July 2010

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

2. Cook County Health & Hospital System John H. Stroger, Jr. Hospital Provident Hospital Oak Forest Hospital Ambulatory and Community Health Network Cook County Department of Public Health Ruth M. Rothstein CORE Center Cermak Health Services The Safety Net Healthcare System for Cook County

3. Process Timeline

4. 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.

5. Uncompensated Care Costs:CCHHS vs. Leading Illinois DSH Hospitals ($496,500M) $53,651M $32,474M $31,093M $19,239M $18,931M $17,593M $11,862M $11,748M $11,625M $11,504M $9,9845M Sources & Notes: 2009 DSH Hospital Report by HFS drawn from 2006 OBRA filings. Advocate, Resurrection, and Sinai DSH hospitals are aggregated..

6. Disparities in Access CCHHS access points are not aligned with the poorer parts of the county, many of which have seen considerable population migration CCHHS Locations and Median Household Income by ZIP Code FQHC/CHC Locations ACHN Locations Hospitals Median HH Income (2007) Sources: CCHHS; Microsoft MapPoint data

7. Compared to other Major Public Health Systems CCHHS Focuses on Acute Inpatient Services Ratio of OP Visits to IP Discharges, 2008 * Includes 600,000 visits paid by LACDHS to private community clinics for uninsured low-income patients. Source: National Association of Public Hospitals

8. The Impact of Healthcare Reform • Fewer uninsured and underinsured. • Increase in available healthcare dollars. • There will remain a significant patient population with no insurance coverage. • Declining federal funding. • Increasing numbers of patients will have a choice.

9. The Impact of Healthcare Reform Cook County Pre-Reform: 850,000+ Uninsured Post-Reform: 225,000+ Uninsured

10. 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.

11. Mission 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.

12. 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.

13. Core Goals Access to Health Services Quality, Service Excellence, and Cultural Competence Service Line Strength Staff Development Leadership

14. Priority Actions by Goal • GOAL I: ACCESS TO HEALTHCARE SERVICES • Eliminate System access barriers at all delivery sites. • Strengthen the ACHN network; develop Comprehensive Community Health Centers at selected sites. • Redevelop Oak Forest Hospital as a Regional Outpatient Center. • 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. • Rebuild Fantus Clinic and restructure as a Regional Outpatient Center.

15. Priority Actions by Goal • GOAL II: QUALITY, SERVICE EXCELLENCE, AND CULTURAL COMPETENCE • Implement System-wide performance improvement initiatives. • Implement System-wide service excellence and cultural competency initiatives. • GOAL III: SERVICE LINE STRENGTH • Continue to develop/strengthen key clinical services. • Develop the infrastructure to support clinical services.

16. Priority Actions by Goal • GOAL IV: STAFF DEVELOPMENT • Dramatically improve staff recruitment, training, and development of systems and processes. • Implement a full range of initiatives to improve staff satisfaction levels. • GOAL V: LEADERSHIP & STEWARDSHIP • Develop CCHHS leadership for today and for the future. • Continue to strengthen the stewardship responsibilities of System Board and management.

17. Patient-Centered Accountability System-Wide Care Management Specialty Care Acuity Emergency Care Post Acute Care Primary 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 Inpatient Care

18. Range of Services Acute Care Regional Outpatient Centers Rehab & Post- Acute Care Comprehensive Community Health Centers • Emergency/trauma/acute inpatient care • Inpatient stabilization and short stay Primary Care • Primary Care • Multi-specialty Care • Urgent Care • OP Surgery • Imaging • Pharmacy • Public Health • Behavioral Health • Oral Health • Heath Educ./ Community Rooms • Primary Care/ Urgent Care • Rotating Specialists • Basic Diagnostic & Treatment Services • Primary Care/ Urgent Care • Basic Diagnostic & Treatment Services

19. Facilities Acute Care Regional Outpatient Center Rehab & Post- Acute Care Comprehensive Community Health Center • John H. Stroger, Jr. Hospital • Provident Hospital Primary Care • Fantus • Oak Forest • Provident • Partnerships • 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

20. Expanded Outpatient Locations Ambulatory Community Health Network Northwest CCHC (new site) ACHN Sites Central ROC – Rebuilt Fantus Comprehensive Community Health Center West CCHC – Cicero Provident ROC CCHC Oak Forest ROC Regional Outpatient Center ROC South CCHC- Cottage Grove

21. Forecast for Primary Care and Specialty Care Visits 2006 – 2015 50% Increase from 2009 to 2015 21 Source: CCHHS, ICS Analysis Actual Visits Projected Visits

22. Forecast Growth of Primary Care and Specialty Care Visits at Provident and Oak Forest 150K 105K 35K 25K Provident Oak Forest 22 Source: CCHHS, ICS Analysis 2009

23. Redistribution of Annual Operating Cash Cash Savings from Operations Investments in Reconfigured Operations

24. County Subsidies 2009 - 2015 (in millions)* FY09 FY15 FY10 FY12 FY13 FY14 FY11 • Actual Subsidies • Strategic Plan • Without Strategic Plan * Subsidies do not include the following indirect costs: Workers Compensation, Malpractice Insurance, Self-Insurance Settlements, Pension, Debt Service Charges.

25. Strategic Capital Requirements 2011 - 2015

26. Expected Benefits • 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

27. Key Messages • 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