Over the past few years, the Department of Defense and Department of Veterans Affairs made great strides in coordinating and developing common health and support services along the entire continuum of care. By working in concert, we have maintained and fostered a more effective, aligned federal health-care partnership. The DoD/VA Joint Executive Council (JEC) was established by the National Defense Authorization Act of Fiscal Year 2003 to oversee and guide the joint health and benefits activities of the Departments. The JEC is the overarching council and links to three supporting councils: the Health Executive Council (HEC), the Benefits Executive Council (BEC) and the Interagency Program Office (IPO). Under this structure, dozens of professionals from DoD and VA have been working closely with one another across departmental lines in about 20 workgroups to improve access, quality and efficiency in diverse business areas. In May 2007, the Wounded, Ill and Injured Senior Oversight Committee (SOC) was created by VA and DoD, co-chaired by their Deputy Secretaries. It included the most senior staff of the departments. The SOC was established to ensure proper oversight and interagency coordination of the recommendations from various commissions and review groups looking at wounded warrior issues. To conduct its work, the SOC established eight workgroups, known as Lines of Action (LOAs), that focused on specific areas. Each LOA, was chaired by and included co-representation from DoD and VA. The LOAs report their efforts and recommendations to the SOC, which granted approved and directed appropriate components of DoD and VA to accomplish the mission. In the past year, both the SOC and the JEC have provided oversight and guidance to more than 500 new initiatives designed to improve interdepartmental cooperation and reduce bureaucratic barriers with a focus on ensuring a seamless transition for our returning severely injured servicemembers. In January 2009, the co-chairs of the JEC signed the Joint Strategic Plan (JSP) for FY 2009-2011. The JSP, an appendix of the FY2008 JEC Annual Report, provides details on collaborative VA/DoD accomplishments and plans designed to strengthen the capabilities of both departments to better serve our beneficiaries. Such areas include financial management, joint facility utilization, pharmacy, medical-surgical supplies procurement, patient safety, deployment health, mental health, clinical guidelines, contingency planning, case management, information management/information technology and benefits delivery This new JSP is unique in that the JEC workgroups also collaborated on their plans with the SOC. All matters that the SOC addressed which were related to both DoD and VA are now aligned under the strategic goals and objectives of the JSP. While the JSP includes many accomplishments and future initiatives, I want to highlight two areas where collaborative efforts are leading successful transformation.

Disability Evaluation System Pilot Program

The Disability Evaluation System (DES) Pilot Program was formed as a result of a recommendation proposed by the Presidents Commission on Care for America’s Returning Wounded Warriors, which called for VA and DoD to completely restructure their disability and compensation systems. The pilot began in November 2007 at one site and featured one medical examination and a single-sourced disability rating with the goal of reducing by half the time it currently takes for a servicemember to transition to veteran status and be provided their VA benefits and compensation.

By the end of FY 2008, 723 servicemembers had participated in the pilot. Of those, 119 completed the process with an average of 203 days or a 62 percent reduction in the amount of time previously required to complete the current DES and VA claim process.

This pilot proved that the DES process can be significantly shortened, wait times for VA benefits can be eliminated and VA ITconnectivity directly impacts timeliness and quality of service. Senior leaders have decided to expand the pilot to additional sites to test the viability of the new process under a broader number of local conditions. A long-term goal of both departments is that of a fully interoperable DoD/VA DES system.

HEC Continuing Education and Training Workgroup

Education and training is another area that has involved transformational coordination between departments. This particular workgroup was established in FY 2005 to facilitate and manage a robust shared training partnership between VA, DoD and the uniformed services. Since its inception, the workgroup has facilitated and managed the sharing of 1,024 training programs, generated a direct cost avoidance of $31 million and implemented $11 million in Joint Incentive Fund (JIF) grants.

The workgroup selects significant shared training initiatives to undertake each fiscal year. Three such initiatives begun in FY 2008 are:

The development of a suite of pharmacy technician training programs: With the support of a JIF grant, the workgroup started a collaborative web-based training project which will be completed by the end of FY 2009. It is believed to be the largest Sharable Content Object Reference Model conformant effort ever launched in the federal system. Pharmacy technicians in VA and DoD will undergo 80 hours of web-based pharmacy technician instruction designed to accelerate training and result in significant cost avoidance for both VA and DoD.

The successful deployment of 19 compensation and pension courses from VHA to DoD: An issue of concern has been the amount of time it takes to conduct compensation and pension examinations for returning Operation Enduring Freedom and Operation Iraqi Freedom veterans. Leadership of both departments developed a strategy to expedite these exams that was in part reliant on the deployment of compensation and pension training for DoD examiners. The VA Employee Education System developed 19 pertinent training courses to meet similar VA training needs. These were reconfigured to run on the DoD Tri-Service Learning Management Systems (LMS) and were deployed two weeks ahead of the target deadline on the DoD MHS Learn LMS.

North Chicago integrated in-service healthcare facility and orientation training program: The workgroup has been administering groundbreaking efforts to facilitate and support a comprehensive leadership, management and staff training program for the Captain James A. Lovell Federal Health Care Center (FHCC) in North Chicago. As the first fully integrated VA/DoD healthcare facility, it will also serve as the model for all VA/DoD facilities of its kind. This program has resulted in the design and development of a three module training program (pre-arrival, orientation and on-going) designed to maximize training efficiency while minimizing the use of staff resources and time away from work. This will be repeated as a refresher course for all staff each year and by the third quarter of FY 2009, it is expected to be fully operational at the FHCC.

The JSP continues to set many goals and challenges for the future. The progress we have made and that will continue to occur is essential. Eradicating the gaps between our two systems and building an uninterrupted seamless continuum of care for our warriors and their families is our highest priority. We owe all of our military and veterans so much for their past and present service to our nation, and we are committed to working together to ensure that they get the very best that our health systems can offer.

Michael E. Kilpatrick, M.D., is Director of Strategic Communications for the Military Health System in the Office of the Assistant Secretary of Defense for Health Affairs.