Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #2 December 6, 2006

1. CONNECT SI Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #2 December 6, 2006 SIH Corporate Offices Frank Knott, President ViTAL Economy, Inc. Fknottmd@earthlink.net

2. Agenda – Healthcare COI Meeting #2 8:30 AM - Welcome, Introductions, Meeting Objectives, Progress Review 8:45 AM - COI Outcome Goals and Asset Mapping Drives Connectivity Needs 9:05 AM – Goal Setting Breakout Sessions for (1)Improved Profitability, (2)Health Outcomes, (3)Critical Skills Shortages, (4)Connectivity 9:50 AM - Reports from each of the four goal setting breakout groups 10:20 AM – Confirm Healthcare COI Priority Measurable Goals 10:50 AM - Clarify COI Work Plan Next Steps, Schedule & Locate Next Mtg 11:00 AM - Wrapup & Close

3. Objectives of Healthcare COI #2 Meeting • Finalize measurable goals in 4 priority outcome areas defined by COI • Establish clear linkage of goal setting, asset mapping as drivers of connectivity • Review and advise on direction of healthcare asset mapping • Review and advise on development of healthcare economic impact model • Set stage for beginning value chain and asset mapping process • Identify Short Term Win opportunities and establish action plans for each • Get ready for Milestone #3 meeting the week of March 19-25 • Establish progress review points leading to March meeting

4. Phase 1 Outcomes GIS Asset Maps Broadband Strategy GDP & Healthcare Economic Models Regional Economic Strategy Healthcare Strategy Regional Economic Framework Five-Year Measurable Goals Implementation & Funding Plan Network Providers COI Strategy Greater Egypt COI Strategy Southeastern COI Strategy Southern Five COI Strategy Greater Wabash COI Strategy Reap the Rewards Connect SI Regional CED COI Strategy Phase 2 GIS Mapping Team Supports COI’s Connect SI 20-County Phase 1 June 06-Sept 07 “Led ByConnect SI Leadership Advisory Board” Connect SI's Blueprint for Success Healthcare Providers COI Strategy

5. Investment Attraction Strategies 24,768 New Hi-Wage Jobs 30,968 Existing Jobs >$5,000/Yr $200 Million+ Increased Annual ICT Market Opportunity** Healthcare Providers COI Strategies $989 Million New KBE Activity 1,600+ Firms 4 CED COI Strategies $2 Billion New Annual Wages Short-Term Win Targets Industry Cluster Strategies 2012 Results* Actions Positive Feedback Loop (Economic Growth Multipliers) Market Growth Drivers — “Demand-Pull” Model Preliminary Goals: Current Broadband Customer Base *Results are only for Interim GE, SE and S5 COI Goals ** Increased ICT Opportunity Based on MIT, OECD Multipliers of GDP

6. Healthcare COI Implementation • 1 - Organize COI, Issue ID, Priorities & Goal Setting Jul - Sep 2006 • Milestone 1b Leadership Mtg September 21, 2006 • Milestone #1b COI Meeting October 24, 2006 • 2 - Finalize Measurable Goals, Begin Value Chain Mapping Dec 2006-Feb 2007 • Review Health Economic Model, Gap Analysis • “Agree on COI Leadership Progress Review Checkpoints Prior to #3” • 3 - Continue Value Chain Mapping, ID & Quantify Mar - Apr ‘07 • Connectivity Implications for Healthcare Providers and Patients • 4 - Prioritize & Define COI Connectivity Requirements May - June ‘07 • Tele-Health Applications & Value Propositions • 5- Develop & Quantify COI Economic & Jobs Strategy July ‘07 • Connect COI Strategy to Connect SI Regional Strategy

7. VE Applications Architecture Connecting The Dots Between Goal Setting, Asset Mapping, Value Linkage, and Increased Availability of Broadband Services To Connect Healthcare Assets for Improved Healthcare COI Outcomes

8. ViTAL Economy — Application Architecture Application Description Users Connected I S S U E S Content Exchanged Technology Alternatives Value Linkage Functional Value Quantitative Value Ranking

9. Geography Demography Topology User/ Application Matrix End-User Business Case Value Linkage Priorities Community Barrier Analysis Integrated Application Priorities ViTAL Economy — Application Architecture Application Description Users Connected I S S U E S Content Exchanged Technology Alternatives Value Linkage Functional Value Quantitative Value Ranking

10. Geography Demography Topology Application Description User/ Application Matrix Users Connected Content Exchanged End-User Business Case Value Linkage Priorities Community Barrier Analysis Integrated Application Priorities Technology Alternatives Functional Value Quantitative Value Ranking ViTAL Economy — Application Architecture Map User/ Technology Matrix Network Gap Analysis Network Services Architecture I S S U E S Application Design Requirements Application Technology Matrix Value Linkage

11. Geography Demography Topology User/ Application Matrix Service Provider Business Case Offer and Commitment End-User Business Case Value Linkage Priorities Community Barrier Analysis Integrated Application Priorities Community Business Case ViTAL Economy — Application Architecture Map N E T W O R K I M P L E M E N T A T I O N Application Description User/ Technology Matrix Network Gap Analysis Network Services Architecture Users Connected Content Exchanged I S S U E S Application Design Requirements Application Technology Matrix Technology Alternatives Value Linkage Functional Value Quantitative Value Ranking

12. VE Application Architecture at Work Western New York Between Erie PA and Buffalo NY Issues • Share Education & Healthcare Resources, Youth Brain Drain, Save Healthcare Assets, Improve Access to Care, Make Remoteness an Asset, Transform Economy, Solutions • First Shared Use Learning Service in NY State-67 Sites • Linked 161 healthcare provider sites across 4 counties and 7 LATAs • 4 County Collaborative Fiber Ring Designed by Community • Created virtual rural healthcare service between Eire, PA and Buffalo, NY • Saved and expanded two hospitals, attracted more medical professionals • Improved health services attracted knowledge workers to transform economy • Transformed Economic Vision to an INFOMUNITY

13. What Are Meaningful/Measurable Goals for the Healthcare COIHealth Outcomes • Network of care • Patient and care registry • Care models, sharing information and records • Leads to best practices for care • Ensure that best practices are acted on • Best care from team • Increase telemedicine

14. GIS Team Asset Mapping Review

15. Value Chain and Asset Mapping • Identify Value Chain Components that are required for each goal area to achieve its measurable outcomes • Map all healthcare assets that need or should be connected to create critical mass and demonstrate ability of region to address access and quality of service regardless of location • Provide a basis for gap analysis

16. Healthcare Data Sources • Due to incomplete health data, we compiled additional information from 15 sources. Some of these include: • Illinois Department of Public Health (Licensed Illinois Hospitals) • American Hospital Directory • Southern Illinois Healthcare • Illinois Primary Health Care Association • Illinois Department of Human Service • http://www.hospital-data.com (compiled from multiple government and commercial sources) • http://www.Qualitycheck.org (The Joint Commission on Accreditation of Health Organizations) • Department of Neurology at Massachusetts General Hospital (HospitalWeb) • Therapist Unlimited • Egyptian Area Agency on Aging • Community Health & Emergency Service Inc. (http://www.chesi.org) • Others

17. Healthcare Data Source Content @ 11/28/06 • Healthcare assets have been compiled by the GIS team for the 20-county region • List of hospitals in the 20-county region • Health Clinics • Doctors ( Family Practice, Pediatrics,Internal Medicine, OB/GYN) • Dental Care Facilities and Dentists • Eye Care Facilities • Health Services • Specialized Services • Nursing Homes • Rehabilitation • Mental Health • Specialized Facilities • Others

18. Healthcare Facilities linked with DSL & Mediacom Courtesy of U.S. Bureau of the Census (TIGER/Line Data, 2000), NAVTEQ (2005), Mediacom (2006)

19. Establish Benchmarks and Set Goals

20. Healthcare COI Measurable Goals Process July 12, 2006 - COI Defines Issues of Challenge and Opportunity September 21, 2006 - COI Leaders Prioritize Four Areas for Benchmarks & Goals 1 - Improved Profitability 2 - Improved Healthcare Outcomes 3 - Improved Connectivity between Healthcare Assets 4 - Reduced Critical Skills Shortages October 24, 2006 - COI breakout groups detail goal & benchmark priorities December 4, 2006 - COI defines current benchmarks and sets goals for 2012

21. Breakout Teams Establish Measurable Goals • Participants breakout into goal area of specific interest to them • Each breakout group reviews and prioritize current goal areas • Discuss how you want to measure accomplishment of stated goal areas • Define data sets to be used to set current benchmarks & 2012 goals • Establish agreed current benchmarks and 2012 goals • Begin process of defining who needs to be at the table to realize results • Recruit team leaders to pursue each agreed goal area • Agree on who and what will be reported out to general session

22. Breakout Group Reports

23. Improved Healthcare Profitability-1

24. Improved Healthcare Profitability-1

25. Improved Healthcare Profitability-2

26. Improved Healthcare Profitability-3

27. Improved Healthcare Outcomes (Aggregated for 20 Counties & by County) • Improved/increased health promotion/disease prevention (Increase the level of participation by 20%) • Increasing Access to Care (Increase the # of providers in each of these areas by 10%) • Improve Chronic Disease Management (Increase the # of people participating in CDM Programs by 10%))

28. Improved Healthcare Outcomes-1 (Aggregated for 20 Counties & by County)

29. Improved Healthcare Outcomes-2 (Aggregated for 20 Counties & by County)

30. Improved Healthcare Outcomes-3 (Aggregated for 20 Counties & by County)

31. Reduce Critical Skills Shortages -1

32. Reduce Critical Skills Shortages -2

33. Work Plan Review and Action Team Task Assignments

34. Healthcare COI Work Plan Prior To October 2006-1 Assign Task Completion to Leaders or Action Teams • Establish a leadership team to manage the work of the healthcare COI (Leaders) • Develop a champion and investor recruitment plan to sustain Connect SI (Team) • Identify healthcare industry research reports for Connect SI team • Clarify how Connect SI could help accelerate/benefit existing initiatives (Leaders) • Define what will enable and sustain regional collaboration versus competition • Establish Marketing Committee to address 5 and 7 • Clarify how the sub-regional input & involvement can be maximized by COI • Sub-Region Engagement team complete this task

35. Healthcare COI Work Plan Prior To October 2006-2 Establish strategies that will address challenges to regional collaboration (Marketing) Complete, and prioritize issues of challenge and opportunity (Team) Prioritize definition of measurable goals for COI (Team) Select the issue that creates the greatest sense of urgency for the COI (Leaders) Focus on collaborations that can result in short term wins linked to process (Leaders) Define what makes your investment of time, talent and treasure worthwhile (Leaders)

36. CONNECT SI Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #2 BACKUP SLIDES December 6, 2006 SIH Corporate Offices Frank Knott, President ViTAL Economy, Inc. Fknottmd@earthlink.net

37. Regional Healthcare Economic Model • Develop a regional healthcare economic model which will allow users to prepare and print standard economic reports outlining key measures such as healthcare’s role in GDP, etc. • Modify the regional economic model. Supplement it with healthcare data from other sources such as regional hospitals, previous studies, medical association statistics, to provide a more detailed analysis of healthcare in the region and within its four economic sub-regions • Conduct a detailed analysis of the leakage of healthcare services from the region to neighboring states. Conduct interviews with healthcare professionals, assess available statistical data from multiple sources to establish a statistical basis for measuring leakage by type of service, location and demographic. • Develop a micro-study of the economic activity related to a typical area hospital based on available data and interviews with regional industry leaders. Develop a standardized regional report on healthcare activity and its economic impact on the region. • Create a standard projections report, so that five-year projections of potential regional economic performance can be produced based on changes in employment and average wage assumptions. Produce an Economic Model Training Manual which explains the model, how to use it and for what it can be used. Conduct a training session in the Connect SI region

38. Measurable Goals Areas Defined October 24, 2006

39. What Are Meaningful/Measurable Goals for the Healthcare COIProfitability • Increase Provider Profitability • To set percentages, had to look at background issues • Set operability goals • Increasing 3rd party reimbursements -- private health insurance • Connected to employers • First and last goal to be benchmark are closely related, one issue • Connect SI could focus on health care hubs • There are four regions, maybe focus on developing hubs within each to draw specialists to the region • These hubs could then bring patients into the region from other centers • The development of related new business would allow employers to expand coverage

40. What Are Meaningful/Measurable Goals for the Healthcare COIProfitability • Create an employer health insurance pool, to particularly assist smaller businesses • Market healthcare services available in area to employers • People do not realize the quality of care available locally and feel they have to go outside region • Through Connect SI, map health services available and then communicate them • Identify specific care, specialists, etc.

41. What Are Meaningful/Measurable Goals for the Healthcare COIProfitability • Identify issues related to profitability of specific types of care such as behavioral, acute, and long-term care • Communicate regional services available to employee assistance programs • Hold county governments accountable to fact that health care is a key employer and community resource and they need to support it. If lose it, will lose economic engine. • Recruit youth in the region as future employees

42. What Are Meaningful/Measurable Goals for the Healthcare COIProfitability • Electronic health records • Major cost issue -- very expensive to implement • Human resources is a key issue to implementation; employees already buy; implementation is grueling • Physicians expect electronic records • Need health care leadership (boards, physicians, CEOs) to get word out about these needs and explain • Connectivity between different healthcare providers is key • Exchange of information creates community health record

43. What Are Meaningful/Measurable Goals for the Healthcare COIProfitability • Frank - create a list serve of team members • If we get access to local team economic models, can create model for region • Need to access economic models for health organizations • Don’t say subsidize. One invests in communities and health.

44. What Are Meaningful/Measurable Goals for the Healthcare COIHealth Outcomes • Health outcomes • Identifies illnesses and health issues that require better outcomes: cancers, cardio-vascular disease, flu and pneumonia, chronic respiratory, strokes, accidents, alzheimers • Comment: add mental illness -- depression, severe mental illness • Consider other measures to focus on • Goal: decreasing prevalence of targeted illnesses • Need to increase collection and sharing of information • Understanding • Increase networking • Increase training around prevention • Improving care received

45. What Are Meaningful/Measurable Goals for the Healthcare COIHealth Outcomes • Network of care • Patient and care registry • Care models, sharing information and records • Leads to best practices for care • Ensure that best practices are acted on • Best care from team • Increase telemedicine

46. What Are Meaningful/Measurable Goals for the Healthcare COIHealth Outcomes • Increasing access • Increase access to resources in following fields: oral, primary, ob/gyn, behavioral, specialists • Map resources available, populations of need, specialists, etc • This would make using resources easier • Would identify tools in community • Set goals for mental illness

47. What Are Meaningful/Measurable Goals for the Healthcare COICritical Skill Shortages • Critical skill shortages • Identify occupation demand • Doctors, specialists, family practice… • mid level practitioners required including nurses, instructors, RNs, LPNs, specialties • Techs required, including specialties such as nuclear medicine • Behavioral health practitioners sought, want at least a masters degree • CNAs and CMAs • Data on occupational demand hard to find, reliability unclear • Break out group recommended conducting a skills needs survey • Market this link to IHA and other employers of medical professions • Survey Who institutions/practices have now and who they will need • All major hospitals have strategic plans -- one source of information • Junior colleges have been active in training and have studied demand to develop programs

48. What Are Meaningful/Measurable Goals for the Healthcare COICritical Skill Shortages • Frank -- need to access service providers for information • How can we do that? • two places -- hospital community through Illinois Hospital Association and Illinois Critical Access Hospital Network • Federally Qualified Health Centers • SIU workforce education program • Survey w/ high completion percentage • Survey educational providers to understand capacity • Identify potential issues • Need support with survey • Frank -- CSI will pull together survey • Mantracon has online survey tool

49. What Are Meaningful/Measurable Goals for the Healthcare COIConnectivity • Connectivity Issues • Financial feasibility • Availability • Broadband • Applications • Goal is health information exchange • Move to full electronic medical records • Convergence • Mobile connectivity • Regional Registry -- list of specialties available

50. What Are Meaningful/Measurable Goals for the Healthcare COIConnectivity • Connectivity Affordability • Current situation: Different size of operators, solo to large • Home $70-90 / month for up to 786 kbps • Solo practice $70-90 / month for up to 786 kbps • Group practice $20-750 / month for T-1 • Small hospitals, $750-1,000/mo for T-1 • Medium hospitals $1,200-1,500/mo for 3 T-1s • Large hospitals, $1,500/ mo 10 mbps • Goals: increase service and reduce costs for each level • Frank -- will survey what users say they have access to and existing demand • Need to create affordability path • Frank - has emergency communication issues come up • Probably issues