The executive agreement (EA) for the Lovell FHCC identifies the desired outcomes. To recapitulate from Chapter 5, they are (compared with operating separate VA and DoD health care centers in the same health care market): more accessible health care, higher-quality health care (e.g., more preventive services and continuity and coordination of care), 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. Chapter 4 indicates that, first, data on some but not all of these outcomes are being collected monthly as part of the 15 integration benchmarks and that, second, it is difficult to discern trends in the short term.

The outcome criteria of most importance are financial, such as the net reduction in costs per episode of care or procedures; clinical, such as the numbers of preventable drug-drug interactions and allergic reactions to drugs; patient-focused, such as time to third appointment and standardized patient satisfaction survey results; and, in the case of the Lovell FHCC, military operational readiness-focused, such as the percentage of recruits unable to graduate on time for medical reasons. The evaluation framework in Appendix B suggests some intermediate-term outcomes that correspond to some of the outcomes expected of the Lovell FHCC listed above, such as higher patient volume and quality of care measures. Other metrics take longer to collect and analyze and are listed as long-term outcomes, such as cost per patient, increased market share, and health status of patients.

As part of this task, the committee was also asked to consider the differences in assessment criteria for FHCCs serving training units (such as the Recruit Training Command [RTC] at Great Lakes) and those serving operational units. Operational units are more varied and have more complex mission-related medical issues than training units. They require medical personnel with knowledge of military medicine, which VA medical personnel do not routinely have, and who respect the unique cultural identity of servicemembers in operational units. There are also service-specific differences in medical needs and the relationship between the medical and line units (e.g., Air Force medical units report to the local operational commander, while the Army and Navy medical commands are centralized). Administrative business functions would be similar for medical units serving training and operational units. Despite these differences between training and operational units, however, the criteria for success in an operational versus a training unit will be similar, although the benchmarks might be set at different levels.

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