specialty care - The Civic Federation

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VISION 2015
Strategic Direction
July 2010
Presented by:
William T. Foley
Chief Executive Officer
Cook County Health & Hospital System
Ruth M.
Rothstein
CORE Center
John H.
Stroger, Jr.
Hospital
Provident
Hospital
Oak Forest
Hospital
Cermak
Health
Services
Cook County
Department of
Public Health
2
The Safety Net
Healthcare System for
Cook County
Ambulatory
and
Community
Health Network
Process Timeline
Action Items
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
3 Plan
Strategic
2Q2009
3Q2009
4Q2009
1Q2010
2Q2010
3Q2010
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
($496,500M)
CCHHS
Advocate Health Care
$53,651M
OSF St. Francis
$32,474M
Sinai Health
$31,093M
Ingalls
$19,239M
Resurrection Health Care
$18,931M
University Chicago
$17,593M
Mercy Hospital & Med Cntr
$11,862M
Norwegian American
$11,748M
MetroSouth
$11,625M
Holy Cross
$11,504M
St Bernard
$9,9845M
5
Sources & Notes: 2009 DSH Hospital Report by HFS drawn from 2006 OBRA filings.
Advocate, Resurrection, and Sinai DSH hospitals are aggregated..
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
6
Compared to other Major Public Health Systems
CCHHS Focuses on Acute Inpatient Services
Ratio of OP Visits to IP Discharges, 2008
7
* Includes 600,000 visits paid by
LACDHS to private community clinics
for uninsured low-income patients.
Source: National Association of Public Hospitals
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.
8
The Impact of Healthcare Reform
Cook County
Pre-Reform:
Post-Reform:
850,000+ Uninsured
225,000+ Uninsured
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
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.
11
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
Priority Actions by Goal
 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.
14
Rebuild Fantus Clinic and restructure as a Regional Outpatient Center.
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
15
1.
Continue to develop/strengthen key clinical services.
2.
Develop the infrastructure to support clinical services.
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
Patient-Centered Accountability
System-Wide Care Management
Specialty Care
Acuity
Emergency Care
Post Acute Care
Primary Care
Patient-Centered Care
Inpatient 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
Acute Care
Regional
Outpatient
Centers
Comprehensive
Community
Health Centers
Primary Care
 Primary Care/
Urgent Care
 Basic
Diagnostic &
Treatment
Services
18
 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/trau
ma/acute
inpatient care
 Inpatient
stabilization
and short stay
Rehab & PostAcute Care
Facilities
Acute Care
Regional
Outpatient
Center
Comprehensive
Community
Health Center
Primary Care
 Fantus
 Oak Forest
 ACHN Clinics as
Primary Care
Centers
 ACHN Clinics
as Primary Care
Centers
 Partnerships with
FQHC’s, CHC’s,
and other agencies
 Partnerships
with FQHC’s,
CHC’s, and
other agencies
19
 Provident
Rehab & PostAcute Care
 John H.
Stroger, Jr.
Hospital
 Provident
Hospital
 Partnerships
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 CCHCCottage Grove
20
Forecast for Primary Care and Specialty Care
Visits 2006 – 2015
50% Increase
from
2009 to 2015
900,000
800,000
2006
700,000
2007
600,000
2008
500,000
2009
2010
400,000
2011
300,000
2012
200,000
21
2013
100,000
2014
0
2015
Source: CCHHS, ICS Analysis
Actual Visits
21
Projected Visits
Forecast Growth of Primary Care and Specialty
Care Visits at Provident and Oak Forest
150K
105K
35K
25K
Provident
22
Oak Forest
Source: CCHHS, ICS Analysis 2009
Redistribution of Annual Operating Cash
Cash Savings from
Operations
Investments in
Reconfigured Operations
Oak Forest
$55M
($40M)
Outpatient Services
Provident
Total Savings
$17M
$72M
($23M)
Enhance Service
Lines/Infrastructure
($9M)
Build/Strengthening
Partnerships
Total Investments
($72M)
23
County Subsidies 2009 - 2015 (in millions)*
FY09
FY10 FY11
FY12
FY13
FY14
FY15
• Actual Subsidies
• Strategic Plan
• Without Strategic Plan
24
* Subsidies do not include the following indirect costs: Workers Compensation, Malpractice Insurance,
Self-Insurance Settlements, Pension, Debt Service Charges.
Strategic Capital Requirements 2011 - 2015
Capital Cost
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
25
$202.4M
2011
2012
2013
2014
2015
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
26
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
27
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