs are clinical services that address illnesses specific to the service-connected veteran population,constitute areas of special VA expertise, or are unique programs addressing the psycho-social needs of certain identified veterans.

Addictive D

isorders

Blind Rehabilit

ation

Geriatri

cs and

Long-T

erm C

are

Gulf W

ar Vete

rans

Hom

elessness

Post T

raum

atic

Stress D

isorder

BP

I

ESTRACTI CES

ORNNOVATI ONS

Rural Access for Readjustment Counseling Services …. SeveralVet Center outstations have been opened on Native American Indian reservation lands. The centers provide a broad base of outreach and case management, as well as counseling, and serve as points of referral into the VA healthcare system. They are staffed by Native American service providers, who maintain sensitivity to the local culture and collaborate with native healing philosophies and practices.

Outpatient Model Program for SCI Evaluations…. VAMC Augusta began providing comprehensive outpatient annual SCI evaluations. Veterans who receive an average of 16 clinical services in 2 - 3 days. Due to veteran travel distances, VA contracted with an SCI residential care home for lodging and personal care assistance. In its first year, the program provided evaluations for 349 veterans, and a minimum of 1047 bed days of care were avoided. Patients are pleased with the efficient scheduling, comprehensive services, lodging arrangements, and the staff assistance.

BP

I

ESTRACTI CES

ORNNOVATI ONS

ELIGIBILITY REFORM enables VHA:

• to provide needed healthcare in the most appropriate setting

• to include preventive and primary care services

• to expand sharing authority

• to enroll veterans in the VHA healthcare system.

RIGHT

SE

RV

ICE

PLACE

TIME

200

300

400

500

600

700

1997 1998 1999 2003

N C B O C U M B E R O F O M M U N IT Y A S E D U T P A T IE N T L IN IC S

S : VHA P P , 1998O U R C E E R F O R M A N C E L A N

267

430 501

659

F YISC AL EA R

1000

2000

3000

4000

5000

6000

7000

8000

9000

A OLL THER

P CRIMARY ARE

M R P C TEDICAL ESIDENTS IN RIMARY ARE RAINING

S : VHA O A AOURCE FFICE OF CADEMIC FFAIRS

38.6%

1996

1997

1998

1999

2000

M

I

ED

CAL

R

I

ES

DENTS

48.4%45.9%41.0%39.3%

F YISCAL EAR

VHA supports 10% of nations graduate medical education positions annually.

VHA supports training for 54,000 people in over 40 allied health professions.

Increasing generalist residencies by 750positions

Reducing specialtyresidencies by 1000positions: - 25 % in AY 97/98, - 50% in AY 98/99 - 25% in AY 99/00.

I N R D P

N C R E A S E T H E U M B E R O FE S E A R C H A N D E V E L O P M E N T R O JE C T S

1600 17001650 1750N PUM BE R O F R O JE CT S

1800

1999

1997

1998

1996

2003

S : VHA P P , 1998OURCE ERFO RMANC E LAN

FISCAL

YEAR

1 7 9 5

1693

1 7 0 0

1666

1800

I N F R P R VA’ H M

D R A

N C R E A S E T H E U M B E R O F U N D E D E S E A R C H R O J E C T SE L E V A N T TO S E A L T H C A R E IS S IO N

IN E S IG N A T E D E S E A R C H R E A S

60 % 80 %70 % 90 % 100 %

1999

1997

1998

1996

2003

S : VHA P P , 1998O URCE ER FORM ANCE LAN

99 %

99 %

99 %

97 %

87 %

FISCAL

YEAR

The purpose of VA’s research program is to discover knowledge and create innovations that

advance the health and care of veterans and the nation.

Both the number of R&D projects and the number of projects specificallyrelevant to VA’s healthcare mission will increase substantially by 2003.

Decrease the systemwide average cost per patient by 30%.

FY96 FY97 F&03decrease bed days of care

2500 1782 1300 per 1000 unique users

increase percent of 50% 54% 75% healthcare budget

expended on outpatient care

46% 69% NA increase the proportionof surgeries and proceduresdone in an ambulatorycare setting

Increase the percent of the operating budget obtained from non-appropriated

sources to 10% of the total.

Increase the percent of patients identified with insurance.

Increase the number of VA medical centers with DoD managed care support contracts (Tricare).

Increase the number of Enhanced Use Leasing projects.

Obtain Congressional authorization for a Medicare pilot.

Refine the

ResourceAllocation

Methodology

F Y 19 9 6 - F Y 19 9 8 R A NESO UR CE L LO CA TIO NS B Y ETW O RK

($ M )IN IL L IO NS

V IS N F Y 1 99 6 F Y 1 99 7 F Y 1 99 8 F Y 19 9 6 -

1 99 7

F Y 19 9 7 -

1 99 8Tota l

1 B OST O N $ 85 4 $ 84 5 $ 80 9 -1 .0 % -4 .2 % -5 .2 %

2 A LBANY $ 43 7 $ 43 4 $ 41 6 -0 .7 % -4 .1 % -4 .8 %

3 B RO NX $ 1,02 2 $ 1,01 7 $ 97 4 -0 .5 % -4 .2 % -4 .7 %

4 P IT T SBURG H $ 77 5 $ 77 9 $ 77 9 0 .5 % 0 .0 % 0 .5 %

5 B ALT IM O RE $ 42 4 $ 44 2 $ 46 0 4 .2 % 4 .1 % 8 .5 %

6 D U RHAM $ 68 2 $ 70 7 $ 70 4 3 .7 % -0 .4 % 3 .3 %

7 A TL ANT A $ 77 8 $ 81 5 $ 85 6 4 .7 % 5 .1 % 1 0.0%

8 B PAY INES $ 96 0 $ 1,01 8 $ 1,07 1 6 .1 % 5 .2 % 11 .6 %

9 N ASH VIL LE $ 68 8 $ 70 0 $ 70 4 1 .7 % 0 .6 % 2 .3 %

10 C INCINN ATI $ 511 $ 53 0 $ 53 5 3 .8 % 0 .9 % 4 .8 %

11 A AN N R BOR $ 65 5 $ 65 7 $ 63 2 0 .4 % -3 .8 % -3 .5 %

12 C HICAG O $ 83 4 $ 82 8 $ 79 5 -0 .8 % -4 .0 % -4 .7 %

13 M INN EAPOL IS $ 41 7 $ 42 6 $ 41 5 2 .0 % -2 .6 % -0 .6 %

14 O M A H A $ 29 1 $ 28 8 $ 27 7 -1 .1 % -3 .8 % -4 .8 %

15 K CAN SAS IT Y $ 58 5 $ 61 6 $ 61 6 5 .3 % 0 .1 % 5 .4 %

16 JAC KSON $ 1,07 4 $ 1,13 5 $ 1,19 4 5 .7 % 5 .1 % 11 .1 %

17 D ALL AS $ 58 7 $ 62 3 $ 65 2 6 .2 % 4 .7 % 11 .2 %

18 P H OEN IX $ 48 5 $ 51 8 $ 54 5 6 .8 % 5 .1 % 1 2.3%

19 D ENVER $ 36 7 $ 38 5 $ 39 4 4 .8 % 2 .4 % 7 .3 %

20 P O RT LAN D $ 58 4 $ 62 2 $ 65 2 6 .4 % 4 .9 % 11 .7 %

21 S FAN R ANCISCO $ 68 8 $ 72 0 $ 73 3 4 .7 % 1 .7 % 6 .5 %

22 L BO NG EACH $ 90 0 $ 91 8 $ 94 3 2 .0 % 2 .7 % 4 .8 %V H A $ 14 ,5 9 8 $ 15 ,0 2 2 $ 15 ,1 5 7 2 .9 % 0 .9 % 3 .8 %

% C HAN GE

N : T V E R A , F Y 1 9 9 6 . T O TE H IS R E FL E C TS T H E IM PA C T O F W IT H C A PS IN R E LA TIO N T O H E T O T A L S IN C L U D E EQ U IPM EN T

N -R M . T .A N D O N EC U R R IN G A IN T EN A N C E A FT E R T H E C A PPIN G H E N U M B E R S M A Y N O T A D D D U E TO R O U N D IN G

Provide seamlessly integrated care, continuousreliable and flexible communications and

information transmission, and timely readilyaccessible management systems.

Improve VHA’s technology infrastructure Telecommunications Infrastructure Project (TIP) Microsoft Exchange Internet/Intranet Functionality ProjectExpand support for clinical operations Clinical Information Resources Network (CIRN) Computerized Patient Record System (CPRS) Government Computer-Based Patient Record (G-CPR) Imaging ProjectExpand support fo r administrative decision making Decision Support System (DSS) Enrollment system Project Non-VA Patient Care Project

Provide seamlessly integrated . . . . . (cont’d)

Improve the interface with VBA Automated Medical Information Exchange (AMIE) Phase II

P V A F E P A M I E IR O P O R T I O N O F A C I L I T I E S I N A C H H A S E O F M P L E M E N T A T I O N

S : V H A C I O O U R C E H I E F N F O R M A T I O N F F I C E

36%

25%

24%

10%

5%

G 2 IRO UP M P L E M E NT A TIO N

G 1 IR O U P M P L EM EN T AT IO N

G 3 IRO UP M P L E M E NT A TIO N

B TE T A E S TING

A TL P HA ES T IN G

VHA will preserve the capability to respond to any kind of incident, from a local event -- such as a small fire in a healthcare facility,to a major disaster -- such as floods, hurricanes, terrorism.

Provide medical backup tothe Department of Defense

in the event of a nationalsecurity emergency.

Provide medical and other support during

federal disaster response.

Provide medical backup tothe Department of Defense

in the event of a nationalsecurity emergency.

Provide for emergencieswithin VHA while

continuing service deliveryfor eligible veterans.

Providesmedical care to 3.6 million

veterans.

Serves as the largestsingle provider of healthprofessions training inthe world.

One of the largestand most productiveresearch organizationsin the country.

Becoming the principal Federal asset for medical assistance in large-scale disasters.

Largest direct care provider for homelesspersons in the country.

A strong decentralizednational network ofhealthcare providers

a full continuum of care

clinical services groundedin clinical care guidelines

VHA today faces the issues and trends of thechanging healthcare marketplace of tomorrow

with a number of distinct advantages.

a 10 dimension qualitymanagement accountabilityprogram

a strong and well qualified staff

a wealth of experience in education, research, chronic care and geriatric care

A strong decentralizednational network ofhealthcare providers

a full continuum of care

clinical services groundedin clinical care guidelines

VHA will focus on five areas where it may assumea leadership role over the next several years.

To set the national standard for healthcare quality management.

To have a compassionate and high quality workforce that is nationally regarded as being in the vanguard of innovation, teamwork, quality and service.

To generate new knowledge at the forefront of national healthcare andthat facilitates improved clinical outcomes.

To build education programs reflecting its experience base and to bein the vanguard of integrating medical education and service deliveryin organized or managed care settings.

To be a national leader in providing exceptional information technologyand services to support delivery of the best healthcare to veterans.

1997

1999

2001