cook county integrated clinical hospitals & health ... sbreport attach 1.pdf · abendshien...

Abendshien AssociatesICS Consulting, Inc.

Strategic Planning –

Project Kick-off and Orientation

Integrated Clinical

Solutions, Inc.

May 16, 2009

Cook County

Hospitals & Health Services


Retreat Agenda

2

Time Item Facilitator

9:00 am Welcome & Introductions Warren Batts

9:15 Purpose & Overview of the Day William Foley

John Abendshien

9:30 Briefing: Framing the Context Michael Koetting

10:00 Key Challenges, Opportunities & Priorities John Abendshien

10:45 BREAK

11:00 Discussion: Defining a “Vision of Success” John Abendshien

Noon LUNCH

12:30 pm Strategic Planning Approach John Abendshien

Mayur Patel

1:15 Community Engagement Mayur Patel

1:30 Role of Strategic Advisory Council William Foley

1:45 Concluding Remarks William Foley

Warren Batts

2:00 Adjournment

Abendshien AssociatesICS Consulting, Inc. 33

Morning Discussion

WELCOME & INTRODUCTIONS

PURPOSE & OVERVIEW OF THE DAY

BRIEFING – FRAMING THE CONTEXT

DISCUSSION – KEY CHALLENGES,

OPPORTUNITIES, AND PRIORITIES

LUNCH


Morning Discussion






LUNCH


Retreat Objectives

Set the stage for the strategic planning process:

– Discuss the current state of CCHHS.

– Identify the critical issues/strategic questions facing CCHHS.

– Develop consensus re: “principles of success.”

Review the strategic planning approach.

Identify planning process “must do’s” and potential pitfalls.

Establish the charge: roles and responsibilities of the Board,

Strategic Planning Advisory Council, Executive Leadership, and

Advisors.

5


Morning Discussion






LUNCH

Cook County Health & HospitalsSystem: Strategic Planning

Board Retreat

May 16, 2009

8

Presentation Goal

Set the context for the remainder ofthe day. Includes basic overview ofservices we provide and high-levelenvironmental scan.

NOTE: Today’s discussion focuses primarily

on the hospitals and clinics. The CORE,

Cermak and the Public Health Department

are important areas, but their issues are on

different dimensions. They will be addressed

at a later date.

Central Admin, 4%

Stroger, 61%CORE, 2%

Cermak/JDT, 5%

Provident, 12%

Oak Forest, 12%

Distributed Clinics, 1%

CCDPH/TB, 2%

9

Majority of Expenses in Clinical Areas

NOTE: After allocations of costs that are specifically traceable to individual facilities.Specialty outpatient activity is largely included in the budgets of the three hospitals, as isprimary care offered at hospital sites.

FY08 Expenditures by Function/Location (Estimated)

10

Activity Summary by Location

Cook County Health and Hospitals System

Utilization Statistics - FY 2008

Oak Distributed

Stroger CORE** Provident Forest Clinics TOTAL

Clinic Visits 394,629 31,280 26,726 18,951 132,002 603,588

Admissions 23,248 5,191 2,799 31,238

Patient Days 116,097 20,815 23,787 160,699

ER Visits 128,599 40,370 28,768 197,737

Case Mix Index* 1.1139 0.9636 0.9847

* Partial year

**Includes only County-funded visits; provides another 30,000 visits with

other funding

11

1. Vulnerable Populations

•Uninsured

•Medicaid

•Medicare

12

Large Number of Uninsured

0

100,000

200,000

300,000

400,000

500,000

600,000

700,000

800,000

900,000

Cook Cnty

Uninsured

Population San

Francisco

785,000* 799,000**

* 2005

** 2007

Number of uninsured people in Cook County equals

entire population of San Francisco

13

Uninsured Need Probably Grown

Number of uninsured from 2005 probably

understates full need:

• Overall population has grown

• Poor economy has increased share of

population uninsured

• Number of underinsured (estimated at 50%

number of uninsured in 2007) has almost

certainly increased even faster

Inpatient Uninsured Cases (Discharges, 2007-2008)

Stroger, 25%

Provident, 6%

Oak Forest, 4%Other Hospitals, 65%

14

County Major Provider for Uninsured

Source: Self-Pay/Charity, CompDataCook Cnty Hosp Discharges

CCHHS provides more than 1/3 of all inpatient care for

uninsured patients, about 18K Cases

Specialty,

244,898

Primary,

273,743

Screening,

53,667

15

Similar Role in Outpatient Care

• Primary care typically offered in other venues—such as

FQHCs and physician offices

• Specialty care disproportionately in CCHHS

• On balance, is probably in same range as inpatient—35%

to 50% of all care to uninsured in Cook County

System

Clinic Visits By

Type, 2008

• Roughly half of

System’s outpatient

care is primary care,

which is not typically

part of hospital care

• CCHHS provides hugely more outpatient care to uninsured

than other hospitals

Inpatient Medicaid Cases (Discharges, 2007-2008)

Stroger, 2.6%

Provident, 0.8%

Oak Forest, 0.2%

Other Hospitals,

96.1%

16

CCHHS Provides Less Medicaid Care

CCHHS provides about 7,000 inpatient admissions to Medicaidclients, less than 4% of Medicaid patients county-wide

Source: CompData,Cook Cnty Hosp Discharges

17

CCHHS Medicare Share Even Smaller

Source: CompData,

Cook Cnty Hosp Discharges

All Others = 268,489

Stroger = 2,585Provident = 462Oak Forest = 267

Medicare county-wide covers 40% more care than Medicaid, but

CCHHS provides only 1% of Medicare inpatient care

Inpatient Medicare Cases (Discharges, 2007-2008)

18

Medicaid Key Part of CCHHS Revenue

Medicaid*, 32%

Medicare, 4%

Other Patient, 3%

Cnty Transfer**,

61%

Medicaid, 29%

Medicare, 11%

Other Patients, 5%

Self-Pay, 55%

System Activity, I/P & O/P (2008) CCHHS Revenue = $1,075M** (2008)

* Includes BIFA/IGT; note all Medicaid

subject to revisions not yet reflected

** Includes loss from operations

Medicaid is the only material source of CCHHS

revenue outside of the County Subsidy Transfers

0

5000

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15000

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19

Others Variable in Care of Vulnerable

Different hospitals provide care to vulnerable populations in different

shares. See example hospitals below.

Source: CompData,

Cook Cnty Hosp Discharges

Vulnerable Populations by Payor (Discharges, 2007-2008)

20

FQHCs Provide Primary Care to Vulnerable

21

Limited Changes Expected

Absent some significant policy change, other hospitalsand FQHCs not likely to expand care of uninsured:

• Community hospitals face increasing marginpressure due to declining revenue from privateinsurers

• Number of FQHCs growing, but federal grantcoverage of uninsured declining—from 56% to48% between 2000 and 2007

Other providers will probably desire to maintain Medicaidactivity—it’s a good payor for FQHCs and adequate forsafety net hospitals

22

2. Potential Opportunities

In current environment, two majoropportunities exist:

• Provide more care

• Increase revenue

23

Provide More Care

• Current care provisions leave gaps in care for uninsured

• Improved throughput and targeting of resources could allow CCHHS to better fill gaps

• Hard data not yet available, but seems very likely 10 to 20 percent throughput improvements possible in existing operations

• Reallocation of resources could allow greater increases in high need areas

• Better throughput would also improve quality of care for existing patients

24

Increase Revenue

Most likely source of increased revenue would be to

increase number of Medicaid patients:

• State has incentive to increase CCHHS share

• FQHCs only provide primary care

• Not all private hospitals competing for Medicaid

Would require:

• Much improved throughput

• Focus on select Medicaid services

• Develop alliances with other providers to provide services in their gaps


Morning Agenda

INTRODUCTIONS


OVERVIEW BRIEFING

DISCUSSION – KEY CHALLENGES,OPPORTUNITIES, AND PRIORITIES

LUNCH


Group Discussion

Discussion Goals:

1) Develop consensus on the fundamental

issues/challenges facing CCHHS.

2) Define a “vision of success.”


Key Challenges Facing CCHHS

Some basic premises...

The size of the vulnerable population (uninsured and under-

insured) is substantial and growing.

CCHHS is the single largest provider of care to the vulnerable

population.

The needs of the vulnerable population exceed manifest

demand.

The demand for services outstrips available resources.


Key Challenges Facing CCHHS (cont’d)

Some basic premises…

The demand for services can be expected to grow.

The availability of funding through subsidy transfers and other

sources will not grow at a corresponding pace.

Other healthcare systems face growing economic pressures

and may be less responsive to the needs of the vulnerable

population.


Key Challenges Facing CCHHS (cont’d)

Some basic premises…

Services provided by CCHHS are:

• Not efficient

• Not particularly well distributed, geographically speaking

• May not represent the optimal mix of services from a mission-

effectiveness standpoint

Other premises—what’s missing??


The Opportunities

Key Strategic “Levers”…

Improve operational effectiveness/throughput

Reconfigure service mix/delivery platform

Rationalize system through “make/buy/partner” relationships

Combination of the above

Other?


Group Discussion

What does success “look like” in 2012?

What are the critical priorities in attaining this

vision of success?

What are the things we must focus on RIGHT

NOW?


Morning Agenda

INTRODUCTIONS


OVERVIEW BRIEFING



LUNCH


Afternoon Agenda

STRATEGIC PLANNING APPROACH

STAKEHOLDER ENGAGEMENT

ROLE OF STRATEGIC ADVISORY COUNCIL

CONCLUDING REMARKS

ADJOURNMENT


Afternoon Agenda




CONCLUDING REMARKS

ADJOURNMENT


Process Overview

Phase 1

Phase 2

Phase 3

Phase 1 – Kick-off & Retreat:

Set the Stage for the Planning Process

Phase 2 – Discovery:

Evaluate Current Position and Opportunities

Phase 3 – Strategic Direction:

Develop a Shared Vision and Strategic Direction

Phase 4 – Financial Plan:

Specify Action Plan and Accountabilities

Phase 5 – Action Plan:

Specify Action Plan and Accountabilities

Phase 4

Phase 5


Project Timetable

36

June-JulyMay

I. Kick-Off &Board Retreat

II. DiscoveryIII. Strategic

Direction

• Steering Group

Kick-Off Meeting

• Engagement Start-

up & Data

Acquisition

• Board Retreat

session

• External Market

Analysis

• CCHHS Profile &

Analysis

• Interviews & Focus

Groups

• Town Hall

Meetings

• Steering Group

Progress Report

• Identification of

Strategic

Opportunities &

Options

• Board/Steering

Group Retreat

• Vision and Goal

Formulation


Major Strategic

Initiatives

IV. Financial Plan

• Development of

Action Plans:

Strategic

initiatives

Timetables

Resource

requirements

Implementation

roles and

responsibilities


Performance Targets

• Translation of

Targets to Specific

Metrics for

Dashboard

Monitoring

Aug.-Sep. Sep.-Oct.

V. Action Plan

• Development of

“momentum”

scenario and

baseline budget

• Financial Modeling

re: Impact of

Strategic Direction

• Completion of 3-

year Financial

Plans

• Development of

Targets and

Metrics for Internal

Management

Reporting

Nov.


Process Outcomes—CCHHS Direction, Focus,

and Action

2000 2001 2002

Revenues $4,234 $5,103 $5,509

Expenses

Salaries 2,008 2,466 2,859

Supplies 1,432 1,478 1,989

Rent 555 789 1,001

Misc. 2,222 2,489 2,876

Net Income (1,333) (1,034) (1,567)

Key InitiativesObjectives andIndicators

Core Goals

Direction – CCHHSPreferred Future State

To become…


Phase 1 – Kick-off & Retreat

1. Kick-off

2. Discovery

3. Strategic

Direction

Work with System leadership to define and structure the following:

An executive leadership group (Executive Team) that will

process oversight, assistance in data acquisition, meeting

coordination, draft report reviews, etc.

A Strategic Planning Advisory Council (Advisory Council)

consisting of System Board, management, and selected

constituency groups

Meet with the Executive Team to discuss and refine strategic

planning objectives and approach, objectives and format for

May Board retreat, agree on a timetable, milestones,

communications, etc.

Facilitate a Board Retreat to formally launch the engagement

process.

Coordinate with the Executive Team and Public Relations

representatives to ensure that Retreat proceedings are

recorded and communicated to various publics in a timely and

appropriate fashion.

4. Financial

Plan

5. Action Plan


Phase 2 – Discovery

1. Kick-off

2. Discovery

3. Strategic

Direction

Provide an assessment of the System’s external and internal

operating environments, critical issues and future options:

Review market data and area healthcare profiles, including

relevant health-related data and projections for Cook County.

Analyze CCHHS’ clinical and operating environment and review

related utilization and medical staff data

Examine other county systems where progressive models have

been implemented; undertake benchmark research on model

structures, financial performance, and operational performance.

Concurrent with the above activities, conduct interviews/focus

group sessions with a variety of stakeholders (100-120).

Facilitate 3-5 “Town Hall” meetings with a cross-section of

County residents/consumers to elicit input re: health care

interests, concerns, and priorities

Based on the above information and evaluations, develop an

overall current state assessment summary

Facilitate a working session with the Advisory Council to share

findings and discuss future development options

4. Financial

Plan

5. Action Plan


Phase 3 – Strategic Direction

1. Kick-off

2. Discovery

3. Strategic

Direction

Work closely with the Leadership Team and the Advisory Council

to develop a vision, core goals, and overall strategic direction for

CCHHS:

Identify CCHHS’ opportunities and options.

As an integral part of the above analyses, complete a portfolio

analysis of CCHHS’ relevant business units and clinical service

lines based on market attractiveness and current capabilities

Identify specific service lines that could be considered as

priorities for focused development Also, evaluate opportunities

for partnership or outsourcing services and/or market segments

that are not an optimal fit with CCHS’ capabilities profile.

Facilitate a Board/Strategic Planning Committee “visioning”

retreat to develop group consensus regarding a shared Vision

for the future development of CCHHS.

Translate the Vision into Core Goals and Strategic Initiatives for

future direction and development.

Summarize Phase 3 outputs and make a progress report to the

Executive Team and Advisory Council.

4. Financial

Plan

5. Action Plan

•Translate the Vision into Core Goals and Strategic Initiatives for future direction and development:


Phase 4 – Financial Plan

1. Kick-off

2. Discovery

3. Strategic

Direction

Develop a 3-year financial forecast:

Develop a baseline forecast (prior to strategic initiatives).

Validate past and current methods of revenue/expense

forecasting and budgeting processes.

Develop the logic structure to perform sensitivity modeling.

Upon completion of the momentum forecast, incorporate

strategic and performance improvement initiatives into the 3-

year forecast.

Based on the developed forecast (baseline plus key strategic

initiatives) complete the forecast/model roll-up, with multiple

iterations, as necessary, prior to final approvals.4. Financial

Plan

5. Action Plan


Phase 5 – Action Plan

1. Kick-off

2. Discovery

3. Strategic

Direction

Translate the preferred strategic direction into an action plan:

Link the overall strategic direction and core goals to specific

strategic initiatives and action steps.

Establish timetables for implementation and ensure initiatives

have identified accountability for execution..

Identify performance metrics as a basis for ongoing dashboard

measures and monitoring.

Link targets, timetables, and responsibilities to Executive and

Board reporting mechanisms.

Complete the draft Strategic Plan and make presentations to

various stakeholders for review and comment.

Based on the input, make final revisions to the draft Strategic

Plan document.

Make final presentations to key stakeholders as appropriate.

Coordinate with the Executive Team and Public Relations

representatives to ensure that the CCHHS Vision and Strategic

Plan are appropriately recorded and communicated.

4. Financial

Plan

5. Action Plan


Framework for Implementation and Results Monitoring

Strategic Direction

Targets &

Key Perf. Indicators Strategic Priorities

Adjustment/Redirection

“Where are we

going?”

Dashboard Metrics, e.g.

• Public/patient metrics

• Outcomes

• Operating results

Core Goals, e.g.

• Access

• Service Excellence

• Cost-effectiveness

• Partnerships

“How are we

doing?”

Action Steps

• Strategic Initiatives

• Timetables

• Responsibilities

CCHHS Vision

1. Kick-off

2. Discovery

3. Strategic

Direction

4. Financial

Plan

5. Action Plan


Afternoon Agenda




CONCLUDING REMARKS

ADJOURNMENT


Stakeholder Engagement

45

Stakeholders Objectives

InterviewsSolicit confidential input from key leadership and

other constituents

Focus GroupsSolicit input from key constituent groups regarding

CCHHS service mix, access, quality, and other key

market and organizational factors

Town Hall Meetings

Solicit input from key stakeholder groups regarding

county health needs, CCHHS current state issues and

future priorities re: clinical services, access, and

organizational characteristics.

Leadership

Meetings/Retreats

Build consensus on current state issues and future

state vision, priorities, strategic initiatives, and action

plans

The strategic planning process will involve a cross-section of stakeholders

to build consensus and define the organization’s future state.


Town Hall Meeting Discussion Guide (sample)

46

Topic Discussion Points Time AllottedPreparation &Arrival

Ensure room and equipment is setup appropriately

Research team to wear name tags

CCHHS reps to mingle with attendees and direct them to chairs

Begin Town Hall promptly at designated time

30 min before

session start

Introductions –Getting Started /Ground Rules

CCHHS rep to thank attendees for coming and sharing their thoughts and

opinions

Introduce facilitators and objectives/format for meeting, e.g. to receive

constructive feedback on the current performance of CCHHS and

potential future direction

Review challenges and accomplishments over last few years

Check to see if the participants have any questions

Hand over to facilitator

Facilitator to explain session ground rules:

10 min

Background onParticipants

Explain that we would like to better understand our audience by asking a

few questions. Raise hands as appropriate:

o How many of you or family member used CCHHS?

o For which services did you use CCHHS?

o What changes have you seen in CCHHS over the last few years?

o Facilitate discussion as appropriate

o Transition to next topic

5 minutes

CommunityHealthcare Needs

What services does CCHHS not provide today that you would like to see

in the future? Note: CCHHS reps to use this opportunity to correct

perceptions if appropriate.

Are there specific geographic areas that have need for CCHHS presence?

Are there other opportunities for CCHHS to distinguish itself as a

healthcare provider?

15 minutes


Town Hall Meeting Discussion Guide (sample)

47

Topic Discussion Points Time AllottedPerceptions ofCCHHS as aProvider

Explain that we want to get their perspective on CCHHS as a healthcare

provider. This is meant to be an interactive and constructive discussion.

Identify the key strengths and weaknesses of the organization. Probes:

o Customer service

o Access to facilities

o Quality of care

o User-friendliness of services/facilities

o Nursing care

o Physicians

o Array/variety of services (note we could highlight specific services)

o Range of preventive services

o Culturally sensitive

o Community outreach

Facilitator to note where there was poor perception. Ask group to offer

constructive input as to why they felt that way and the opportunities for

improvement.

What examples can you provide where CCHHS has done a very good

job and that they should continue to build?

20 minutes

Catch All Is there any thing we didn’t discuss about community needs, CCHHS

perception, or other issues that you would like to add?

5 min

Closing Synthesize findings. Reiterate how we will use this information. Thank the

group.

5 min

TOTAL TIME 60 minutes


Afternoon Agenda




CONCLUDING REMARKS

ADJOURNMENT

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