July 2010 VISION 2015 Strategic Direction Presented by: William T. Foley Chief Executive Officer.

July 2010

VISION 2015

Strategic Direction

Presented by:

William T. Foley

Chief Executive Officer

Cook County Health & Hospital System

Cook County Department of Public Health

Ambulatory and

Community Health Network

Provident Hospital

Oak Forest Hospital

John H. Stroger, Jr.

HospitalRuth M. Rothstein

CORE Center

Cermak Health

Services

The Safety Net Healthcare System for

Cook County

2

3

Process TimelineAction Items 2Q2009 3Q2009 4Q2009 1Q2010 2Q2010 3Q2010

Discovery

Community/Stakeholder Input

Individual Interviews/Group Meetings

Strategic Direction Developed

Town Hall Meetings

Passage of Health Reform

Action Planning

Financial Planning

CCHHS Board Approves Strategic Plan

Cook County Board Approves Strategic Plan

Current State Assessment

Significant unmet healthcare needs.

Large disparities in access to healthcare and location of healthcare services.

System resources are disproportionately centered around inpatient environment.

Can not sustain current service delivery model in the changing environment.

Cost structure requires significant realignment to drive efficiency.

4

Uncompensated Care Costs:CCHHS vs. Leading Illinois DSH Hospitals

Sources & Notes: 2009 DSH Hospital Report by HFS drawn from 2006 OBRA filings. Advocate, Resurrection, and Sinai DSH hospitals are aggregated..

5

($496,500M)

$53,651M

$32,474M

$31,093M

$19,239M

$18,931M

$17,593M

$11,862M

$11,748M

$11,625M

$11,504M

$9,9845M

Disparities in Access

6

Median HH Income (2007)

Sources: CCHHS; Microsoft MapPoint data

CCHHS access points are not aligned with the poorer parts of the county, many of which have seen considerable population migration

FQHC/CHC Locations

ACHN Locations

Hospitals

CCHHS Locations and Median Household Income by ZIP Code

Ratio of OP Visits to IP Discharges, 2008

Source: National Association of Public Hospitals

* Includes 600,000 visits paid by LACDHS to private community clinics for uninsured low-income patients.

Compared to other Major Public Health Systems CCHHS Focuses on Acute Inpatient Services

7

8

The Impact of Healthcare Reform

There will remain a significant patient population with no insurance coverage.

Declining federal funding.

Increasing numbers of patients will have a choice.

Fewer uninsured and underinsured.

Increase in available healthcare dollars.

The Impact of Healthcare Reform

Pre-Reform:

850,000+ Uninsured

Post-Reform:

225,000+ Uninsured

Cook County

9

GUIDING PRINCIPLES Shift to a population-centered vs. hospital-centered health

delivery model.

Enhance accessibility to services.

Align service delivery with population demand for services.

Build specialty care capability to fulfill unmet needs.

Extend primary care services through partnerships.

Provide quality-cost effective healthcare.

Focus on service excellence, employee satisfaction, and leadership development.

Strengthen CCHHS image in the market.10

To deliver integrated health services with dignity and

respect regardless of a patient’s ability to pay; foster

partnerships with other health providers and

communities to enhance the health of the public; and

advocate for policies which promote and protect the

physical, mental and social well being of the people of

Cook County.

11

Mission

Vision

In support of its public health mission, CCHHS will be

recognized locally, regionally, and nationally —and by

patients and employees—as a progressively evolving

model for an accessible, integrated, patient-centered,

and fiscally-responsible healthcare system focused on

assuring high-quality care and improving the health of

the residents of Cook County.

12

Core Goals

I. Access to Health Services

II. Quality, Service Excellence, and Cultural Competence

III. Service Line Strength

IV. Staff Development

V. Leadership

13

GOAL I: ACCESS TO HEALTHCARE SERVICES

1. Eliminate System access barriers at all delivery sites.

2. Strengthen the ACHN network; develop Comprehensive Community

Health Centers at selected sites.

3. Redevelop Oak Forest Hospital as a Regional Outpatient Center.

4. Restructure Provident Hospital as a Regional Outpatient Center,

focused inpatient facility, and maintain emergency services.

Alternatively, continue to pursue collaboration with the University of

Chicago Medical Center.

5. Rebuild Fantus Clinic and restructure as a Regional Outpatient Center.

14

Priority Actions by Goal

GOAL II: QUALITY, SERVICE EXCELLENCE, AND CULTURAL COMPETENCE

1. Implement System-wide performance improvement initiatives.

2. Implement System-wide service excellence and cultural competency

initiatives.

GOAL III: SERVICE LINE STRENGTH

1. Continue to develop/strengthen key clinical services.

2. Develop the infrastructure to support clinical services.

15

Priority Actions by Goal

GOAL IV: STAFF DEVELOPMENT

1. Dramatically improve staff recruitment, training, and development of

systems and processes.

2. Implement a full range of initiatives to improve staff satisfaction

levels.

GOAL V: LEADERSHIP & STEWARDSHIP

1. Develop CCHHS leadership for today and for the future.

2. Continue to strengthen the stewardship responsibilities of System

Board and management.

16

Priority Actions by Goal

Patient-Centered Accountability

System-Wide Care Management

Acuity

Primary Care

Specialty Care

Emergency Care

Inpatient Care

Post Acute Care

Patient-Centered Care•Ready access to full continuum of services

•Top-quartile quality & service excellence

•System-wide case management + care coordination

•Integrated patient records

•Provider partnerships to complement System capabilities

17

Range of Services

Primary Care

Comprehensive Community

Health Centers

Regional Outpatient Centers

Acute Care

Rehab & Post- Acute Care

Primary Care/ Urgent Care

Rotating Specialists

Basic Diagnostic & Treatment Services

Primary Care Multi-specialty

Care Urgent Care OP Surgery Imaging Pharmacy Public Health Behavioral

Health Oral Health Heath Educ./

Community Rooms

Emergency/trauma/acute inpatient care

Inpatient stabilization and short stay

Primary Care/ Urgent Care

Basic Diagnostic & Treatment Services

18

Facilities

Primary Care

Comprehensive Community

Health Center

Regional Outpatient

Center

Acute Care

Rehab & Post- Acute Care

ACHN Clinics as Primary Care Centers

Partnerships with FQHC’s, CHC’s, and other agencies

ACHN Clinics as Primary Care Centers

Partnerships with FQHC’s, CHC’s, and other agencies

Fantus

Oak Forest

Provident

John H. Stroger, Jr. Hospital

Provident Hospital

Partnerships

19

Expanded Outpatient Locations

CCHC

ROC

ACHN Sites

Ambulatory Community Health Network

Northwest CCHC(new site)

Northwest CCHC(new site)

West CCHC – CiceroWest CCHC – Cicero

Oak Forest ROCOak Forest ROC

South CCHC- Cottage GroveSouth CCHC-

Cottage Grove

Provident ROCProvident ROC

Central ROC – Rebuilt FantusCentral ROC – Rebuilt Fantus

Comprehensive Community Health Center

Regional Outpatient Center

20

Source: CCHHS, ICS Analysis

Forecast for Primary Care and Specialty Care Visits 2006 – 2015

50% Increase from

2009 to 2015

21Actual VisitsActual Visits Projected VisitsProjected Visits21

Source: CCHHS, ICS Analysis 2009

Forecast Growth of Primary Care and Specialty Care Visits at Provident and Oak Forest

22

25K

105K

35K

150K

Provident Oak Forest

Redistribution of Annual Operating Cash

Oak Forest $55M

Provident $17M

Total Savings $72M

($40M) Outpatient Services

($23M) Enhance Service Lines/Infrastructure

($9M) Build/Strengthening Partnerships

($72M) Total Investments

Cash Savings from Operations

Investments in Reconfigured Operations

23

County Subsidies 2009 - 2015 (in millions)*FY09 FY10 FY11 FY12 FY13 FY14 FY15

* Subsidies do not include the following indirect costs: Workers Compensation, Malpractice Insurance, Self-Insurance Settlements, Pension, Debt Service Charges.

• Actual Subsidies • Strategic Plan• Without Strategic Plan

24

Strategic Capital Requirements 2011 - 2015

Capital Cost $ 2011 2012 2013 2014 2015

IT Infrastructure $57.4M

Fantus Rebuild$92M

PC clinic expansion/upgrade $9M

CCHC clinic expansion/upgrade$13M

Provident restructuring$12M

Oak Forest redevelopment$19M

Forecasted Strategic Capital Requirements $202.4M

25

Improved Access to Healthcare Services

Improved Customer Service/Patient Satisfaction

Growth in Services to 900K Outpatient Visits by 2015

Accountable and Patient Focused Workforce

Performance Driven Leadership

Improved Infrastructure

Expected Benefits

26

A Plan for Growth that is cost neutral

To meet the demands of Healthcare Reform

Invest in our people

Professionalize our organization and build a new image

Build strong partnerships to serve more people that are in need of our services

Improve our facilities and technology

Key Messages

27