VA Testimony of Gordon Mansfield before Congress on March 28, 2006

United States Department of Veterans Affairs

THE HONORABLE GORDON H. MANSFIELD
DEPUTY SECRETARY OF VETERANS AFFAIRS
BEFORE THE SUBCOMMITTEE ON MILITARY QUALITY OF LIFE AND
VETERANS AFFAIRS AND RELATED AGENCIES
HOUSE APPROPRIATIONS COMMITTEE
U.S. HOUSE OF REPRESENTATIVES
VA/DOD JOINT INCENTIVE FUND

March 28, 2006

Good Morning Mr. Chairman and members of the Committee. Thank you for your invitation to discuss the Joint Incentive Fund (JIF). This program is one of many important collaborative efforts between the Department of Veterans Affairs (VA) and the Department of Defense (DoD).

Our goals for this program are ambitious and vital to the missions of both Departments. We seek to promote and develop collaborative partnerships that enhance the cost-effective use of Federal healthcare resources and maximize the shared use of resources. Most importantly, our goals are to improve access to care by beneficiaries, improvements in the quality of care received by those beneficiaries, and gain efficiencies in delivering services to those beneficiaries.

The FY 2003 National Defense Authorization Act, Public Law 107-314, Section 721, requires that DoD and VA establish a joint incentives program, through the creation of a DoD-VA Health Care Sharing Incentive Fund. The intent of the program is to identify, fund, and evaluate creative local, regional, and national sharing initiatives.

A DoD-VA Memorandum of Agreement (MOA) signed on July 8, 2004, assigned VA as administrator of the fund under the direction of the VA/DoD Health Executive Council (HEC). VA is responsible for executing funding transfers for projects approved by the HEC.

Each year the Departments issue a joint call for proposals. All submissions must include a description of the proposal, business case analysis, and an official certification by the Service and VISN/Chief Officer that the proposal will be either self-financing, have no recurring costs, or that recurring costs will be funded within existing budgets after JIF funding ends. The Departments have developed templates, which are provided in the call to assure consistent submissions by the applicants. A joint VA/DoD work group reviews the proposals and makes recommendations to the VA/DoD Health Executive Council for approval. Criteria used to evaluate proposals include:

Improves Quality of Care;

Improves Access of Care;

Supports Mission Priority / Corporate Direction;

Provides Reasonable Return on Investment;

Identifies Measurable Performance Data;

Supports VA/DoD Joint Strategic Plan;

Measures Size and Scope of Impact; and

Defines Other Intangible Benefits.

Both VA and DoD are required to contribute $15 million each year from FY 2004 through FY 2007 to the Joint Incentive Fund. The funds remain available to facilitate the incentives program until expended, but the authority for the joint incentives program terminates at the end of FY 2007. Total minimum contributions from each Department will be $60 million, with a combined total of $120 million over the four years (FY 2004-FY 2007). To date, 33 projects have been approved with a total funding of $58 million. All projects funded in FY 2004 and FY 2005 have implemented start-up of joint operations.

Some of the more noteworthy projects are:

Mobile MRI units at VA Black Hills HCS/ Ellsworth AFB South Dakota, Cheyenne VAMC/ F.E. Warren AFB and Boise VAMC/ Mountain Home AFB. These mobile MRI's will provide state of the art diagnostic capability with much improved access at significantly reduced costs thereby enhancing the quality of care provided to veterans and active duty personnel assigned in their respective geographic regions.
VHA CO/Defense Supply Center, Philadelphia - Medical/Surgical Supply This proposal is focused on synchronizing the medical/surgical (med/surg) catalog data and pricing among four VA/DoD components: Distribution and Pricing Agreements (DAPAs), Federal Supply Schedules (FSSs), the DoD Master Data Sync database, and the National Item File (NIF).
DoD/VA National - Continuing Education Sharing Plan
This project will assess the technical and functional feasibility of utilizing existing collaborative and/or distributed learning architectures currently available within the VA/VHA and DoD/Military Health System (MHS).
Women’s Health Center and Mammography (NAVHOSP Great Lakes-North Chicago VAMC)
As part of the ongoing integration of services between VA and DoD at Great Lakes, the projects will purchase equipment and additional staffing to expand mammography capacity to service both women veterans and DoD beneficiaries. Also included is the creation of a comprehensive women’s health center.

Interim Project Reviews (IPRs) are conducted quarterly for all JIF projects throughout the funding life of the project. IPR are jointly prepared by the VA and DoD representatives from each site. Special emphasis is placed on lessons learned and exportability to other sites. Reporting categories include:

Major Accomplishments;

Major Upcoming Events / Milestones;

Detailed Schedule Review;

Financial Review;

Noteworthy Action Items; and

Problems / Issues Management.

Evaluation is based on progress in achieving the goals stated in the original project submission. Measurements such as return on investment are used to measure operating performance and efficiency in utilizing funding provided. Direct benefits such as cost avoidance have a measurable impact on budgets or costs, and indirect benefits such as productivity changes provide returns not directly measurable. It is important to take a measured approach to calculating both types of benefits; however, indirect benefits pose the most difficult challenge. Strategies for measuring the value of an indirect benefit include; employee and patient satisfaction surveys, benchmarking information, and results of a pilot or test case.

Lessons learned are applied to many aspects of the project – including overarching interests, project announcement, solicitation of proposals, communications, and implementation. These will be reviewed, assessed and wherever possible will be implemented for process improvement and exportability.

I believe the JIF program has potential that has not been fully realized due to time constraints in getting fully up to speed. Obligation of JIF project funds has been slower than anticipated. The major reasons for this delay are the following:

The time required to develop project proposals and conduct a comprehensive review.
The first year of funding for projects considered in FY 2004 and FY 2005 was not allocated until the start of the following fiscal year.
There has also been a longer than anticipated start-up time for many projects due to hiring, facility requirements and equipment purchases.

VA fully supports the intent and success of the JIF program. We are continuing to refine the submission and review process to align the selection of projects and the start of obligations more closely to the funding years. VA and DoD have strongly encouraged identification and development of joint projects that will benefit the delivery of care to beneficiaries of both Departments.

Mr. Chairman, I conclude by reaffirming VA’s commitment to faithfully serve and support veterans, and to be good stewards of the taxpayers’ money. I believe the Joint Incentive Fund program embodies these principles.

I look forward to responding to your questions about this program.