Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #3 May 23, 2007

1. CONNECT SI Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #3 May 23, 2007 Rend Lake College Frank Knott, President ViTAL Economy, Inc. Fknottmd@earthlink.net

2. Current Healthcare COI Vision Statement • Supporting the collaboration and interconnection among healthcare providers and patients to improve: • Healthcare access • Health outcomes • Provider profitability • Through a qualified healthcare workforce in Southern Illinois

3. Healthcare COI Phase 1 Planning Cycle • 1 - Organize COI, Issue ID, Priorities & Goal Setting Jul - Sep 2006 • Milestone 1b Leadership Mtg September 21, 2006 • Milestone #1b COI Meeting October 24, 2006 • 2 - Establish Goal Setting Teams and Set Team Work Plans Dec 2006-Feb 2007 • Review Health Economic Model, Gap Analysis • Action Team Meetings Jan 2006-Mar 2007 • Milestone #2b COI Meeting Mar 2007 • 3 - Begin Value Chain Mapping, ID & Quantify Mar - Apr ‘07 • Connectivity Implications for Healthcare Providers and Patients May 23, 2007 • 4 - Prioritize & Define COI Connectivity Requirements May - June ‘07 • Tele-Health Applications & Value Propositions (Completed by Connectivity Goal Team) • 5- Develop & Quantify COI Economic & Jobs Strategy July-Sept ‘07 • Connect COI Strategy to Connect SI Regional Strategy • Health COI Milestone #5 COI strategy will be integrated with other COI strategies by Oct 2007

4. Agenda – Healthcare COI Meeting #3 8:30 AM - Welcome, Introductions, Meeting Objectives, COI Leaders Update 8:45 AM - Goal Setting & Physician Team Reports, Value Linkage Group Review 9:45 AM - Connecting the Dots Discussion- Strategies to Leverage Multiple Goals 10:15 AM - Learn Value Chain Maps, Quantify Value-Proposition for Each Goal 10:30 AM - Goal Setting Team Breakouts-Value Chain Maps + Value proposition 11:10 AM - Goal Setting Team Work Plan Schedule Prior to Milestone #5 - 7/16-20 11:30 AM - Adjourn

5. Objectives of Healthcare COI #2b Meeting • Finalize and Quantify Goal Setting Recommendations for the COI • Look for common short-term win strategies that can leverage multiple goals • Value Chain Mapping and Value Proposition Definition by Goal Setting Teams • Learn what constitutes a value chain and how to map a value chain for each goal • Learn and develop value propositions for each action plan collaborator • Learn the value linkage process • Insure connection of goals, value linkage and action plans • Establish work plan for COI goal setting teams prior to July COI Milestone #5 Meeting

6. Phase 1 Outcomes GIS Asset Maps Broadband Strategy GDP & Healthcare Economic Models Regional Economic Strategy Healthcare Strategy Regional Economic Framework Five-Year Measurable Goals Implementation & Funding Plan Network Providers COI Strategy 27,298 New Hi-Wage Jobs 41,461 Existing Jobs >$5,000/Yr Greater Egypt COI Strategy Southeastern COI Strategy Southern Five COI Strategy Greater Wabash COI Strategy $642 Million New KBE Activity 1,600+ Firms Connect SI Regional CED COI Strategy >$2 Billion New Annual Wages +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out Of Poverty $200 Million Information Technology Investment GIS Mapping Team Supports COI’s Connect SI 20-County Phase 1 June 06-December 07 “Led ByConnect SI Leadership Advisory Board” Healthcare Providers COI Strategy

7. Goal Setting Action Team Reports • Profitability • Critical Skills • Outcomes • Connectivity

8. Connect SI Healthcare Community of Interest Increase Provider Profitability Group

9. Working Group Parameters

10. Benchmarks for Development

11. Cardiology DRGs

12. Oncology DRGs

13. Orthopedics DRGs

14. Changing the Private Insurance Proportion in Payor Mix Proposed Goals 2004 Actuals Proposed5% Swap:Increasecommercialclients 5%, Reduce Medicaid clients5%,througheconomicgrowth Source: CompData

15. Reasons for Patient Out-Migration From the Connect SI Regional Hospitals

16. Factor Affecting Profitability Beyond the Control of Regional Hospitals

17. Profitability Measures Three Measures of Patient Migration: Cardiology, Oncology, and Orthopedics Based on 2005 DRGs Note: This is a minimum as Tennessee and other states are not included Source: COMPdata, SIH, SMGS Inc using specialized database form Herveywerks

18. Comments… Profitability Goal Setting Team

19. Critical Skills Shortage Goal Setting Team

20. Auna Searcey SIC Betty Musgrave T-Prep Brad Futrell Hamilton Memorial Hospital Carol Belt Shawnee Community College Cary Minnis, Chair MANTRACON Dawn Wickman Illinois Hospital Association Debbie Murphy HRMC Doris Martin Shawnee Develop Council J.D. Murphy Kim Sanders SIU Center for Rural Health Lianbin Cui MANTRACON Critical Skills Shortage Group Marilyn Falaster John A Logan College Jackie Clements SIUE School of Nursing Mary Ellen Abell John A. Logan College Nancy Buttry Illinois Eastern C.C. Pamela Appleton SICCM Roger Boma Mid-5 Sandra Goldman Wabash Development Sharon Baisley Tony Petersen MANTRACON Tonya Floyd VAMC Kim Watson SIU Workforce Development

21. Challenges and Opportunities • It is difficult to find accurate, up to date, employment information • There are numerous health occupations facing shortages • Our group can facilitate lasting change to increase the quality and quantity of the healthcare workforce

22. Short Term Win Actions Underway • Our group has identified baseline employment levels and established goals for 26 occupations • An educational survey detailing numbers of applicants, students accepted, graduated, etc. has been completed • We are currently identifying root causes and solutions for the nursing occupations.

23. Critical Skill Shortages Goal Setting Team-1

24. Critical Skill Shortages Goal Setting Team-2

25. Critical Skill Shortages Goal Setting Team-3

26. Critical Skill Shortages Goal Setting Team-4

27. Vision of the Future We hope to create a sustainable, robust educational pipeline that will provide the highest quality workforce to meet the needs of the healthcare providers in the region while providing meaningful jobs to our local residents

28. Comments… Critical Skill Shortages Goal Setting Team

29. Improved Health Outcomes Goal Setting Team

30. Our group considered, over several months, the following listed areas: • Cancer, Cardiovascular Disease, Strokes • Flu and Pneumonia, Chronic Respiratory • Substance Abuse, Depression, Severe Mental Illness, • Alzheimers, Accidents • Also considered were issues of access with regard to • Oral, OB/GYN, Behavioral and other Specialists • Increased training of providers around retention • Increased education of patients around retention Outcomes Goal Setting Team

31. The group decided to focus all of its resources on one overarching goal that would potentially impact a number of other downstream health outcomes. Therefore our goal is: Reduce cardiovascular disease mortality from 215 ->166 deaths per 100,000 by 2012 (Healthy People 2010). Four strategies will guide achievement of this goal. • Increase physical activity levels (exercise) of population • Improve eating habits • Decrease tobacco use • Increase diabetes management Final Healthy Outcome Goals

32. Comments… Outcomes Goal Setting Team

33. Improved Connectivity Goal Setting Team

34. Healthcare COI Goals • Connectivity & Collaboration Workgroup • Prioritize Health Resource Gaps for short-term and long-term action • Identify Telehealth/Telemedicine and Health Information Technology applications to address priority areas synergistically • Increase connectivity to health care providers to effectively and affordably improve health outcomes in priority areas

35. March 30 Goal Setting Team Objectives • Identify 4-5 regional health care initiatives • High-speed telecommunications connectivity • Involve multiple health care entities • Improve • Health care access • Improve health outcomes • Improve provider profitability

36. Fifty different individuals representing 30 different healthcare organizations within the Connect SI region reviewed 14 different connectivity applications identified in prior meetings. From this process five priority e-health applications were identified: • Electronic Master Patient Index • Linking Hospitals and Physicians with Electronic Health Records • Mental Health Primary Consulting • Workforce Education and Training • Tracking System for Drug Seekers • Action plan teams were assigned to work on the five priorities March 30, 2007 Goal Setting Meeting Results

37. Comments… Connectivity Goal Setting Team

38. Estimating The Potential Impact and Inter-Relationship of Economic Development and Healthcare COI Strategies

39. 27,298 New Hi-Wage Jobs 41,461 Existing Jobs >$5,000/Yr $642 Million New KBE Activity 1,600+ Firms >$2 Billion New Annual Wages +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out Of Poverty $200 Million Information Technology Investment Where we are -------- Where we are going Desired Future State 2012 Current State 2004 • Insured population 10% • Medicaid 26% • Medicare 18% • Uninsured 32% Insured Medicaid A Far BetterPayor Mix than Today Medicare Uninsured Note: 60% of the US population hademployment based insurance in 2004 Source: Estimates based on IPLAN, and Census Bureau data

40. Proposed Profitability Goal Potential Impacts:Recaptured DRGs, Increased Insured Patients Potential direct jobs from recaptured services, select DRGs • Recaptured DRGs Generate jobs: • Recapture $22 million in health revenue • Generate 236 direct SI jobs • Increased Commercial clients(insurance) increases revenues: • Commercial clients increase revenues • 5% shift could lead to • $8m increased revenue • 85 direct new health jobs Orthopedics Oncology Cardiology Source: Calculated using BEA RIMS II multipliers

41. Potential Critical Skills Goal Impacts:New Health Positions Total potential impacts of Critical Skills Goals Indirect Employment: Employment in down-stream industries that result from the presence of a particular business, activity or industry. Indirect employment is generally generated in industries that supply or provide services the direct business, activity or industry. Induced Employment: Employment generated because of expenditures made by individuals employed directly or indirectly by the particular business, activity or industry. Source: Calculated using BEA RIMS II multipliers

42. Proposed Goals:Relationship to Connect SI How theHealthCOISupports Connect SI 27,298 New Hi-Wage Jobs How Connect SI Supports Health Interests 41,461 Existing Jobs >$5,000/Yr $642 Million New KBE Activity 1,600+ Firms 7,571 New Hi-Wage Jobs +4500 Families with Healthcare Coverage >$2 Billion New Annual Wages +4500 Families with Healthcare Coverage >$250 million New Annual Wages Lift 10,000Citizens Outof Poverty Lift 10,000 Citizens Out Of Poverty $20 Million Information Technology Investment Jobs, Wages,Insurance, NewEnterprises $200 Million Information Technology Investment Win Win Win = Connect SI Goals

43. Connect SI Physician Meetings March 1& April 19 Summary Meeting Notes

44. Physicians View of What is Different About Connect SI • Solutions are more tangible • Connect SI presents a bigger opportunity for success • Connect SI presents a common ground for a fragmented constituency • Linking healthcare to economic development is an intriguing idea • Collaboration between competing systems is an impressive start

45. What We Want Our Focus To Be • Produce tangible solutions to technology upgrades required by law • Remain broad-based as we search for these solutions • Remain a diverse group of physicians and non-physicians working together to affect change in the health care field • Continue to meet to share information and experiences on neutral ground (not the doctors lounge) • Shift our focus from that of competitor to that of professionals willing to cooperate and collaborate • Focus on improved patient outcomes, while looking for win/win in all decisions • Grow the healthcare economy

46. What Will Make Participation in Connect SI A Valuable Experience for the Medical Profession • Make my life easier • Make my patients safer • Make me more efficient/productive • Benefit the practitioner by doing good for the patient

47. What Will Make My Life Easier? • Get doctors to think as a group - establish an identity as we are southern Illinois, not a suburb of any other region • Share our expertise within the region. • Market within our region and to each other (cross referrals) Changing referral patterns. • Make paperwork easier and more common sense - logical. Create a solution that is beyond the “individual hospital” mentality. • Change competition perception to collaboration model. Receiving hospital compliments the referring physician. This relationship builds confidence in patient opinion and within the healthcare system. Compliment rather than tear down • Immediate and accurate access to health information • Enable new physicians in setting up their practices. Almost a business incubator or “welcome wagon”. An outside entity is necessary to work within the Stark laws.

48. What Will Make My Patients Safer? • Communal/shared information. Master index. Electronic and tied to a data base that includes pharm. Interactions. Technology can assist physicians care for their patients. Include pharmacists in this conversation. Collaboration will allow for better patient outcomes. • Translate/convert VA EMR program to allow small providers to access this tremendous resource.

49. What Will Make Me More Efficient? • Communal knowledge - “smart card”. Short of that what could we do? • Accessible regional medical records relative to HIPPA(change the laws). • Improve Medicaid reimbursement by state agencies for region both in timeliness and rates - this is strictly politics. • Address malpractice premiums - a critical issue in the region

50. What Will Benefit Practitioner By Doing What is Good for the Patient? • Improved access to medical records • Spend more time with the patient by reducing paperwork • Real-time, continuous loop of patient health information - Integrating best practice for the patient with best practice for preventative health in general population. • Help practitioner to do his/her job by providing them information about the cases so better care decisions can be made. • Reduce medical errors • Reduce missed preventative opportunities • Reducing unnecessary costs, thereby expediting diagnosis and treatment • Work within pay for performance initiative