Abendshien AssociatesICS Consulting, Inc.
Strategic Planning –
Project Kick-off and Orientation
Integrated Clinical
Solutions, Inc.
May 16, 2009
Cook County
Hospitals & Health Services
Abendshien AssociatesICS Consulting, Inc.
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
Abendshien AssociatesICS Consulting, Inc. 44
Morning Discussion
WELCOME & INTRODUCTIONS
PURPOSE & OVERVIEW OF THE DAY
BRIEFING – FRAMING THE CONTEXT
DISCUSSION – KEY CHALLENGES,
OPPORTUNITIES, AND PRIORITIES
LUNCH
Abendshien AssociatesICS Consulting, Inc.
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
Abendshien AssociatesICS Consulting, Inc. 66
Morning Discussion
WELCOME & INTRODUCTIONS
PURPOSE & OVERVIEW OF THE DAY
BRIEFING – FRAMING THE CONTEXT
DISCUSSION – KEY CHALLENGES,
OPPORTUNITIES, AND PRIORITIES
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
10000
15000
20000
25000
30000
CCHHS
Rus
h
UIC
St.
Eliz
/St.
Mar
yM
t. Sin
ai
St.
Jam
es (c
ombine
d)
Jack
son
Par
kHoly
Cro
ssU o
f CChildre
n's
Alexian
Bro
ther
s
Adv
ocat
e Chr
ist
SelfPay/Charity
Medicare
Medicaid
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
Abendshien AssociatesICS Consulting, Inc. 2525
Morning Agenda
INTRODUCTIONS
PURPOSE & OVERVIEW OF THE DAY
OVERVIEW BRIEFING
DISCUSSION – KEY CHALLENGES,OPPORTUNITIES, AND PRIORITIES
LUNCH
Abendshien AssociatesICS Consulting, Inc. 26
Group Discussion
Discussion Goals:
1) Develop consensus on the fundamental
issues/challenges facing CCHHS.
2) Define a “vision of success.”
Abendshien AssociatesICS Consulting, Inc. 27
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.
Abendshien AssociatesICS Consulting, Inc. 28
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.
Abendshien AssociatesICS Consulting, Inc. 29
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??
Abendshien AssociatesICS Consulting, Inc. 30
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?
Abendshien AssociatesICS Consulting, Inc. 3131
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?
Abendshien AssociatesICS Consulting, Inc. 3232
Morning Agenda
INTRODUCTIONS
PURPOSE & OVERVIEW OF THE DAY
OVERVIEW BRIEFING
DISCUSSION – KEY CHALLENGES,
OPPORTUNITIES, AND PRIORITIES
LUNCH
Abendshien AssociatesICS Consulting, Inc. 3333
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
Abendshien AssociatesICS Consulting, Inc. 3434
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
Abendshien AssociatesICS Consulting, Inc. 3535
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
Abendshien AssociatesICS Consulting, Inc.
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
• Identification of
Major Strategic
Initiatives
IV. Financial Plan
• Development of
Action Plans:
Strategic
initiatives
Timetables
Resource
requirements
Implementation
roles and
responsibilities
• Identification of
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.
Abendshien AssociatesICS Consulting, Inc. 37
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…
Abendshien AssociatesICS Consulting, Inc. 3838
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
Abendshien AssociatesICS Consulting, Inc. 39
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
Abendshien AssociatesICS Consulting, Inc. 4040
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:
Abendshien AssociatesICS Consulting, Inc. 4141
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
Abendshien AssociatesICS Consulting, Inc. 4242
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
Abendshien AssociatesICS Consulting, Inc. 4343
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
Abendshien AssociatesICS Consulting, Inc. 4444
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
Abendshien AssociatesICS Consulting, Inc.
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.
Abendshien AssociatesICS Consulting, Inc.
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
Abendshien AssociatesICS Consulting, Inc.
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
Abendshien AssociatesICS Consulting, Inc. 4848
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
Abendshien AssociatesICS Consulting, Inc. 4949
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
Abendshien AssociatesICS Consulting, Inc. 5050
Afternoon Agenda
STRATEGIC PLANNING APPROACH
STAKEHOLDER ENGAGEMENT
ROLE OF STRATEGIC ADVISORY COUNCIL
CONCLUDING REMARKS
ADJOURNMENT
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