Tulare Regional Medical Center

1. Tulare RegionalMedical Center Comprehensive, Quality and Innovative Care in your backyard…

2. Background 112 Bed Acute Care Hospital Serving approximately 170,000 people in the Tulare County and its surrounding area Provides emergency, diagnostic, elective and surgical care Operates 4 rural health clinics, 1 wellness center Future expansion will include a new medical tower, an FQHC, and an additional rural health clinic

3. TRMC's Current Situation: SWOT Analysis STRENGTHS WEAKNESSES THREATS OPPORTUNITIES

4. Financial Snapshot Source: CA OSHPD

5. Strategic Plan Overview • Performance Improvement Initiatives • Clinical processes • Financial processes • Physician Recruitment and Community Development • “Be Healthy Tulare” Marketing Campaign

6. Performance Improvement Initiative

7. Performance Improvement Initiatives • Two performance improvement initiatives for both clinical and financial processes • Focus clinical QI initiative on the following areas: • Readmissions: • Heart attack- 19.8% • Heart failure- 27.3% • Pneumonia- 21.8% • TRMC is not be paid for episodes of care resulting from readmission within 30 days

8. Performance Improvement Initiatives • Poor quality of care scores will soon have a financial impact on TRMC • Starting in October 2012, Medicare’s Value-Base Purchasing will withhold 1-2% of TRMC payment • Will track and reward performance based on: • 12 process of care measurements • 8 patient satisfaction scores from HCAHPS • 30-day mortality rates • 8 hospital acquired conditions

9. Financial Process Improvement • Critically important to address weakness in financial processes now before the payment environment changes • Disproportionate Share Hospital(DSH) fund payments will be gradually decreasing due to ACA from 2014-2020 need to ensure financial viability without additional  payments • Three areas of financial management that need to be closely monitored and actively improved in order to retain financial stability: • Occupancy Rate • Bad Debt Rate • Days in Accounts Receivable

10. Financial Process Improvement Change due to increased number of licensed acute beds

11. Financial Process Improvement

12. Financial Process Improvement Fiscal Year

13. Physician Recruitment & Community Development

14. Physician Recruitment and Community Development Challenges: • TRMC in rural, lower income area - presents challenge to physician recruitment • 25 admitters account for 87% of all referrals, leaving TRMC vulnerable to change • Areas of particular concern - Cardiology, Ob/Gyn, Family Practice, Orthopedic Surgery • Revenue at risk at minimum $16 million • In Summary- Physician recruitment needs to be addressed and relationships with referring physicians need to be fostered

15. Physician Recruitment and Community Development Solution: Immediate - Use NHSC loan forgiveness programs as a draw for primary care providers Long Term - Reorient physician recruiting efforts towards a community development approach

16. Physician Recruitment and Community Development 1) Immediate - Use NHSC loan forgiveness programs as a draw for primary care providers • 4 Rural Health Centers and Future FQHC are eligible under National Health Services Corps Loan Forgiveness Program • Notify current staff of eligiblityto apply for loan repayment assistance. • Inform primary care providers when interviewing them for positions that TRMC site is NHSC-approved and therefore they may be eligible to apply for loan repayment if they accept your open position. • Utilize NHSC Recruitment Site to alert prospective and current Corps members to TRMC open positions. • ACA expands funding for FQHCs and the NHSC program - this opportunity is growing

17. Physician Recruitment andCommunity Development 2) Long Term - Reorient physician recruiting efforts towards a community development approach • Modeled after a successful rural recruitment program in Arkansas funded by RWJF • Combines traditional recruiting/retention and community development • Mobilize community members; with long-term goal todevelop community into more attractive place for providers • In RWJF funded pilot, average recruitment fees with this approach were $18,750 per provider – our projection is approximately $30,000 per provider due to CA labor costs

18. Physician Recruitment andCommunity Development Recruiter Position: • Works with residents/primary care providers/health care facilities to design and implement community improvements that make the area more attractive to new and existing providers • Builds relationships with local health care providers and residents and works to unite them into action groups • Provides technical assistance to enhance local capacity to self-assess needs and map resources • Informs community about alternative solutions to increasing access to primary care, such as use of nonphysician professionals (nurse practitioners and physician assistants) • Assists in developing grant proposals to bring needed resources to the community • Nurtures new providers to ease their transition into their new community • Links new providers with resources to improve practice retention.

19. One more thing… Marketing

20. Marketing Campaign A reminder of what we are facing… • Hospital’s historical reputation and public perception and the continuation of that negative public image • Low market share in desirable service lines and payer categories • Growing competition with other regional providers and the need to differentiate • Little philanthropic support from the community • Growing need for chronic disease management and strategies to address obesity

21. Be Healthy Tulare!

22. “Be Healthy Tulare!” Marketing Campaign The Campaign AIMS to… • Revitalize TRMC’s public image as a leader in the delivery of healthcare in the community by highlighting recent performanceimprovement work and addressing drivers of health in the Tulare community • Advancere-branding of TRMC’s approach to healthcare (Emphasis on Prevention/Wellness and Quality) • Enhance TRMC’s visibility within and outside of the county • Improvecommunity goodwill/customer loyalty • Position TRMC as the principal partner in advancing the total health of the communities it serves

23. “Be Healthy Tulare!” Marketing Campaign Identifying our approach…

24. “Be Healthy Tulare!” Marketing Campaign Strategic Focus Areas

25. “Be Healthy Tulare!” Marketing Campaign • Care Delivery • “Comprehensive, Quality and Innovative Care in your backyard…”is the key message • Heavily market Maternal and Child Health services • Focus on pregnant women • Aggressively capture stories and share • Highlight recent performance improvement initiatives • Cardiac and Respiratory care • Share patient stories- videos are extremely effective • Key Message: Show the community we are the leading healthcare provider in the region

26. “Be Healthy Tulare!” Marketing Campaign • Workforce Wellness • Internally-focused campaign to motivate TRMC employees and physicians to be “healthy eating, acting living” role models in their community • Explore possibilities of extending Evolution Fitness and Wellness Center membership to TRMC staff, if not done already • Quarterly wellness event – “Get-Fit Challenge” • Capture the experience and share • Key Message: TRMC’s commitment to health care is not limited only to its patients

27. “Be Healthy Tulare!” Marketing Campaign • Community Wellness Campaign: • Investment and/or development of local healthy eating, active living initiatives • ID and collaborate with local community partners (e.g. schools) • Targeted Employee and Community Engagement • Targeted community service activities with TRMC Senior Leadership and community partners (year-long projects) • Employee-driven community service projects • Retired Physician Program (Transition to Public Health Wellness Advocates) • Key Message: Demonstrate TRMC’s commitment to the total health of the communities it serves

28. “Be Healthy Tulare!” Marketing Campaign Graphic depicting Marketing Strategy Overview

29. Strategic Plan Summary

30. Appendix 1: Value-Based Purchasing

31. Appendix 2: Revenue at Risk Revenue at Risk

32. Appendix 3: Recruiting Budget Projected Program Budget