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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

Evaluation of the Lovell Federal
Health Care Center Merger

__________________________

Findings, Conclusions, and Recommendations

Committee on Evaluation of the Lovell
Federal Health Care Center Merger

Board on the Health of Select Populations

INSTITUTE OF MEDICINE
             OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

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NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.

This study was supported by Contract/Grant No. HT0011-10-C-0002 between the National Academy of Sciences and the Department of Defense. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the views of the organizations or agencies that provided support for the project.

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Suggested citation: IOM (Institute of Medicine). 2012. Evaluation of the Lovell Federal Health Care Center merger: Findings, conclusions, and recommendations. Washington, DC: The National Academies Press.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

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              OF THE NATIONAL ACADEMIES

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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COMMITTEE ON EVALUATION OF THE LOVELL FEDERAL HEALTH CARE CENTER MERGER

MICHAEL M. E. JOHNS (Co-Chair), Chancellor, Emory University, Atlanta, GA

STEPHEN M. SHORTELL (Co-Chair), Dean of the School of Public Health, Blue Cross of California Distinguished Professor of Health Policy & Management, and Professor of Organization Behavior, School of Public Health and Haas School of Business, University of California, Berkeley

NANCY R. ADAMS, Senior Partner, Martin, Blanck & Associates, Falls Church, VA

GEORGE K. ANDERSON, Executive Director, Association of Military Surgeons of the United States, Bethesda, MD

PETER B. ANGOOD, Chief Executive Officer, American College of Physician Executives, Tampa, FL

LAWTON R. (ROBERT) BURNS, Chair of the Health Care Management Department, James Joo-Jin Kim Professor, and Professor of Health Care Management, Wharton School, University of Pennsylvania, Philadelphia

EMMANUEL G. CASSIMATIS, President and Chief Executive Officer, Educational Commission for Foreign Medical Graduates, Philadelphia, PA

TIMOTHY C. FLYNN, Senior Associate Dean for Clinical Affairs, College of Medicine, and Chief Medical Officer, Shands Hospital, University of Florida, Gainesville

LARRY M. MANHEIM, Research Professor in the Institute for Healthcare Studies and the Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL

JOHN E. MAUPIN, JR., President and Chief Executive Officer, Morehouse School of Medicine, Atlanta, GA

KAREN L. MILLER, Senior Vice Chancellor for Academic and Student Affairs, University of Kansas Medical Center, Kansas City

FRANCES M. MURPHY, President, Sigma Health Consulting, LLC, Silver Spring, MD

J. MARC OVERHAGE, Chief Medical Informatics Officer, Siemens Health Services, Malvern, PA

SUSANNE TROPEZ-SIMS, Associate Dean of Clinical Affiliations and Professor of Pediatrics, Meharry Medical College, Nashville, TN

CAROLYN (CINDY) WATTS, Professor and Chair of the Department of Health Administration, Virginia Commonwealth University, Richmond

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Consultants

DAVID K. BARNES, Advanced Policy Solutions, Bethesda, MD

THOMAS A. D’AUNNO, Executive Vice Dean, Mailman School of Public Health, Columbia University, New York, NY

IOM Study Staff

MICHAEL McGEARY, Study Director

SUSAN R. MccUTcHEN, Senior Program Associate

LAVITA SULLIVAN, Senior Program Assistant

FREDERICK (RICK) ERDTMANN, Director, Board on the Health of Select Populations

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

Reviewers

This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report:

Elizabeth H. Bradley, Yale School of Public Health

Timothy G. Buchman, Emory University School of Medicine

Jon B. Christianson, University of Minnesota School of Public Health

Audrey C. Drake, Department of Veterans Affairs (Deputy Chief Nursing Officer Emeritus)

Nancy E. Dunlap, University of Alabama at Birmingham

Richard G. Frank, Harvard Medical School

Kyle L. Grazier, University of Michigan School of Public Health

James E. Hastings, Department of Veterans Affairs Pacific Islands Health Care System

Richard E. Oliver, University of Missouri School of Health Professions

Jonathan B. Perlin, Hospital Corporation of America

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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Lawrence M. Riddles, American College of Physician Executives

Paul H. Rockey, Accreditation Council for Graduate Medical Education

Hector P. Rodriguez, University of California, Los Angeles, School of Public Health

James M. Walker, Geisinger Health System

Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations, nor did they see the final draft of the report before its release. The review of this report was overseen by Charles E. Phelps, University of Rochester, and David R. Challoner, University of Florida. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Preface

An important experiment in federal health care delivery is taking place in North Chicago, Illinois. In 2010, the Navy and the Department of Veterans Affairs (VA) consolidated their medical centers, which had operated 1.5 miles apart from each other for many years, into a joint health care center named the Captain James A. Lovell Federal Health Care Center (FHCC) after the well-known astronaut who lives near the facility. In a time of severe fiscal constraints and heightened concern about smoothing the transition of injured military servicemembers from active duty to veteran status, the possibility of providing better care at less cost by combining military and VA medical centers in the same health care market has great appeal. The outcomes of the Lovell FHCC experiment, therefore, are of significant interest to federal policy makers.

The 1995 Defense Base Consolidation and Realignment Commission decided to consolidate Navy recruit training, then in three locations, at the Naval Station Great Lakes, located near the city of North Chicago. This decision gave more urgency to the need to replace the old and obsolete Navy hospital with a new hospital, an action the Navy had planned for 2007. In 1999, a VA task force proposed converting the North Chicago VA medical center from a hospital to an outpatient facility, which was strongly opposed by veterans, community leaders, and their representatives in Congress. The solution reached by the VA/Department of Defense (DoD) Health Executive Council (HEC) was to have the Navy use the VA hospital for inpatient and emergency services rather than to build a new Navy hospital. The new arrangement was expected to reduce costs for the Navy and the VA while

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

increasing the patient workload enough to justify keeping the VA hospital open. The Navy began to use the North Chicago VA medical center for acute inpatient mental health services in 2003 and for all inpatient medical, surgical, and pediatric services in 2006.

In 2002, the HEC directed the Navy to build an outpatient facility next to the North Chicago VA medical center, so that all care for veterans and Navy servicemembers and other DoD beneficiaries could be provided in one location. This model had been pioneered in Albuquerque, New Mexico, where the VA medical center provides inpatient services to DoD beneficiaries, who receive their outpatient care at the Air Force ambulatory care center next to it. Similarly, veterans in Hawaii and south-central Alaska receive outpatient services from VA ambulatory care facilities built beside the Army and Air Force hospitals in Honolulu and Anchorage, respectively, where they go to receive inpatient services. These cooperative arrangements, in addition to several other similar, extensive VA/DoD health care sharing arrangements in various locations around the United States, are called “joint ventures.” In joint ventures, the VA medical center and the military medical center agree to reimburse each other for services received.

In 2005, the HEC made the momentous decision to go beyond the joint venture model and create the first “integrated” FHCC in North Chicago, which was characterized by a combined medical staff organized in a single set of clinical departments under one chief medical executive, a single set of administrative units, and a single chain of command under one FHCC chief executive. The date set for full integration was October 1, 2010, barely 5 years in the future.

The decision was based on the idea that a single organization should be able to provide better care for patients at lower cost for taxpayers than would a joint venture. The care should be better because it would be more comprehensive and coordinated, and the financial costs should be reduced because of economies of scale, reduced duplication, and other efficiencies. Local Navy and VA leaders fully embraced the concept of the Lovell FHCC, especially the idea of having one staff and one system wherever possible rather than having two side by side. The systems in question included quality assurance, patient medical records, provider accreditation, budgeting and accounting, personnel management, purchasing, and physical plant management.

A long and complicated process ensued, which included accommodating the separate but overlapping missions of the DoD and the VA health systems; reconciling the different policies and procedures, performance measures, and organizational cultures of the Navy and the VA; and overcoming several statutory limitations on interdepartmental integration, such as strictures on transferring property and personnel. Chapter 3 in this report reviews this implementation process, identifies the main issues that had

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

to be resolved between the Navy and the VA, and documents how they were resolved—sometimes fully, sometimes partially, and sometimes not at all.

Some areas of incomplete or nonintegration, such as having to operate the provider accreditation systems of both departments, have resulted in continued duplication and thus are reducing potential efficiencies. Others affect patient care. Most critically, the VA and the DoD electronic health record (EHR) systems are not compatible, and few of the software programs created to make them interoperable—that is, to make it possible to enter one EHR system (or an interface) and view and enter information in both EHR systems simultaneously so that care can be optimized—were operational when the Lovell FHCC opened. To ensure, at a minimum, that patient safety is not compromised by harmful drug interactions or allergies, the Lovell FHCC had to develop costly manual pharmacy workarounds. When DoD patients are seen by VA specialty, inpatient, and emergency medicine providers, manual workarounds are necessary to enter the clinical information recorded in the VA EHR system into the DoD EHR system. We should note that this problem has been recognized and was part of the reason that in early 2011 the DoD and VA secretaries committed their departments to developing a joint EHR system, beginning with the single pharmacy system that is greatly needed at the Lovell FHCC.

In Chapter 4, our committee assesses the results of the integration experiment, to the extent they can be ascertained after less than 2 years of operation. Clearly, the leaders of the North Chicago FHCC initiative have succeeded, through tremendous effort, in creating a single organization serving both beneficiary populations. However, the degree of integration of clinical and administrative services varies across the organization, mostly because of external constraints. Nonetheless, the more important questions are whether the creation of the FHCC in North Chicago has been worthwhile and if it is a good model for merging the VA and the DoD health care delivery systems in other locations where they have facilities in close proximity.

The Lovell FHCC has not been in operation long enough to determine the benefits accrued and to assess whether it has been cost effective. Appendix B contains an evaluation framework that would be useful for the DoD and the VA to adopt so that at the end of the 5-year demonstration period for the Lovell FHCC these organizations will be able to decide whether the merger is worthwhile and whether it can be replicated elsewhere. In the meantime, our report recommends some ways that the departments could facilitate integration by resolving differences in department policies, procedures, and systems at the national level.

We would like to thank many people who helped with this study. Most are listed in the Acknowledgments section of the report; others contributed by agreeing to give confidential interviews, which were extremely helpful.

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×

We are particularly grateful to Janice Halkovich of the Lovell FHCC for arranging interviews and access to data and for helping to schedule presentations at the committee’s two meetings in North Chicago. We would also like to thank the hardworking members of the committee who attended the meetings, read extensive materials between meetings, and helped draft the report and review its several iterations. Their experience and expertise were critical to this evaluation and in formulating the committee’s consensus conclusions and recommendations. Finally, we would like to thank the Institute of Medicine staff—Michael McGeary, Susan R. McCutchen, and LaVita Sullivan—who diligently collected the enormous amount of information that forms the basis of this report and organized our meetings to facilitate productive discussions.

Michael M. E. Johns, and
Stephen M. Shortell, Co-Chairs
Committee on Evaluation of the
Lovell Federal Health Care Center Merger

Page xiii Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Acknowledgments

Many individuals and organizations contributed to the study. In particular, the committee and staff would like to thank the individuals listed below who took the time to provide information about, and their views of, the implementation, operation, and impacts of the Captain James A. Lovell Federal Health Care Center (Lovell FHCC). The committee would also like to thank the approximately 50 individuals who agreed to be interviewed on a confidential basis, who cannot be listed here but who provided important input into the study.

Mark Albrecht, Lovell FHCC

Mary Ann Allred, Lovell FHCC

CDR Martin Anerino, Lovell FHCC

Norman Arnswald, Veteran/Lovell FHCC Customer

CAPT Dale Barrette, Lovell FHCC

CAPT David J. Beardsley, Lovell FHCC

CAPT Steven G. Bethke, Recruit Training Command, Naval Station Great Lakes

Thomas Bresciano, Lovell FHCC

Jill K. Center, Government Accountability Office (GAO)

Kenneth L. Cox, Office of the Assistant Secretary of Defense for Health Affairs, Department of Defense (DoD)

Joseph X. DiMario, Rosalind Franklin University of Medicine and Science

CDR Bridgette Faber, Lovell FHCC

Imran Faizi, Lovell FHCC

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Debra M. Filippi, DoD/Department of Veterans Affairs (VA) Interagency Program Office

Lenny Floom, Veteran/Lovell FHCC Customer

LCDR Aaron Frank, Lovell FHCC

Leanne Fredrickson, Lovell FHCC

Sarah Fouse, Lovell FHCC

CMC Ross Gilliatt, Lovell FHCC

Janice Halkovich, Lovell FHCC

Tariq Hassan, Lovell FHCC

CAPT Rich Hayden, Lovell FHCC

COL Claude Hines, Jr., Military Health System, DoD

Patrick Hull, Lovell FHCC

Andre Greedan, Lovell FHCC

Ronald Kaplan, Rosalind Franklin University of Medicine and Science

Laura Kelly, VA Northern California Health Care System

CMDR Ruth Kline, Lovell FHCC

CDR Eileen Knoble, Lovell FHCC

CAPT Norman Lee, Lovell FHCC

Frank Maldonado, Lovell FHCC

Karen T. Malebranche, Office of Interagency Health Affairs, VA

John G. Manczko, Lovell FHCC

Tiffany McFadden, Lovell FHCC

Barbara Meadows, Lovell FHCC

Gloria E. Meredith, Rosalind Franklin University of Medicine and Science

James Miller, Lovell FHCC

Paul Morgan, Lovell FHCC

CAPT Maryalice Morro, Navy Medicine East, Bureau of Medicine and Surgery, U.S. Navy

Clifford Moudy, Lovell FHCC

Jeffrey A. Murawsky, Veterans Integrated Service Network 12, VA

Robert Opsut, Office of the Assistant Secretary of Defense for Health Affairs, DoD

CAPT Kevin Otte, Lovell FHCC

CAPT James Oxford, Lovell FHCC

Kelvin Parks, Lovell FHCC

Nancy L. Parsley, Rosalind Franklin University of Medicine and Science

Michael Peck, Lake County Veterans Assistance Commission

LCDR Donna Poulin, Lovell FHCC

Robert Charles Powell, Constituent, Illinois 10th Congressional District

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Wendy Rheault, Rosalind Franklin University of Medicine and Science

Russell Robertson, Rosalind Franklin University of Medicine and Science

Mary Schindler, Lovell FHCC

Marianne Semrad, Lovell FHCC

Robert Sorensen, Lovell FHCC

Patrick L. Sullivan, Lovell FHCC

Gregory X. Swanson, TRICARE North Region

Keith Tietmeyer, Office of Information and Technology, VA

Estan Villarreal, Veteran/Lovell FHCC Customer

Piyush Vyas, Lovell FHCC

K. Michael Welch, Rosalind Franklin University of Medicine and Science

E. Jane Whipple, GAO

Lt. Col. Doreen Wilder, David Grant U.S. Air Force Medical Center

Malissa G. Winograd, GAO

Edwin Zarling, Lovell FHCC

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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B-1   Framework for Evaluating Department of Veterans Affairs and Department of Defense Health Care Collaborations

D-1   Key Variables in Collaboration Among Health Care Organizations

D-2   Summary of Empirical Studies of the Effects of Hospital Mergers, Systems, and Alliances on Hospital Financial Performance and Quality of Care

D-3   Summary of Empirical Studies of Outcomes of Collaboration Among Health Care Organizations

D-4   Application of Best Practices to Collaboration Among Heath Care Organizations: Technical and People-Focused Leadership Tasks

FIGURES

3-1   Lovell Federal Health Care Center leadership organization chart

4-1   Selected HEDIS results for the Lovell Federal Health Care Center, 2005–2011 (percentage of patients) (Part 1)

4-2   Selected HEDIS results for the Lovell Federal Health Care Center, 2005–2011 (percentage of patients) (Part 2)

4-3   Selected HEDIS results for the Lovell Federal Health Care Center, 2005–2011 (percentage of patients) (Part 3)

4-4   ORYX results for heart attack patients at the Lovell Federal Health Care Center, 2008–2011 (percentage of patients)

4-5   ORYX results for heart failure patients at the Lovell Federal Health Care Center, 2008–2011 (percentage of patients)

4-6   ORYX results for pneumonia patients at the Lovell Federal Health Care Center, 2008–2011 (percentage of patients)

4-7   Selected SCIP results for the Lovell Federal Health Care Center, 2008–2011 (percentage of patients)

4-8   TRICARE patient ratings of the Lovell Federal Health Care Center, 2011 (100-point scale)

4-9   TRICARE patient ratings of access to care and physician-patient communication at the Lovell Federal Health Care Center, 2003–2011 (100-point scale)

4-10 TRICARE patient ratings of aspects of care at the Lovell Federal Health Care Center, 2003–2011 (100-point scale)

4-11 Department of Veterans Affairs outpatient satisfaction scores, fiscal years 2009–2011

Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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Abbreviations and Acronyms

200H Naval Hospital Great Lakes (also referred to as NHGL)
 
ACC ambulatory care center
AHLTA Armed Forces Health Longitudinal Technology Application
ANACI Access National Agency Check with Inquiries
APC ambulatory payment classification
APN advanced practice nurse
ARC Allocation Resource Center
 
BAH Booz-Allen & Hamilton (former name for Booz Allen Hamilton)
BHIE Bi-directional Health Information Exchange
BRAC Base Realignment and Closure
BUMED Bureau of Medicine and Surgery
 
CAC common access card
CAP community-acquired pneumonia
CARES Capital Asset Realignment for Enhanced Services
CCQAS Centralized Credentials and Quality Assurance System
CHAMPUS Civilian Health and Medical Program of the Uniformed Services
CHDR Clinical Data Repository/Health Data Repository
CMOP Consolidated Mail Order Pharmacy
CMS Centers for Medicare & Medicaid Services
CNA Center for Naval Analyses
Page xxiv Cite
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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CO commanding officer
CPRS Computerized Patient Record System
CR continuing resolution
CTG clinical task group
 
DMHRSi Defense Medical Human Resources Systems-internet
DMLSS Defense Medical Logistics Standard Support
DoD Department of Defense
DOS disk operating system
DSS Decision Support System
DWV dental weighted value
 
EA executive agreement
eDR enhanced document referral
ED emergency department
EDM executive decision memorandum
EHR electronic health record
ESA executive sharing agreement
 
FHCC federal health care center
FHCF federal health care facility
FLITE Financial and Logistics Integrated Technology Enterprise program
FMS Financial Management System
FTE full-time equivalent
FY fiscal year
 
GAO Government Accountability Office (since 2004) or General Accounting Office (prior to 2004)
GIP Generic Inventory Package
GLAC Great Lakes Acquisition Center
 
HEC Health Executive Council
HEDIS Healthcare Effectiveness Data and Information Set
HR human resources
 
ICTB Inter-facility Credentialing Transfer Brief
ICU intensive care unit
IDC independent duty corpsman
IDES Integrated Disability Evaluation System
iEHR integrated electronic health record
IM information management
IM/IT information management/information technology
Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
×
IOM Institute of Medicine
IPO Interagency Program Office
IT information technology
 
JEC Joint Executive Council
JFURSWG Joint Facility Utilization Resource Sharing Working Group
JIF Joint Incentive Fund
JMFDF Joint Medical Facility Demonstration Fund
 
LTG leadership task group
 
MAXIMO Department of Veterans Affairs asset management commercial, web-based software program
MHS Military Health System
MOA memorandum of agreement
MRI magnetic resonance imaging
MSPT mission specific pass-through
MS-RWP Medicare severity relative weighted product
MTF military treatment facility
 
NACI National Agency Check with Inquiries
NCOD National Center for Organizational Development
NCVAMC North Chicago Veterans Affairs Medical Center
NDAA National Defense Authorization Act
NFEC Naval Facilities Engineering Command
NHCGL Naval Health Clinic Great Lakes
NHCU nursing home care unit
NHGL Naval Hospital Great Lakes (also referred to as 200H)
NME Navy Medicine East
NMLC Naval Medical Logistics Command
NRMC Naval Regional Medical Center
NSGL Naval Station Great Lakes
 
OHA Office of Health Affairs
OMB Office of Management and Budget
OPM Office of Personnel Management
ORYX Joint Commission’s performance measure
 
PA physician’s assistant
PACS picture archiving and communication system
PIV personal identity verification
PSC personal services contract
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Suggested Citation:"Front Matter." Institute of Medicine. 2012. Evaluation of the Lovell Federal Health Care Center Merger: Findings, Conclusions, and Recommendations. Washington, DC: The National Academies Press. doi: 10.17226/13482.
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RTC Recruit Training Command
RTC Recap Recruit Training Command Recapitalization Program
RVU relative value unit
RWP relative weighted product
 
SAC Stakeholder Advisory Committee
SCIP Surgical Care Improvement Project
 
TFL TRICARE for Life
TRICARE military health care insurance system
TSC Training Support Center
 
USS United States ship
 
VA Department of Veterans Affairs
VAMC Department of Veterans Affairs medical center
VHA Veterans Health Administration
VISN Veterans Integrated Service Network
VistA Veterans Health Information Systems and Technology Architecture
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The 2010 opening of the Captain James A. Lovell Federal Health Care Center (FHCC) created a joint entity between the Department of Defense (DoD) and the Department of Veterans Affairs (VA) that replaced two separate centers in North Chicago. VA and DoD leaders envisioned a state-of-the-art facility that would deliver health care to both DoD and VA beneficiaries from northern Illinois to southern Wisconsin, providing service members and veterans seamless access to an expanded array of medical services. Unprecedented for the military and the VA, the Lovell FHCC would integrate clinical and administrative services under a single line of authority.

The DoD asked the IOM to evaluate whether the Lovell FHCC has improved health care access, quality, and cost for the DoD and the VA, compared with operating separate facilities, and to examine whether patients and health care providers are satisfied with joint VA/DoD delivery of health care.

Evaluation of the Lovell Federal Health Care Center Merger: Findings, conclusions, and Recommendations finds that initial implementation of the Lovell FHCC has provided important lessons about how to integrate VA and DoD health care services and has identified remaining obstacles that the departments could overcome to make such mergers more effective and less costly to implement. The IOM recommends that the VA and the DoD develop a comprehensive evaluation plan to objectively judge its success or failure, with measurable criteria, that would provide essential knowledge for both the Lovell FHCC and future endeavors.

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