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FY10 Flag / SES Offsite

Business Discussion

5 July 2009

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AgendaOverview

• PBB Discussion

• IT Discussion– What works / challenges / other

• Contracts

• Discussion Items

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PBB…what is it?

• Controlled introduction of quality and effectiveness performance elements.

• An internal management control tool--links budget to performance.

• Will adjust/reallocate funds during execution year (at mid-year) and potentially effect programming years.

• Creates incentives for desired performance

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PBB FY08-09 Differences

IMR EBHC Bed CapacityPublicHealth

% Indeterminate -- MTFs -- NMSC

-- BUMED

Asthma-- Spirometry-- Hospital --- Admissions --- ER VisitsPerinatal-- 3rd & 4th degree tears-- Readmissions-- AOI (shadow)

OB Production Targets-- Birth volume -- In MTF -- Referrals

Tobacco Cessation-- Screening (Y/N) --- Percent users-- Diagnostic (shadow)-- Interventions (shadow) --- Consult --- Prescription

PPSDeploymentMitigationPPB FY08 = + + + + +

Workload--RVUs--RWPs--MH Bed Days

% Indeterminate --MTFs

Measures:AsthmaDiabetes A1c levelDiabetes A1c testDiabetes LDLBreast ScreeningColorectal & CervicalCancer Screening (Shadow)

Ratioof beds filledto bedcapacity

Shadowed:Execution rateof Public HealthP.E.

Positive adjustmentfor deployed personnel and correlated to lostPPS workload.

ProposedPPB FY09 = PPS IMR EBHC

PerformanceIncentives

PublicHealth

DeploymentMitigation+ + + + +

45% 5% 10% 5% N/A

5% 5% 10% 5%49%

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PPS AdjustmentsPPS

MRRS Intermed

Cmd Name

PBB Reporting Unit Type

PBB Reporting Unit Code PBB Reporting Unit Name PPS_Value

PPS_O & M Adjusted

PPS Reduction Taken in Nov 08

PPS Reduction

Taken in Jul 09

Total of PPS Reductions

Balance of 10% W/H Restoral Net PPS

NCA HQ - NCA HQ (2 IMR Groups) 0 0 0 NCA MTF 0067 NNMC BETHESDA (16,576,563) (8,122,516) 0 NCA MTF 0068 NHCL PATUXENT RIVER (337,068) (165,163) 0 NCA MTF 0306 NHCL ANNAPOLIS 121,712 59,639 0 NCA MTF 0385 NHCL QUANTICO 578,143 283,290 0 NCA MTF 0386 Regional 0 (4,406,137) (1,407,766) (5,813,903) 4,256,000 2,848,234

NCA -> (16,213,776) (7,944,750) (4,406,137) (1,407,766) (5,813,903) 4,256,000 2,848,234 EAST HQ N0130 NAVMED EAST (1 IMR Group) 0 0 0 EAST MTF 0038 NH PENSACOLA (4,854,835) (2,378,869) 0 EAST MTF 0039 NH JACKSONVILLE (1,810,724) (887,255) 0 EAST MTF 0056 NHCL GREAT LAKES 552,418 270,685 0 EAST MTF 0091 NH CAMP LEJEUNE (1,627,611) (797,529) 0 EAST MTF 0092 NH CHERRY POINT 0 0 EAST MTF 0100 NHC NEW ENGLAND 1,441,967 706,564 0 EAST MTF 0103 NH CHARLESTON (184,280) (90,297) 0 EAST MTF 0104 NH BEAUFORT (223,155) (109,346) 0 EAST MTF 0118 NH CORPUS CHRISTI (702,734) (344,340) 0 EAST MTF 0124 NMC PORTSMOUTH (6,661,408) (3,264,090) 0 EAST MTF 0615 NH GUANTANAMO BAY 0 0 0 EAST MTF 0617 NH NAPLES 0 0 0 EAST MTF 0618 NH ROTA 0 0 0 EAST MTF 0624 NH SIGONELLA 0 0 0 EAST Regional (9,962,506) (4,881,628) (9,073,723) (2,899,065) (11,972,788) 15,066,000 12,166,935

NME -> (24,032,868) (11,776,105) (9,073,723) (2,899,065) (11,972,788) 15,066,000 12,166,935 WEST HQ N0146 NAVMED WEST (1 IMR Group) 0 0 0 WEST MTF 0024 NH CAMP PENDLETON 14,370,774 7,041,679 0 WEST MTF 0028 NH LEMOORE (1,846,294) (904,684) 0 WEST MTF 0029 NAVMED SAN DIEGO 5,485,303 2,687,799 0 WEST MTF 0030 NH TWENTY NINE PALMS 137,696 67,471 0 WEST MTF 0126 NH BREMERTON 3,623,939 1,775,730 0 WEST MTF 0127 NH OAK HARBOR (7,856,740) (3,849,802) 0 WEST MTF 0280 NHCL HAWAII 17,327 8,490 0 WEST MTF 0620 NH GUAM 0 0 0 WEST MTF 0621 NH OKINAWA 0 0 0 WEST MTF 0622 NH YOKOSUKA 0 0 0 WEST Regional 0 (2,131,976) (681,169) (2,813,145) 11,440,000 10,758,831

NMW -> 13,932,005 6,826,683 (2,131,976) (681,169) (2,813,145) 11,440,000 10,758,831 Navy Medicine (26,314,639) (12,894,173) (15,611,836) (4,988,000) (20,599,836) 30,762,000 25,774,000

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PBB AwardsPBB Categories OTHER

PBB Reporting Unit Code PBB Reporting Unit Name IMR

Births Prod'n Targets

EBHC Asthma Hosp.

EBHC Asthma ED

Visits

EBHC Perinatal

Lacerations

PH Tobacco

Screening

PBBTotal

Deploy-ment

Mitigation

PBB & Deployment Mitigation

- NCA HQ (2 IMR Groups) (7,245) (7,245) (7,245)0067 NNMC BETHESDA 0 0 0 30,900 130,627 0 161,527 288,286 449,813 0068 NHCL PATUXENT RIVER 9,467 0 6,868 0 16,335 165,163 181,498 0306 NHCL ANNAPOLIS 24,682 15,720 15,720 0 56,121 56,121 0385 NHCL QUANTICO 18,934 15,723 7,862 0 42,519 42,519

NCA -> 45,838 0 31,443 61,349 130,627 0 269,257 453,449 722,706

N0130 NAVMED EAST (1 IMR Group) (7,970) (7,970) (7,970)0038 NH PENSACOLA 0 0 32,368 32,368 9,614 0 74,351 74,351 0039 NH JACKSONVILLE 0 0 22,559 0 65,047 0 87,605 87,605 0056 NHCL GREAT LAKES 0 6,090 6,090 0 12,180 12,180 0091 NH CAMP LEJEUNE 87,571 0 24,544 0 54,729 0 166,843 797,529 964,372 0092 NH CHERRY POINT 40,477 0 0 0 40,477 452,787 493,264 0100 NHC NEW ENGLAND 89,262 21,239 0 0 110,500 110,500 0103 NH CHARLESTON 30,430 10,750 10,750 0 51,930 90,297 142,227 0104 NH BEAUFORT 50,379 0 3,863 0 54,242 54,242 0118 NH CORPUS CHRISTI 0 6,086 0 0 6,086 344,340 350,426 0124 NMC PORTSMOUTH 0 277,500 0 0 121,250 0 398,750 398,750 0615 NH GUANTANAMO BAY 34,246 2,812 2,812 0 0 39,871 39,871 0617 NH NAPLES 0 8,909 0 0 0 8,909 8,909 0618 NH ROTA 25,407 3,455 864 0 0 29,725 29,725 0624 NH SIGONELLA 30,068 10,379 10,379 0 0 50,825 50,825

NME -> 379,869 277,500 149,190 67,126 250,639 0 1,124,325 1,684,953 2,809,278

N0146 NAVMED WEST (1 IMR Group) (9,660) (9,660) (9,660)0024 NH CAMP PENDLETON 237,548 0 0 18,500 107,923 0 363,971 363,971 0028 NH LEMOORE 59,556 0 5,145 10,291 0 0 74,992 510,749 585,741 0029 NAVMED SAN DIEGO 315,000 0 0 0 217,564 0 532,564 532,564 0030 NH TWENTY NINE PALMS 68,299 5,029 0 35,759 0 109,087 109,087 0126 NH BREMERTON 138,385 179,000 12,707 12,707 53,098 0 395,897 395,897 0127 NH OAK HARBOR 32,652 0 21,858 21,858 24,490 22,904 123,762 123,762 0280 NHCL HAWAII 54,581 10,191 40,764 0 105,536 105,536 0620 NH GUAM 0 4,138 8,277 0 0 12,415 12,415 0621 NH OKINAWA 78,490 4,690 9,380 39,918 0 132,478 132,478 0622 NH YOKOSUKA 160,362 35,303 35,303 8,214 27,001 266,183 266,183

NMW -> 1,135,212 179,000 99,063 157,081 486,966 49,905 2,107,226 510,749 2,617,975

N0129 NAVMED SUPPORT CMD (3,864) (3,864) (3,864)N1838 BSO 18 STUDENT UICS 0 0 0 N0180 NM MPT&E 0 0 0

N0181 NAVMED RESEARCH CMD 13,331 13,331 13,331

N0183 NAVMED LOGISTICS CMD 0 0 0

N0184 NAVMISSA 0 0 0 N0185 NAV MAR CORPS PB HLTH 13,476 13,476 13,476

NMSC -> 22,943 0 0 0 0 0 22,943 0 22,943

- BUMED (3 IMR Groups) (31,662) (31,662) (31,662)

BUMED -> (31,662) 0 0 0 0 0 (31,662) 0 (31,662)

Navy Medicine Total 1,552,201 456,500 279,696 285,556 868,232 49,905 3,492,090 2,649,151 6,141,241

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PBB Awards - HEDISCMD TYPE

PBB Reporting Unit Code PBB Reporting Unit Name HEDIS

NCA HQ - NCA HQ (2 IMR Groups)NCA MTF 0067 NNMC BETHESDA 180,053 NCA MTF 0068 NHCL PATUXENT RIVER 36,060 NCA MTF 0306 NHCL ANNAPOLIS 20,667 NCA MTF 0385 NHCL QUANTICO 41,020

NCA -> 277,799 EAST HQ N0130 NAVMED EAST (1 IMR Group)EAST MTF 0038 NH PENSACOLA 175,245 EAST MTF 0039 NH JACKSONVILLE 198,075 EAST MTF 0056 NHCL GREAT LAKES 58,322 EAST MTF 0091 NH CAMP LEJEUNE 79,319 EAST MTF 0092 NH CHERRY POINT 47,939 EAST MTF 0100 NHC NEW ENGLAND 78,749 EAST MTF 0103 NH CHARLESTON 37,838 EAST MTF 0104 NH BEAUFORT 32,452 EAST MTF 0118 NH CORPUS CHRISTI 25,601 EAST MTF 0124 NMC PORTSMOUTH 345,682 EAST MTF 0615 NH GUANTANAMO BAY 1,899 EAST MTF 0617 NH NAPLES 9,674 EAST MTF 0618 NH ROTA 2,385 EAST MTF 0624 NH SIGONELLA 6,199

NME -> 1,099,378 WEST HQ N0146 NAVMED WEST (1 IMR Group)WEST MTF 0024 NH CAMP PENDLETON 147,699 WEST MTF 0028 NH LEMOORE 34,996 WEST MTF 0029 NAVMED SAN DIEGO 476,336 WEST MTF 0030 NH TWENTY NINE PALMS 30,521 WEST MTF 0126 NH BREMERTON 167,408 WEST MTF 0127 NH OAK HARBOR 30,927 WEST MTF 0280 NHCL HAWAII 72,163 WEST MTF 0620 NH GUAM 33,549 WEST MTF 0621 NH OKINAWA 25,173 WEST MTF 0622 NH YOKOSUKA 33,845

NMW -> 1,052,616

Navy Medicine Total 2,429,793

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PBB Discussion• What are the behaviors we want to incentivize?

• Current method:– PAE engages advisory boards, M3 staff, regions /

field activities to gather ideas– M3/M8 preview enroute to CEB

• Measures must have public data to support

• Limited number of measures

– CEB approves

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PBB Discussion• What are the behaviors we want to incentivize?

• For the future: – How broad a discussion do we want? (ownership)

• Are advisory boards acceptable?

– How / where do we throttle inputs to focus efforts?– How do we react to “gaming”?

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PBB Discussion• What are the behaviors we want to incentivize?

• Challenges: – Stability vs flexibility– IMR—quality measures? Link to EMPARTS?– Measure-worthy but difficult:

• GME

• Training

• Others??

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IT Discussion

121. Other = Utilities, Rent & Communication; Travel Transportation, Fuels and Equip Maintenance

2. Includes all sources Budget, OCO, WW, MERCHF

OtherOther

Civilian/Contracted Personnel

Civilian/Contracted Personnel

Other Purchase Svcs (HPSP, IMIT Supt, Janitorial)

Other Purchase Svcs (HPSP, IMIT Supt, Janitorial)

Supplies, Equip &Special Projects

Supplies, Equip & Special Projects

0.0

0.5

1.0

1.5

2.0

2.5

3.0

3.5

4.0

FY09 Actuals FY10 Plan

$B

$43M Medical Backfill$70M Medical Backfill

$872M Contractors$867M Contractors

FY09/10 Major Procurements$3.56B $3.47B

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Contracting Discussion

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Wrap-up Discussion• How can we improve our contracting processes to ensure seamless support to

activities where / when required? – Contracting liaison at regions? – Streamlined / integrated with workload plan, to create an ‘acquisition plan’ for

healthcare professionals? (Funding and SOWs could flow from the workload plan….).

– Other?

• How can we better align resources to limit sub-optimization and ensure integration with deployments, operational requirements, and the benefit mission?

• How can we expand ownership of PBB in Navy Medicine?

• What are the critical IT issues for the next 18 months?