Without a formal evaluation plan, the success of the integration effort will be more difficult to determine after the 5-year demonstration period than it should be because not all the data needed for an evaluation are being collected prospectively.
RECOMMENDATION 5. In considering the Captain James A. Lovell Federal Health Care Center merger and future collaborative arrangements, 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.
Expand the Knowledge Base on Federal Health Care Collaborations
The DoD and the VA have not systematically analyzed the experience of the Lovell FHCC and the lessons that may be learned from it in considering if and where to establish additional integrated health care centers modeled after the Lovell FHCC merger.
The Lovell FHCC offers a number of lessons learned about what works well—and what does not—that would be useful to future FHCC decision makers and planners. The mergers of private-sector health care organizations do not provide adequate models for integration of federal health care organizations because they are narrowly based on increasing market share and revenue and usually do not involve clinical integration, only administrative consolidation. Published studies demonstrate substantial variation in performance after collaborative ventures. Nonetheless, lessons learned and pertinent data would be useful for both the Lovell FHCC and future endeavors (Appendix D contains a paper commissioned by the committee on the experiences of VA/DoD joint ventures and private-sector health care mergers).
RECOMMENDATION 6. The Department of Veterans Affairs (VA) and the Department of Defense (DoD) should fund studies to address the key findings and questions raised by the experiences of the Captain