Cook County Health & Hospitals System: Strategic Planning Stakeholders Forum

1. Cook County Health & Hospitals System: Strategic Planning Stakeholders Forum November 14, 2008 UIC Student Center West 828 South Wolcott, 3:00 p.m.

2. Cook County Health & Hospitals System 2008 Cook County Health & Hospitals System 2

3. Mission Statement 2008 Cook County Health & Hospitals System To provide a Comprehensive Program of Quality Health Care, with Respect and Dignity, to the Residents of Cook County, regardless of their ability to pay. 3

4. Today’s Goals An overview of the strategic planning process and objectives. An overview of our preliminary findings on the current environment. 2008 Cook County Health & Hospitals System 4

5. 2008 Cook County Health & Hospitals System Planning Process Strategic Goals • Securing the operational stability of the CCHHS. • Developing more specific long term goals (in spite of immediate challenges). 5

6. 2008 Cook County Health & Hospitals System Planning Process First Steps • Gathering, analyzing and interpreting data from the external environment. • Community participation in the planning process to solicit feedback and ensure transparency. 6

7. 2008 Cook County Health & Hospitals System Initial Findings • Changes in the surrounding community-population shifts, economic changes, birth rates • Changes in Cook County Health & Hospitals System (CCHHS) • Changing external forces will affect the future. • Existing internal forces will affect the future. 7

8. 2008 Cook County Health & Hospitals System Changes in Population • Total county population declining, but growth in Suburban Cook County partially offsetting decline in Chicago population. • Hispanic and non-white population growing—Suburban Hispanic population grew 34%, more than 100,000 individuals. 8

9. 2008 Cook County Health & Hospitals System Growth in Poverty • Income grew faster in Chicago than in suburbs. • Portion of population below poverty line grew faster in Suburban Cook County. 9

10. The Uninsured 2008 Cook County Health & Hospitals System • Overall decline in uninsured between 2000 and 2005—but preliminary data suggests increases since 2005. • Metro and Chicago decline in uninsured. • All decline in Chicago—number of uninsured in Suburban Cook County increased by 43% (although still smaller than in Chicago).

11. 2008 Cook County Health & Hospitals System Births Declining – Faster in Chicago • Births are declining everywhere in the County • More slowly in Suburban Cook County

12. 2008 Cook County Health & Hospitals System Where do Stroger patients live? FY 2007 Note: There are 43 zip codes in Stroger’s Primary Service Area (PSA) that account for 18,902 or 80% of the hospital’s 23,548 total discharges. The top 3 zips, 60612 (West Town), 60623 (Lawndale) and 60608 (Pilsen) account for 13% of PSA discharges. *Total discharges exclude normal newborns

13. 2008 Cook County Health & Hospitals System Where do Oak Forest patients live? FY 2007 Note: There are 44 zip codes in Oak Forest’s PSA that account for 2,258 or 80% of the hospital’s 2,813 total discharges. The top 3 zips, 60426 (Harvey), 60628 (Roseland) and 60411 (Chicago Heights) account for 18% of PSA discharges. *Total discharges exclude normal newborns

14. 2008 Cook County Health & Hospitals System Where do Provident patients live? FY 2007 Note: There are 10 zip codes in Provident’s PSA that account for 4,802 or 80% of the hospital’s 5,944 total discharges. The top 3 zips, 60615 (Kenwood-Hyde Park), 60653 (Kenwood-Oakland) and 60609 (Bridgeport) account for 33% of PSA discharges. *Total discharges exclude normal newborns

15. 2008 Cook County Health & Hospitals System System Hospitals: Average Daily Census by Hospital, 2004 thru 2007 Source: IDPH Data, 2004-2007

16. 2008 Cook County Health & Hospitals System System Hospitals: Admission Trends, 2004-2007 Source: IDPH Data, 2004-2007

17. 2008 Cook County Health & Hospitals System ACHN Clinic Locations

18. Visits: Ambulatory Community Health Network Clinic Visits by LocationFY2005 - 2008 2008 Cook County Health & Hospitals System Source: ACHN Manual Counts

19. 2008 Cook County Health & Hospitals System CCHHS Financing: Summary CCHHS Sources of Support FY04 - FY09 ($M) 1.66 Bill 2.02 Bill 1.88 Bill 1.74 Bill 1.79 Bill 1.71 Bill Source: Audited Financial Statements, FY 04-08; Management estimate for FY 08-FY 09 Source: Audited statements and internal documents;

20. 2008 Cook County Health & Hospitals System IGT/BIPA Funds Declining Over Time Source and Notes: County’s Health Care System Lost $120.5 Million in “Supplemental” Medicaid Revenues Between FY05 and FY08; Slide provided by the Center for Budget and Tax Accountability (CTBA);

21. 2008 Cook County Health & Hospitals System BIPA Funding Shared with State

22. 2008 Cook County Health & Hospitals System Cook County Health & Hospitals SystemFY 2008-FY2009 Budget Comparison

23. 2008 Cook County Health & Hospitals System Adopted Appropriations: Health Fund

24. 2008 Cook County Health & Hospitals System Adopted Appropriations: Capital

25. CCHHS Patient Payor Mix 2008 Cook County Health & Hospitals System 25

26. Public Hospital Subsidy 2008 Cook County Health & Hospitals System 26

27. Policy Issues National healthcare reform. Charity care as government policy. Patient Safety and Quality Measurement/Pay for Performance structures. Proposed regulations that may constrain providers of healthcare to the poor. 2008 Cook County Health & Hospitals System 27

28. Regional/National Trends Shifting City/County Demographics ongoing city gentrification, inflow of uninsured immigrants. Increasing out-of-pocket expenses. Public Hospital financing issues in the U.S. Insufficiency of specialty care access and resources for the poor. Anticipated shifts/trends in healthcare delivery. The overall economic downturn that threatens tax revenue shortages. 2008 Cook County Health & Hospitals System 28

29. Existing Internal Forces Weakened infrastructure in IT and revenue cycle throughout the institution threatens our ability to move forward. Tumultuous changes led to the loss of many critical human resources that need to be rebuilt in order to move forward. Customer service scores display a gap that will keep us from succeeding. 2008 Cook County Health & Hospitals System 29

30. Positive Developments Support from the County Board President and Commissioners for the creation of an independent CCHHS Board, and the opening up of the governance decision-making process. The opening of the new John H. Stroger hospital facility. The preliminary acceptance of the CCHHS’ recommended 2009 Budget. Reduction of costs through the use of a Group Purchasing Organization (GPO). The work with the Revenue Cycle consultants is showing progress and positive returns. 2008 Cook County Health & Hospitals System

31. Next Steps – Your Input What are the Hard Decisions? You tell us. What are the three mostimportant services CCHHS delivers to the people of Cook County? What are the three services you are willing to give up in order to assure the most important services? What questions do we need to answer in order to develop an actionable Strategic Plan? 2008 Cook County Health & Hospitals System 31

32. 2008 Cook County Health & Hospitals System Questions?