Many obstacles were identified in achieving the vision of these joint ventures or models of DoD/VA collaboration. The obstacles were remarkably similar across the organizations. Most frequently identified were IT problems due to different and incompatible electronic data systems. Lack of shared EHR systems led to a number of cross-organizational systems problems. Efforts to address IT issues were costly and slow. Statistical data required for reporting and accreditation mandates proved more difficult to collect because of compatibility issues. Joint billing systems and procedures for sharing resources proved challenging as well. Purchasing of equipment and supplies was difficult due to different processes used by the DoD and the VA systems. Workarounds were created, but these were not always efficient.

Most of the joint ventures had issues with financing operations, financial systems, or tracking economic impacts. Efforts to address funding flow and allocation processes were an ongoing challenge. Mixed reimbursement regulations made the evaluation of revenues and expenses less accurate for the collaborative organization than for the DoD or the VA system alone. The economic impact of different staffing models using both DoD and VA personnel was difficult to measure for some of the organizations. Most included some type of joint planning or oversight as one way to improve human resource processes and financial management.

Despite systems obstacles, leaders, managers, and caregivers sought a variety of ways to address problems because of strong commitment to high-quality patient care. At the time of this evaluation, most of the organizations had in-progress plans for enhanced services going forward, for example, expanded subspecialty care, restorative medical specialties, advanced rehabilitation services, vision services, and long-term pain management plans for patients. Self-reported progress on a variety of parameters for these nine case studies of unique DoD/VA collaborative efforts was generally positive. While challenges and obstacles remain and some joint ventures have reduced their overall sharing due to changing organizational needs (e.g., Albuquerque), none reported plans for dissolution of their entire collaboration effort.


The committee commissioned a review of the literature evaluating collaborative ventures among private hospitals and physician groups (see Appendix D). The review, conducted by Thomas D’Aunno, summarized

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