5250 old orchard road skokie, illinois 60077 comanche county hospital authority enterprise...
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5250 Old Orchard Road Skokie, Illinois 60077 www.sg2.com
Comanche County Hospital AuthorityEnterprise Strategic Plan 2009–2013
November 18, 2008
Angus Cameron Ricky Garcia
Benjamin KlineGreg Scrine
Contents Project Overview
Market and Organizational Assessment
Demand Forecast
Facilities Forecast
Strategic Priorities
Confidential and Proprietary © 2008 Sg2 3
Project Team
Sg2
Angus Cameron Regional Vice President, Client Engagement Lead
Greg Scrine Senior Vice President, Consulting Lead
Ricky Garcia Consultant, Project Manager
Benjamin Kline Senior Analyst, Project Analyst
Confidential and Proprietary © 2008 Sg2 4
Project Objectives and Phases Project Objectives:
Build a collaborative management and physician organizational five-year vision and consensus-driven set of strategies
Develop a strategic plan that identifies the requirements necessary to build successful clinical programs and informs the master facilities plan
Project Phases: Phase I – Develop current state assessment and demand forecast Phase II – Evaluate opportunities and formulate strategic plays Phase III – Develop and refine strategic plan
Contents Project Overview
Market and Organizational Assessment
Demand Forecast
Facilities Forecast
Strategic Priorities
Confidential and Proprietary © 2008 Sg2 6
CCHA Service Area and Institution Locations
Southwestern Medical Center
Reynolds Army Community Hospital
Lawton Indian Hospital
Duncan Regional Hospital
Jackson County Memorial Hospital
Comanche County Memorial Hospital
Note: Hospitals marked outside of PSA have more than 45 bedsSources: CCHA; Sg2 Analysis, 2008.
Sayre Memorial Hospital
INTEGRIS Clinton Regional Hospital
Pauls Valley General Hospital
Grady Memorial Hospital
Great Plains Regional Medical Center
Elkview General Hospital
Wilbarger General Hospital
33+ Hospitals in Greater
Oklahoma City
United Regional Health, North Texas – Wichita Falls Campus, Red River, HealthSouth Rehab and Wichita Valley
Primary Secondary
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6%
5%
11%
30%
10%
-7%
-6%
7%
17%
0%
00-17
18-44
45-64
65-UP
Overall
23%25% 23% 24%
36%37%35% 38%
26%24%26%
25%
15%14% 16% 13%
2007CCHAMarket
(PSA/SSA)
18-44
45-64
65+
00-17
Population Distribution by Age CohortCCHA Market (PSA/SSA) 2007–2017
Sources: Claritas; National data from Third Wave Research; Sg2 Analysis, 2008.
% Change in PopulationCCHA Market (PSA/SSA) 2007–2017
CCHA Market (PSA/SSA)
National
2017
National
100% = 313K 313K 302,383K 331,658K
CCHA Market Population Will Remain Flat
2007
National
2017CCHAMarket
(PSA/SSA)
Confidential and Proprietary © 2008 Sg2 8
0
25,000
50,000
75,000
100,000
125,000
Comanche County Baseline BRAC - Direct Military BRAC - Non-Military
Comanche County Population Growth with BRAC Impact, 2007-2017
Population
* See Figure 4-1: Population/Employment Summary on next slideNote: Comanche County Baseline data from Claritas.Sources: Claritas; Lawton / Ft. Sill Growth Management Plan: Impacts Due to BRAC; Sg2 Analysis, 2008.
Comanche County Will See Population Growth Due to BRAC
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017
Baseline 111,348 111,111 110,875 110,640 110,405 110,170 110,021 109,872 109,723 109,574 109,426
Direct Mil. - 245 489 734 978 1,223 1,468 1,712 1,957 2,202 2,446
Non-Mil. - 517 1,034 1,551 2,068 2,585 3,102 3,620 4,137 4,654 5,171
Total 111,348 111,873 112,399 112,925 113,451 113,978 114,591 115,204 115,816 116,429 117,043
=(17,881-14,701)*13
=(73,753-67,031)*13
10 Year Growth: 5%
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Greater than 51
26 to 50
11 to 25
Population Density, 2007 (pop. / sq. mile)
6 to 10
1 to 5
Sources: Claritas; Sg2 Analysis, 2008.
Southwestern Medical Center
Reynolds Army Community Hospital
Lawton Indian Hospital
Duncan Regional Hospital
Jackson County Memorial Hospital
Comanche County Memorial Hospital
Sayre Memorial Hospital
INTEGRIS Clinton Regional Hospital
Pauls Valley General Hospital
Grady Memorial Hospital
Great Plains Regional Medical Center
Elkview General Hospital
Wilbarger General Hospital
United Regional Health, North Texas – Wichita Falls Campus, Red River, HealthSouth Rehab and Wichita Valley
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Note: CCHA discharges are from CY 2007; market and market share data is from CY 2006; analysis excludes DRG 391.Sources: CCHA; Oklahoma State Department of Health; Sg2 Analysis, 2008.
CCHA Inpatient Market Share (PSA/SSA)
Several of the Service Area’s Largest Markets Remain Virtually Untapped
26%
46%
57%
7%
8%
2%7%
15%
2%
17%
23%Overall CCHA Market Share =
CountyCCHA
DischargesMarket
DischargesCCHA
Mkt. Share
Comanche 6,804 11,461 57%
Stephens 727 6,411 10%
Jackson 445 5,328 7%
Grady 94 5,102 2%
Caddo 730 4,352 17%
Kiowa 312 2,271 15%
Washita 25 2,033 2%
Tillman 414 1,482 26%
Harmon 65 1,379 7%
Jefferson 122 1,023 13%
Greer 50 943 8%
Cotton 447 690 46%
Overall 10,830 42,475 23%
10%
13%
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Service Line Outmigrators % OutmigrationCY 2006 Market
DischargesWhere Are They Going?
Cardiovascular 2,376 33% 7,1751. INTEGRIS Baptist MC (672)2. Oklahoma Heart Hospital (663)
Women's Health 1,715 28% 6,1771. Oklahoma University MC (628)2. Norman Regional Hospital (179)
Orthopedics 1,555 37% 4,2001. McBride Orthopedic Hospital (378)2. Oklahoma Spine Hospital (215)
Cancer 941 37% 2,5451. Oklahoma University MC (300)2. INTEGRIS Baptist MC (195)
Pulmonary 797 18% 4,4901. INTEGRIS Baptist MC (141)2. Oklahoma University MC (107)
General Medicine 772 16% 4,9071. INTEGRIS Southwest MC (168)2. Oklahoma University MC (73)
General Surgery 742 32% 2,3131. INTEGRIS Baptist MC (160)2. Oklahoma University MC (147)
Gastroenterology 659 19% 3,5421. INTEGRIS Baptist MC (181)2. Oklahoma University MC (73)
Neurosciences 650 27% 2,4331. Oklahoma University MC (73)2. Norman Regional Hospital (188)
Other 2,189 30% 7,2381. Oklahoma University MC (166)2. Great Plains Regional MC (69)
Total 11,455 27% 42,4751. Oklahoma University MC (2,113)2. INTEGRIS Baptist MC (1,799)
CCHA Market (PSA/SSA) Inpatient Outmigration by Service Line, CY 2006
Notes: Outmigrators defined as patients residing in CCHA’s service area and receiving care outside the service area; Other includes Nephrology, Endocrine, Psychiatry, Oncology, Urology, Hematology, Otolaryngology, Thoracic Surgery, Injury, Trauma; Cancer volumes are flagged at the ICD9 level and are therefore double counted in this analysis / Sources: Local market data provided by Oklahoma State Department of Health; Sg2 Analysis, 2008.
Over One-Fourth of the Overall Market is Seeking Care Outside of the Service Area
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Greater than 500
101 to 500
11 to 100
6 to 10
CCHA Outpatient Origin, CY 2007
1
2
3
4
5
6
7
8
9
10
Note: Outpatient origin excludes visits.Sources: CCHA; Sg2 Analysis, 2008.
0 to 5
×
CountyCY 2007Volumes
Origin Distribution
Comanche 69,801 67%
Stephens 7,228 7%
Caddo 5,435 5%
Jackson 3,843 4%
Tillman 3,694 4%
Cotton 3,395 3%
Kiowa 2,182 2%
Jefferson 1,051 1%
Grady 975 1%
Harmon 485 0.5%
Greer 435 0.4%
Washita 198 0.2%
Outside 5,928 6%
Grand Total 104,650 100%
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Sources: CCHA; Sg2 Analysis, 2008.
CountyCY 2007
DischargesOrigin
Distribution
Comanche 6,804 63%
Caddo 730 7%
Stephens 727 7%
Cotton 447 4%
Jackson 445 4%
Tillman 414 4%
Kiowa 312 3%
Jefferson 122 1%
Grady 94 1%
Harmon 65 1%
Greer 50 0.5%
Washita 25 0.2%
Outside 595 5%
Grand Total 10,830 100%
Greater than 100
51 to 100
11 to 50
1 to 10
CCHA Inpatient Origin, CY 2007
×
1
2
3
4
5
67
8
9
10
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Geographic Attractiveness Drivers Absolute Population Growth Population Density Average Household Income Average Household Healthcare Expenditures
Geographic Attractiveness Drivers Absolute Population Growth Population Density Average Household Income Average Household Healthcare Expenditures
Source: Sg2 Analysis, 2008.
Decision Scale
Lev
el o
f A
ttra
ctiv
enes
s
0 to 8
33 to 40
25 to 32
17 to 24
9 to 16
×
10 Miles
Southwestern Medical Center
Reynolds Army Community Hospital
Lawton Indian Hospital
Duncan Regional Hospital
Jackson County Memorial Hospital
Comanche County Memorial Hospital
Sayre Memorial Hospital
INTEGRIS Clinton Regional Hospital
Pauls Valley General Hospital
Grady Memorial Hospital
Great Plains Regional Medical Center
Elkview General Hospital
Wilbarger General Hospital
United Regional Health, North Texas – Wichita Falls Campus, Red River, HealthSouth Rehab and Wichita Valley
Confidential and Proprietary © 2008 Sg2 15
23%
57%
10%17% 15%
26%
11%
31%
5%
5%4%
10%
15% 5%
23%
5%
4%
7%
22%
4%
39%
16%
75%
45%
24%
15%7%
9%
3%
16%
10%
75%
12%
62%10%
5%
10%33%
9%
46%
6%
5%
9%
4%
6%
5%
6%
5%
7%
4%5%5%
51%
10%
Overall Comanche Stephens Jackson Grady Caddo Kiowa Washita Tillman Other
Other
OU Medical Center
Integris Baptist MC
St. Anthony Hospital
Harmon Memorial Hospital
Elkview General Hospital
Grady Memorial Hospital
Duncan Regional Hospital
Jackson County Memorial
Southwestern MC
CCHA
Inpatient Market Share (PSA/SSA) by County, CY 2006
Mkt. Discharges: 42,475 11,461 6,411 5,328 5,102 4,352 2,271 2,033 1,482 4,035
Notes: Analysis excludes DRG 391; Other includes Harmon, Jefferson, Greer and Cotton; Values less than 4% not labeled.Sources: Local market data provided by Oklahoma State Department of Health; Sg2 Analysis, 2008.
CCHA Has a Stronger Presence in Collar Counties
Anadarko and
Carnegie (22%)
Memorial Hospital (41%)
Majority to Greater OK City
Great Plains and INTEGRIS
Clinton (40%)
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23%29% 28%
24% 20% 23% 19%
11%6% 10%
11%13%
19%
13%
12% 11%13%
9%8%
10%
13%
10% 7%
11%
10%9%
7%11%
7%
5%4%
4% 9%8%
4%5%
10%
5%
12% 7% 4%
22% 24%16%
30%19% 21% 21%
5% 4%
5%4%4%
Overall Cardiovascular Women's Health Orthopedics Cancer Neurosciences Other
Other
OU Medical Center
Integris Baptist MC
St. Anthony Hospital
Harmon Memorial Hospital
Elkview General Hospital
Grady Memorial Hospital
Duncan Regional Hospital
Jackson County Memorial
Southwestern MC
CCHA
Inpatient Market Share (PSA/SSA) by Service Line, CY 2006
Mkt. Discharges: 42,475 7,175 6,177 4,200 2,545 2,433 22,490
Notes: Analysis excludes DRG 391; Cancer volumes are flagged at the ICD9 level and are therefore double counted in this analysis; Values less than 4% not labeled.Sources: Local market data provided by Oklahoma State Department of Health; Sg2 Analysis, 2008.
CCHA Maintains a Leadership Position in Highly Fragmented Market
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Inpatient Market Share (PSA/SSA) by Subgroup, “Other” Category, CY 2006
22% 24%16%
30%
19% 21% 21%
0%
10%
20%
30%
40%
Other Institutions Market Share
Rank OverallCardio-
VascularWomen’s
Health Orthopedics CancerNeuro-
sciencesOther
1. Oklahoma Heart Hospital, 2%
Oklahoma Heart Hospital, 9%
Norman Regional Hospital, 3%
McBride Clinic Ortho Hospital, 9%
Mercy Health Center, 5%
Great Plains Regional MC, 3%
Memorial Hospital and Phys. Group, 2%
2. Mercy Health Center, 2%
INTEGRIS Southwest MC, 2%
Great Plains Regional MC, 2%
Oklahoma Spine Hospital, 5%
Norman Regional Hospital, 2%
INTEGRIS Southwest MC, 2%
Physicians Hospital of Anadarko, 2%
3. Great Plains Regional MC, 2%
Carnegie Tri-County Hospital, 1%
Mercy Health Center, 2%
Mercy Health Center, 2%
Memorial Hospital and Phys. Group, 2%
Mercy Health Center, 2%
Carnegie Tri-County Hospital, 2%
4. Memorial Hospital and Phys. Group, 2%
Memorial Hospital and Phys. Group, 1%
Lakeside Women's Hospital, 1%
Community Hospital, 2%
Deaconess Hospital, 1%
Memorial Hospital and Phys. Group, 2%
Mercy Health Center, 2%
5. INTEGRIS Southwest MC, 1%
Great Plains Regional MC, 1%
Weatherford Reg. Hospital, 1%
Great Plains Regional MC, 1%
Carnegie Tri-County Hospital, 1%
Carnegie Tri-County Hospital, 1%
INTEGRIS Southwest MC, 1%
6. Carnegie Tri-County Hospital, 1%
Norman Regional Hospital, 1%
INTEGRIS Canadian Valley, 1%
Bone and Joint Hospital, 1%
Great Plains Regional MC, 1%
Norman Regional Hospital, 1%
Great Plains Regional MC, 1%
Sources: Oklahoma State Department of Health; Sg2 Analysis, 2008.
Specialty Hospitals in Oklahoma City Are Drawing Significant Inpatient Volumes
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57%62%
75%
51% 48% 50% 53%
31% 24%
19%
27% 34%41% 36%
5%
5%
9%4% 4%
5%14%
5% 4%11%
Overall Women's Health Cardiovascular Orthopedics Cancer Neurosciences Other
Other
OU Medical Center
Integris Baptist MC
St. Anthony Hospital
Harmon Memorial Hospital
Elkview General Hospital
Grady Memorial Hospital
Duncan Regional Hospital
Jackson County Memorial
Southwestern MC
CCHA
Inpatient PSA (Comanche County) Market Share byService Line, CY 2006
PSA Discharges: 11,461 1,960 1,679 1,213 719 714 5,895
Notes: Analysis excludes DRG 391; Cancer volumes are flagged at the ICD9 level and are therefore double counted in this analysis; Values less than 4% not labeled.Sources: Local market data provided by Oklahoma State Department of Health; Sg2 Analysis, 2008.
A Majority of Comanche County Cases Stay at Home
9% to orthopedic specialty hospitals
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Sg2 Innovation Adoption Categories
Innovators 1
Develop and test new approaches Invest in research/development at an early stage Initiatives often cited at national meetings and in journals
Early Adopters
2
Seek to be the first in their market to adopt new technologies Adopt before broad-scale clinical trials are complete and/or reimbursement is secure Often report on the first widespread use of a particular technology
Consensus Adopters
3
Focus on technologies that are generally accepted and broadly available in their market
Adopt new approaches after several years of reports at national meetings
Cautious Adopters
4
Lag behind organizations of similar size in adoption of mature technologies Are slower to adopt new technologies due to a variety of factors, including capital
constraints, staff limitations, local consumer behavior and organizational priorities
Late Adopters
5
Characteristically have outdated technology and systems Often do not incorporate technology planning into strategy and future development
decisions Often are skeptical of new technologies
1 2 3 4 5Innovators Consensus LateEarly Cautious
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1 2 3 4 5
Cancer
Cardiovascular
Imaging
Neurosciences
Orthopedics
Surgery
Clinical Services & Technology Adoption Profile: Summary
Innovators Late Adopters
Sources: Sg2 STEP™ On-line; Sg2 Analysis 2008.
= Current CCHA Position = Proposed CCHA Position
Confidential and Proprietary © 2008 Sg2 21
There is Medical Staff Succession Risk in Key Clinical Areas
31%25%
48%
57%
42%
41%
23%
69%
45%
38%
57%
29%
57%50% 50%
33%
50%
50%
31%
18%
58%29%
27%
63%
29%
14%
50%
18%25%
14%18%25%
12% 12%
50%29%
50%
62%
9% 15%
57%
9% 14%
67%
61+
51-60
35-50
00-34
Medical Staff 186 51 26 17 13 13 11 8 7 7 7 6 6 6 4 4
Note: Medical staff includes MDs, DOs, PAs and ARNPs; Not all subspecialties included.Sources: CCHA; Sg2 Analysis, 2008.
Age Distribution of Medical Staff at CCHA, 2008
Contents Project Overview
Market and Organizational Assessment
Demand Forecast
Facilities Forecast
Strategic Priorities
Confidential and Proprietary © 2008 Sg2 23
Economy
Technology
Sociocultural Factors
Payment
Population
Consumerism
Care Delivery
Sg2’s Impact of Change® Forecasting Model
Facility Needs Beds Procedure rooms ORs Ancillaries Etc.
Strategic Forecast
OperationalForecast
OutpatientVolumes
InpatientDischargesand Days
BaselineUtilization Outpatient Shift Impact of Change®
2008–2018
Confidential and Proprietary © 2008 Sg2 24
Inpatient Discharges Will Remain Flat Over the Next Decade
Note: Analysis excludes DRG 391.Sources: Sg2 Impact of Change® v7.0; Sg2 Analysis, 2008.
10,500
10,700
10,900
11,100
11,300
11,500
2007 2009 2011 2013 2015 2017
CCHA Institution Inpatient Discharges, CY 2007 – CY 2017
Population-Based Forecast
Sg2 Forecast 0%
Discharges
CCHA CY 2007 CY 2017 % Change
Discharges 10,830 10,847 0%
Patient Days 54,599 50,875 (7%)
ALOS 5.04 4.69 (7%)
3%
Confidential and Proprietary © 2008 Sg2 25
91
78
77
117
120
293
1,206
1,033
424
1,406
619298
750
1,110
428728
236
1,127
0%
10%
20%
30%
40%
50%
60%
70%
-30% -20% -10% 0% 10% 20% 30% 40%
EPSSpine
CAD
PCI
CHF
Arrhythmia
DiagnosticCath
Vascular - Surgical
CABG
Joint
Gyn
Breast
Lung
Prostate
Neurological
DigestiveSystem
Kidney &Urinary Tract
Fracture - Surgical% Market Growth,
CY 2006-16
Market Share, CY 2006
Clinical Prioritization Matrix – Market Share & Forecasted Growth by Key Service LineInpatient Market Share and Forecasted Discharge Growth by Subspecialty, CCHA
Notes: Refer to Appendix for Subgroup definition.Sources: CCHA and Oklahoma State Department of Health; Sg2 Analysis, 2008.
Bubble size reflects 2007 Market discharges
Cancer
Cardiovascular
Orthopedics
Overall Forecasted Market Growth: 2%
OverallCCHA Market Share: 23%
Confidential and Proprietary © 2008 Sg2 26
9178
77
1,127
236
728
428
1,110
750
298
619
1,406
424
1,033
1,206
120
117
$0
$3,000
$6,000
$9,000
$12,000
-30% -20% -10% 0% 10% 20% 30% 40%
EPS
Spine
CADCHF
Arrhythmia
DiagnosticCath
Vascular - SurgicalCABG
Joint
Gyn
Breast
Lung
Prostate
Neurological
Digestive System
Kidney & Urinary Tract
Fracture - Surgical
% Market Growth, CY 2006-16
CM/Case, CY 2007
Clinical Prioritization Matrix – Contribution Margin & Forecasted Growth by Key Service LineInpatient CM/Case and Forecasted Discharge Growth by Subspecialty, CCHA
Notes: Refer to Appendix for Subgroup definition.Sources: CCHA and Oklahoma State Department of Health; Sg2 Analysis, 2008.
Bubble size reflects 2007 Market discharges
Cancer
Cardiovascular
Orthopedics
Overall CCHA CM/Case: $4,629
463
CM/Case: $15,875
PCI
Overall Forecasted Market Growth: 2%
Confidential and Proprietary © 2008 Sg2 27
Outpatient Institution Volume Growth Will Outpace a Population Based Estimate
CCHA Institution Outpatient Volumes, CY 2007 – CY2017
102,000
105,000
108,000
111,000
114,000
2007 2009 2011 2013 2015 2017
Volumes
CCHA CY 2007 CY 2017 % Change
Volumes 104,650 111,352 6%
Sources: Sg2 Impact of Change® v7.0; Sg2 Analysis, 2008.
Population-Based Forecast
Sg2 Forecast
6%
4%
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A Number of Clinical Groups Will See Outpatient Procedural GrowthOutpatient Procedure Ten Year Growth Rates by Clinical Group, CCHA Institution (CY 2007– CY 2017)
7% 7%
3%
15% 16%
4%
17%
-6%
9%
-2%
6%
-10%
-5%
0%
5%
10%
15%
20%
25%CCHA
CCHA OverallInteg-ument
Cardio-vascular
Musculoskeletal
Cancer GIEndo-crine
GYN Urinary Nervous Other
CY 2007 Volumes 7,190 1,893 1,653 1,080 805 748 609 579 258 125 245
Absolute Change 478 123 55 164 129 33 103 (34) 23 (3) 14
*Excludes visits; Analysis includes major and intermediate procedures only.Note: Cancer does not sum to Overall.Sources: Impact of Change® v7.0; Sg2 Analysis, 2008.
% Growth
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CT and MRI Will Show the Strongest Volume Growth Among All Modalities
Outpatient Imaging Ten Year Growth Rates by Modality,CCHA Institution (CY 2007– CY 2017)
8%
38%33%
-2%
10%
-20%
4%
-30%
-10%
10%
30%
50%
CCHA
CCHA Overall CT MRI X-ray US SPECTNuclear Medicine
CY 2007 Volumes 48,554 8,638 3,876 28,943 5,532 898 667
Absolute Change 3,999 3,260 1,267 (620) 241 (179) 29
Advanced Imaging Standard Imaging
*Excludes visits.Sources: Impact of Change® v7.0; Sg2 Analysis, 2008.
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CCHA Should Expect Growth in Chemotherapy and Radiotherapy
12%
20%CCHA
CCHA Radiotherapy Chemotherapy Interventional Oncology
CY 2007 Volumes 7,698 677Procedures include thermal ablations, catheter-delivered
therapies, endoscopic approaches and energy-based
therapies.Absolute Growth 942 138
Outpatient Cancer Radiation and Chemotherapy Ten Year Growth Rates, CCHA Institution (CY 2007 – CY 2017)
Sources: CCHA; Sg2 Impact of Change® v7.0; Sg2 Analysis, 2008.
28%
Sg2 National Forecast
Contents Project Overview
Market and Organizational Assessment
Demand Forecast
Facilities Forecast
Strategic Priorities
Confidential and Proprietary © 2008 Sg2 32
The Transformation of the Hospital
Capital and Labor Information and Logistics
Health System Market Maker
• Physicians organize around capital
• Physicians bring patients
• Local monopolies
• Hospital stay is the center of care
• Long stay, large nursing input
• Municipal finance model
• Physicians organize around patient
• Physicians own patients
• Competition Hosp-Hosp & Hosp-Doc
• Hospital stay is one element of care
• High service intensity, knowledge worker
• Corporate finance model
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Vision Elements
Capacity constrained
Comanche county focused
Community hospital
Fragmented physician community
Financially constrained (8% EBITDA margin)
Available capacity to support growth
Multi-county focused
Regional referral center (selected services)
Cohesive and sustainable physician community
Financially sustainable (12% EBITDA margin)
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Strategic Priorities
Evolve the Medical Group Platform
Evolve the Medical Group Platform
Enhance Capabilitiesin Core Clinical Programs
Enhance Capabilitiesin Core Clinical Programs
VisionCreate Capacity in Key Facility Areas
Create Capacity in Key Facility Areas
Create a Culture of Ownership & Accountability
Create a Culture of Ownership & Accountability
1
23
4
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Strategic Priority #1:
Evolve the Medical Group PlatformStrategic Objective
Evolve the essential physician platform to foster the ongoing renewal (succession planning) and growth (incremental new physicians) of the CCHA medical staff
Rationale
The current economic model is unsustainable and threatens the long term viability of the CCHA organization
A robust and sustainable physician group model is an essential strategic asset to CCHA and a requirement for continued growth of local programs and services
The creation of an organizational core competency in the recruitment and development of CCHA-aligned medical staff is essential to retention and growth of market position
Confidential and Proprietary © 2008 Sg2 36
Strategic Plays Targets Timeline Accountability
1. Evolve the CCHA Medical Group model: Include as a department of CCHA Develop physician leadership and governance Migration to productivity based compensation Design agenda to include:
Growth orientation Patient experience Clinical quality Succession planning and recruiting Economic sustainability
Model Developed(Y/N)
Model Substantially Implemented
(Y/N)
End of Q3CY 2009
End of Q4CY 2010
TBD
2. Invest in physician leadership development: Identify potential physician leaders for development Invest in physician leadership education Dedicate time, resources and funds for program
Program / Services
Developed (Y/N)
End of Q4CY 2009
TBD
3. Enhance CCHA’s in-house recruiting capability: Develop lifestyle proposition package Design call-burden management program and
communication materials Develop alternative physician sourcing channels (e.g.,
physicians with local ties) Employ dedicated physician recruiter
Program / Services
Developed (Y/N)
Physician Recruiter
Employed (Y/N)
End of Q4CY 2009
End of Q4CY 2009
TBD
Strategic Priority #1:
Evolve the Medical Group Platform
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Strategic Priority #1:
Overcoming Barriers to Group Evolution
There is no alternative…the current economic model is unsustainable and threatens the organization’s viability
Compensation by specialty unit avoids cross subsidies (e.g., ortho w/ ortho)
Keep clinician admin time light, just enough to act as one strategic unit
Give physicians a real stake in practice operations and capital decisions
Can’t move to productivity based comp without losing physicians
Internal group cross specialty subsidies don’t work…
Bureaucratic admin structure wastes productive clinical time…
Physician collaboration ends up just being social…
Barriers Paths Forward
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Strategic Priority #1:
Comanche Medical Group Strawman
Comanche County Hospital Authority
Board of Directors
Comanche County Memorial Hospital
CAO and EVP CCHA
Comanche Medical Group
Exec Dir and EVP CCHA
Management Council Physicians and Admin Represent Practice Units Specific Admin Compensation
Practice Units
UnitOrtho
UnitNeuro
Unit Others
Etc
President & CEO
Confidential and Proprietary © 2008 Sg2 39
Strategic Priority #1:
Federation Group Model
Shared Services Physician leadership, administrative and staff Billing Purchasing
Shared Responsibilities Proactive operations and efficiency Overhead expense management Capital spending
Specialty 1
Economic Unit
Comp
Specialty 2
Economic Unit
Comp
Specialty 3
Economic Unit
Comp
Specialty n
Economic Unit
Comp
Practice Performance Comp Pool
Confidential and Proprietary © 2008 Sg2
Strategic Priority #2:
Create Capacity in Key Facility AreasStrategic Objective
Create capacity to enable program growth in selected areas
Rationale
Profitable volumes currently leave the CCHA market to go to other providers and the ability to accommodate certain attractive case types is critical to achieving financial sustainability
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Confidential and Proprietary © 2008 Sg2
Strategic Plays Targets Timeline Accountability
1. Develop highly efficient case management program, key elements include:
Model design Role definition Resource management and staffing Data management tools and reporting
Capabilities Developed
(Y/N)
End of Q2CY 2009
TBD
2. Establish comprehensive CHF program (See Cardiovascular Section)
Clinic Operational
(Y/N)
End of Q2CY 2009
TBD
3. Evaluate the current surgical and interventional platform:
Cath lab scheduling, prep and recovery care model
Surgical capacity and case mix
Evaluation Complete (Y/N)
End of Q4CY 2009
TBD
4. Evaluate campus master plan and facility optimization: Use of McMahon-Tomlinson Nursing Center Current bed configuration
Evaluation Complete (Y/N)
End of Q4CY 2011
TBD
5. Evaluate off campus or freestanding business model potential:
Imaging services Ambulatory surgery and endoscopy services
Evaluation Complete (Y/N)
End of Q4CY 2011
TBD
Strategic Priority #2:
Create Capacity in Key Facility Areas
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Confidential and Proprietary © 2008 Sg2
CCHA Bed Need Forecast WithBRAC Impact and ALOS Reduction
Bed Type
Days
2007 – 2017% Change
Actual Beds2008*
Projected Beds2017
∆ Beds2007 – 2017
(Deficit)/Surplus
CurrentOccupancy
2007 2012 2017
Med/Surg 32,620 29,276 29,038 (11%) 139 124 15 64%
ICU 4,146 3,698 3,650 (12%) 12 11 1 95%
CCU 1,624 1,460 1,451 (11%) 8 7 1 56%
CVCU 4,897 4,185 3,967 (19%) 16 13 3 84%
Bed Need Forecast, CY 2007 – CY 2017, Current Occupancy
Bed Type
Days
2007 – 2017% Change
Actual Beds2008*
Projected Beds2017
∆ Beds2007 – 2017
(Deficit)/Surplus
TargetOccupancy
2007 2012 2017
Med/Surg 32,620 29,276 29,038 (11%) 139 99 40 80%
ICU 4,146 3,698 3,650 (12%) 12 12 0 80%
CCU 1,624 1,460 1,451 (11%) 8 5 3 80%
CVCU 4,897 4,185 3,967 (19%) 16 14 2 80%
Bed Need Forecast, CY 2007 – CY 2017, Target Occupancy
* Staffed bed count as of 2008.Note: ALOS reduction targets 0.5 day decrease in ALOS by 2012. This 0.5 day decrease is maintained from 2012-2017.Sources: CCHA; Sg2 Analysis, 2008. 42
Confidential and Proprietary © 2008 Sg2
CCHA Ancillary Need Forecast WithBRAC Impact
Modality
Current Utilization Target Utilization
FY 2008 Units
FY 2008Encounters
%Growth ’08-’18
IPNeed
OP Need
FY 2018 Total Need
IPNeed
OP Need
FY 2018 Total Need
(Deficit)/Surplus
CT 3 9,608 34% 1.0 3.0 4.0 0.4 0.9 1.3 1.7
MRI 2 4,216 35% 0.3 2.4 2.7 0.1 1.3 1.4 0.6
U/S 5 10,044 10% 1.6 3.9 5.5 1.3 3.2 4.5 0.5
X-Ray (Fixed) 6 31,419 5% 1.5 4.8 6.3 1.3 4.1 5.4 0.6
Mammography 2 5,143 12% 0.0 2.2 2.2 0.0 1.7 1.7 0.3
SPECT/NucMed 3 3,038 10% 0.8 2.5 3.3 0.6 2.0 2.6 0.4
Imaging Forecast, FY 2008 – FY 2018
Procedure Rooms
Current Utilization Target Utilization
FY 2008 Units
FY 2008Encounters
%Growth ’08-’18
IPNeed
OP Need
FY 2018 Total Need
IPNeed
OP Need
FY 2018 Total Need
(Deficit)/Surplus
ORs 10 6,858 7% 3.1 7.6 10.7 2.4 6.0 8.4 1.6
Cath Lab 2 2,755 9% 0.5 1.7 2.2 0.4 1.3 1.7 0.3
GI Lab 3 3,858 11% 0.3 3.0 3.3 0.2 2.0 2.2 0.8
Procedure Room Forecast, FY 2008 – FY 2018
Sources: CCHA; Sg2 Analysis, 2008.43
Confidential and Proprietary © 2008 Sg2
Strategic Priority #2: Case Management Program Development Case Management Model Design
Standardize processes, establish protocols for accountability, and develop productivity standards Develop and facilitate implementation teams focused on communication, operations, clinical
practice and desired program outcomes Role Definition
Complete detailed role analysis to determine the correct skill mix of RN case managers and medical social workers
Define roles and responsibilities of the medical staff, CM medical director, case managers, medical social workers and nursing staff during the admission, concurrent review and discharge phases of care
Resource Management and Staffing Realign existing FTE resources and hire additional support as appropriate to achieve outcomes Provide clinical mentoring of case management staff in their new roles (e.g., discharge planning,
clinical care coordination, physician collaboration, insurance contracts and payment operations) Implement a case manager education plan to define best practice improvement opportunities
and strategies for physician involvement Data Management Tools and Reporting
Implement reporting tools to assist case managers and departmental staff in efficiently managing patients with the redesigned model
Implement a daily supervisory tool for coordination and accountability of case management resources
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Confidential and Proprietary © 2008 Sg2
Example: Analysis of LOS Opportunity by Physician
Strategic Priority #2:
Case Management
Cases include all attending physicians; GMLOS = geometric mean length of stay; ALOS index = physician ALOS divided by GMLOS.Sources: General Hospital ; Sg2 Analysis, 2008
Greatest Potential for
Targeted High-Volume,
High-ALOS Physicians
Average
GMLOS
Discharges
AL
OS
In
dex
Area of Best Practice0.0
0.5
1.0
1.5
2.0
2.5
3.0
0 100 200 300 400 500 600 700
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Confidential and Proprietary © 2008 Sg2 46
Strategic Priority #3: Enhance Capabilities in Core Clinical ProgramsStrategic Objective
Enhance the scope and capabilities of selected clinical services to retain more cases locally, garner new cases from the broader market, fully leverage branding and differentiation opportunities, and facilitate long-term durable patient relationships Cardiovascular Orthopedics Spine Cancer
Rationale
Clinical capability strategic initiatives are focused on cardiovascular, orthopedics, spine and cancer; these are key areas of disease burden, market demand and financial viability, as well as service expectations from the Lawton community
Building clinical programming will require significant time and effort; limiting the number of priority areas in the short-term, and slowly expanding over time, improves the likelihood of success
Capital and organizational focus limitations preclude broad-based investment in and focus on all clinical programs
Confidential and Proprietary © 2008 Sg2 47
Strategic Plays Targets Timeline Accountability
1. Obtain National Society of Chest Pain Centers accreditation
Accreditation Acquired (Y/N)
End of Q2CY 2009
TBD
2. Form Chest Pain Network and expedited referral channels with nearby hospitals:
Establish concierge service (one call transfers) Focus on Duncan, Altus and Hobart area hospitals
Network Established (Y/N)
End of Q4CY 2009
TBD
3. Develop a comprehensive CHF clinic Clinic Operational
(Y/N)
End of Q2CY 2009
TBD
4. Develop formalized stroke program: Obtain JCAHO stroke center certification Establish protocols with outlying hospitals Become preferred EMS destination for stroke
Program Established (Y/N)
End of Q4CY 2009
TBD
5. Develop the EMS channel: Identify opportunities to develop and strengthen
relationships with market area squads Develop comprehensive regional plan for STEMIs
with regional hospitals Develop protocols for staff
EMS Program Established (Y/N)
End of Q2CY 2010
TBD
Strategic Priority #3:
Cardiovascular
Confidential and Proprietary © 2008 Sg2 48
Strategic Plays Targets Timeline Accountability
6. Establish cardiology clinic(s) in key market(s): Stephens County – 73533 (Total of 734 CV
Discharges and 15% Market Share) Medical Cardiology - 431 Cardiac Surgery - 55 Interventional & EP - 150 Vascular - 98
Stephens County – 73055 (Total of 246 CV Discharges and 23% Market Share)
Medical Cardiology - 138 Cardiac Surgery - 13 Interventional & EP - 51 Vascular – 44
Clinic(s) Operational (Y/N)
End of Q2CY 2010
TBD
7. Develop electrophysiology capabilities: Recruit fellowship-trained EP Implement EP lab
Capabilities Developed (Y/N)
End of Q4CY 2010
TBD
8. Invest in direct-to-consumer and direct-to-physician media campaign
Marketing Plan Implemented
(Y/N)
End of Q4CY 2010
TBD
Strategic Priority #3:
Cardiovascular
Confidential and Proprietary © 2008 Sg2 49
Strategic Plays Targets Timeline Accountability
1. Recruit three orthopedic surgeons – one surgeon to serve as service line champion
Three Orthopods Recruited (Y/N)
End of Q4CY 2009
TBD
2. Pursue aggressive cost management on implants via a request for proposal process
RFP Process Complete (Y/N)
End of Q4CY 2009
TBD
3. Enhance and promote the total joint replacement program: Expedite work up to procedure process Adopt aggressive quality initiative (eliminate “never” events) Optimize referring physician communications Create a patient follow up program Develop leading communication and education materials
Program Developed (Y/N)
Marketing Plan Implemented (Y/N)
Total TJR Discharges:
600
End of Q2CY 2010
End of Q3CY 2010
End of Q4CY 2010
TBD
4. Enhance and promote the sports medicine program: Accelerate diagnosis process (e.g., MRI to scope to
treatment) Evaluate additional opportunities to partner with area sports
teams (e.g., “after work” leagues, high school and college teams)
Provide directed promotion and education for all athletic organizations
Market sports medicine offering directly to patients via internet and print communication channels
Program Developed (Y/N)
Marketing Plan Implemented (Y/N)
End of Q2CY 2011
End of Q3CY 2011
TBD
5. Explore an affiliation with McBride Orthopedic Hospital: Recruitment Others to be identified
Evaluation Complete (Y/N)
End of Q4CY 2011
TBD
Strategic Priority #3:
Orthopedics
Confidential and Proprietary © 2008 Sg2
Strategic Plays Targets Timeline Accountability
1. Develop a comprehensive spine/back pain program, components include:
Imaging and diagnostics Surgery Physical and occupational therapy Pain management and rehabilitation
Program Developed (Y/N)
End of Q2CY 2011
TBD
2. Invest in direct-to-consumer and direct-to-physician media campaign
Marketing Plan Implemented
(Y/N)
End of Q3CY 2011
TBD
3. Pursue aggressive cost management on implants via a request for proposal process
RFP Process Complete (Y/N)
End of Q4CY 2009
TBD
Strategic Priority #3:
Spine
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Confidential and Proprietary © 2008 Sg2
Revenue/Patient
Strategic Priority #3: Comprehensive Spine Care Provides Multiple Revenue Opportunities
Back Pain: 80% of the Population
450K780K
13.7Mvisits
39M hours
3.2M
10.3M
PT/OT = physical therapy and occupational therapy; CAM = complementary and alternative medicine.Sources: MedPac, 2005; Sg2 Analysis, 2008.
7.2M4.1M
$43–$724$349–$506
$405–$1,238
$333–$632
Avg. $5,041
$405–$1,238
Patient Diagnostics X-Ray MR
Noninvasive Treatments PT/OT CAM
Percutaneous Procedures Spinal
InjectionsSurgery IP OP
Rehab
Volume
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Confidential and Proprietary © 2008 Sg2 52
Strategic Plays Targets Timeline Accountability
1. Expand market penetration in core tumor type areas (breast, colorectal, lung and prostate) by:
Increasing community screening efforts in colonoscopies, mammographies and DRE/prostate-specific antigen tests
Creating focused marketing and awareness campaign around tumor specific services
Outreach Initiated (Y/N)
Marketing Plan Implemented (Y/N)
End of Q2CY 2009
End of Q2CY 2009
TBD
2. Establish a patient-focused service model that accomplishes positive breast screening to diagnosis in less than 5 days:
Communicate positive screening within 24 hours Complete ultrasound and additional views within 24 hours Perform biopsy within 24 hours Obtain pathology report within 24 hours
Process Executed in Less Than 5
Days
End of Q2CY 2009
TBD
3. Develop breast reconstruction capabilities: Consider training general surgeon in oncoplastic surgery Explore relationship with OK City based plastic surgeon
Training Evaluated (Y/N)
Relationship Explored (Y/N)
End of Q2CY 2009
End of Q2CY 2009
TBD
4. Aggressively promote thoracic surgery capabilities across the region through outreach activities and continuing education
Marketing Plan Implemented (Y/N)
End of Q2CY 2009
TBD
5. Recruit pulmonologist and dedicated female breast surgeon Physicians Recruited (Y/N)
End of Q4CY 2010
TBD
6. Migrate endoscopy procedures to the ambulatory setting Migration Complete (Y/N)
End of Q4CY 2010
TBD
Strategic Priority #3:
Cancer
Confidential and Proprietary © 2008 Sg2 53
Strategic Plays Targets Timeline Accountability
7. Prepare to consolidate urology services from: Ft. Sill Duncan Altus
Ft. Sill Succession Plan Completed
(Y/N)
Duncan and Altus Succession Plan Completed (Y/N)
End of Q2CY 2009
End of Q4CY 2010
TBD
8. Employ leading technologies to differentiate the center’s diagnostic capabilities:
Breast MRI PET/CT
Technologies Implemented (Y/N)
End of Q4CY 2010
TBD
Strategic Priority #3:
Cancer
Confidential and Proprietary © 2008 Sg2 54
Strategic Priority #3:
Oncoplastics TrainingObjective Consider training a general surgeon in oncoplastic techniques to augment their
technical capabilities and increase patient satisfaction
Definition Oncoplastic surgery combines cancer surgery (e.g., lumpectomy) with cosmetic techniques; it is aimed mainly at women with early-stage breast cancer
Oncoplastic surgeons are trained in plastic surgery techniques that preserve or restore a breast’s shape or appearance
Advantages/Benefits
Allows breast cancer patients to reduce the number of times they are operated upon and expedites psychological recovery
Can benefit patients who need a mastectomy by helping their bodies prepare for subsequent reconstruction
Training in oncoplastic techniques can assist cancer surgeons in managing a shortage of reconstructive surgeons
Physician Training
There is currently no professional certification for oncoplastic techniques Introductory oncoplastic training is offered by the following organizations:
American Society of Breast Surgeons – sponsors introductory course at annual meeting; provides sessions on surgical assessment and techniques
The American Society of Breast Disease – holds 3-day “School for Oncoplastic Surgery” in Texas, including a session at the cadaver laboratory at Baylor Medical Center
Intensive training is needed for more complicated procedures, such as reconstruction using artificial implants
Confidential and Proprietary © 2008 Sg2 55
Strategic Priority #3:
Oncoplastics Training
Price - $1,475
Confidential and Proprietary © 2008 Sg2 56
Strategic Priority #4: Create a Culture of Ownership & AccountabilityStrategic Objective
Create a cohesive team with the motivation, skills and collaborative spirit enables CCHA to execute operationally and strategically while making the organization the preferred employer and physician partner
Rationale
Establishing a sense of pride and commitment among all CCHA associates is foundational to the ability to execute as an organization
A positive and cohesive culture where employees and physicians have pride in “wearing the CCHA jersey” is essential to attracting and retaining the best people
Confidential and Proprietary © 2008 Sg2 57
Strategic Plays Targets Timeline Accountability
1. Develop and roll out performance objectives and metrics tied to the organization’s Strategic Priorities:
Capacity creation Physician Platform evolution Clinical program development Culture development
Established (Y/N)
End of Q1CY 2009
TBD
2. Determine whether to pursue Nursing Magnet Designation Evaluation Completed
(Y/N)
End of Q2CY 2009
TBD
3. Establish CCHA Leadership Development Academy: Craft tenets and “CCHA Leadership” guiding principles Identify candidate selection criteria for all staff levels Allocate funds and resource to manage program Identify external resources to support program
Program Implemented
(Y/N)
End of Q4CY 2010
TBD
4. Instill an organizational focus on cost and resource efficiency: Focus on improving cost/reimbursement ratio Develop improved reporting system of
inpatient/outpatient (IP/OP) Medicare cases using ratios of costs to charges
Set organizational contribution margin goals for high volume Medicare case types
Establish a reporting system to provide regular enhanced reports to physicians
Program and Processes Developed
(Y/N)
End of Q2CY 2009
TBD
Strategic Priority #4: Create a Culture of Ownership & Accountability
Confidential and Proprietary © 2008 Sg2 58
Strategic Plays Targets Timeline Accountability
5. Revise and refine associate selection process: Develop a standard and CCHA ideal Training for managers in employee selection Develop standard interviewing process
Processes Operational (Y/N)
End of Q1CY 2009
TBD
6. Develop standardized communication materials for all new associates and physicians: Welcome video Revise orientation package
Materials Developed (Y/N)
End of Q2CY 2009
TBD
Strategic Priority #4: Create a Culture of Ownership & Accountability
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