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©2007 ViTAL Economy, Inc. 1 Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #3 May 23, 2007 Rend Lake College CONNECT SI Frank.

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Presentation on theme: "©2007 ViTAL Economy, Inc. 1 Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #3 May 23, 2007 Rend Lake College CONNECT SI Frank."— Presentation transcript:

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

2 ©2007 ViTAL Economy, Inc. 2 Current Healthcare COI Vision Statement Supporting the collaboration and interconnection among healthcare providers and patients to improve: m Healthcare access m Health outcomes m Provider profitability m Through a qualified healthcare workforce in Southern Illinois

3 ©2007 ViTAL Economy, Inc. 3 Healthcare COI Phase 1 Planning Cycle 1 - Organize COI, Issue ID, Priorities & Goal Setting Jul - Sep 2006 Milestone 1b Leadership MtgSeptember 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 MeetingsJan 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 PatientsMay 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 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 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 m Learn what constitutes a value chain and how to map a value chain for each goal m Learn and develop value propositions for each action plan collaborator m Learn the value linkage process m 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 ©2007 ViTAL Economy, Inc. 6 Connect SI 20-County Phase 1 June 06-December 07 Led By Connect SI Leadership Advisory Board Greater Egypt COI Strategy Southeastern COI Strategy Southern Five COI Strategy Greater Wabash COI Strategy 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 GIS Mapping Team Supports COIs Healthcare Providers COI Strategy Network Providers COI Strategy Connect SI Regional CED COI Strategy >$2 Billion New Annual Wages 41,461 Existing Jobs >$5,000/Yr 27,298 New Hi-Wage Jobs $642 Million New KBE Activity 1,600+ Firms +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out Of Poverty $200 Million Information Technology Investment

7 ©2007 ViTAL Economy, Inc. 7 Goal Setting Action Team Reports m Profitability m Critical Skills m Outcomes m Connectivity

8 ©2007 ViTAL Economy, Inc. 8 Connect SI Healthcare Community of Interest Increase Provider Profitability Group

9 ©2007 ViTAL Economy, Inc. 9 Working Group Parameters

10 ©2007 ViTAL Economy, Inc. 10 Benchmarks for Development

11 ©2007 ViTAL Economy, Inc. 11 Cardiology DRGs

12 ©2007 ViTAL Economy, Inc. 12 Oncology DRGs

13 ©2007 ViTAL Economy, Inc. 13 Orthopedics DRGs

14 ©2007 ViTAL Economy, Inc. 14 Changing the Private Insurance Proportion in Payor Mix HOSPITAL VISITS % of VISITSGOAL Commercial10,67416.2% + 5% to 21.2% Medicaid11,85618.0% - 5% to 13.0% Medicare32,63949.6% Other8,23212.5% Self Pay2,4093.7% TOTALS65,810100.0% Source: CompData Proposed 5% Swap: Increase commercial clients 5%, Reduce Medicaid clients 5%, through economic growth Proposed 5% Swap: Increase commercial clients 5%, Reduce Medicaid clients 5%, through economic growth 2004 Actuals Proposed Goals

15 ©2007 ViTAL Economy, Inc. 15 Reasons for Patient Out-Migration From the Connect SI Regional Hospitals

16 ©2007 ViTAL Economy, Inc. 16 Factor Affecting Profitability Beyond the Control of Regional Hospitals

17 ©2007 ViTAL Economy, Inc. 17 Profitability Measures CARDIOLOGY*Connect SIMissouriIndianaKentuckySt. JohnsMemorialAll Admissions8,2681,5048807771664611,641 % Admissions71.0%12.9%7.6%6.7%1.4%0.4%100.0% Days27,1316,7604,0793,31675718342,226 % Days64.3%16.0%9.7%7.9%1.8%0.4%100.0% ONCOLOGY**Connect SIMissouriIndianaKentuckySt. JohnsMemorialAll Admissions64534874101841,180 % Admissions54.7%29.5%6.3%8.6%0.7%0.3%100.0% Days2,9671,98739478462126,206 % Days47.8%32.0%6.3%12.6%1.0%0.2%100.0% ORTHOPEDICS^Connect SIMissouriIndianaKentuckySt. JohnsMemorialAll Admissions2,9791,08342634442254,899 % Admissions60.8%22.1%8.7%7.0%0.9%0.5%100.0% Days13,0384,2932,0261,5451436821,113 % Days61.8%20.3%9.6%7.3%0.7%0.3%100.0% Source: COMPdata, SIH, SMGS Inc using specialized database form Herveywerks 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

18 ©2007 ViTAL Economy, Inc. 18 Profitability Goal Setting Team Comments…

19 ©2007 ViTAL Economy, Inc. 19 Critical Skills Shortage Goal Setting Team

20 ©2007 ViTAL Economy, Inc. 20 Critical Skills Shortage Group Auna SearceySIC Betty MusgraveT-Prep Brad FutrellHamilton Memorial Hospital Carol BeltShawnee Community College Cary Minnis, ChairMANTRACON Dawn WickmanIllinois Hospital Association Debbie MurphyHRMC Doris MartinShawnee Develop Council J.D. Murphy Kim SandersSIU Center for Rural Health Lianbin CuiMANTRACON Marilyn FalasterJohn A Logan College Jackie ClementsSIUE School of Nursing Mary Ellen Abell John A. Logan College Nancy ButtryIllinois Eastern C.C. Pamela AppletonSICCM Roger BomaMid-5 Sandra GoldmanWabash Development Sharon Baisley Tony PetersenMANTRACON Tonya FloydVAMC Kim WatsonSIU Workforce Development

21 ©2007 ViTAL Economy, Inc. 21 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 Challenges and Opportunities

22 ©2007 ViTAL Economy, Inc. 22 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. Short Term Win Actions Underway

23 ©2007 ViTAL Economy, Inc. 23 Critical Skill Shortages Goal Setting Team-1 Areas of Critical Skill Shortages 2004 Employee Levels 8-Year Change Based on COI 2012 Goal% Change Registered Nurses32491776502555% Nursing Aides, Orderlies …2210672288230% Licensed Practical Nurses794272106634% Medical Assistants33624057671% Pharmacists27419246670% Med & Clinical Lab Technologists 27816043857% Advanced Practice Nurses14710425171%

24 ©2007 ViTAL Economy, Inc. 24 Critical Skill Shortages Goal Setting Team-2 Areas of Critical Skill Shortages 2004 Employee Levels 8-Year Change Based on COI 2012 Goal% Change Pharmacy Technicians26016043862% Medical & Clinical Lab Technicians 21712834555% Physician Assistants15911227170% Medical Record and Health Information Technicians 28311239536% Respiratory Therapists13711224982% Physical Therapists2318031135% Radiologic Technologists2118029138%

25 ©2007 ViTAL Economy, Inc. 25 Critical Skill Shortages Goal Setting Team-3 Areas of Critical Skill Shortages 2004 Employee Levels 8-Year Change Based on COI 2012 Goal% Change Occupational Therapists1528023253% Nursing Instructors/Faculty1358021559% Physicians, Surgeons, Non-Invasive, All Other 1664821429% Family and GPs1434819136% Surgical Technologists1224817039% Pharmacy Aides994814748% General Dentists1403217223%

26 ©2007 ViTAL Economy, Inc. 26 Critical Skill Shortages Goal Setting Team-4 Areas of Critical Skill Shortages 2004 Employee Levels 8-Year Change Based on COI 2012 Goal % Change Surgeons, Invasive1103214229% Diagnostic Medical Sonographers 52328462% Occupational Therapist Assistants 34165047% Psychiatrists1261850% Child Psychiatrists167600% Total Jobs in 26 Categories9,9764,67614,67647% Insufficient information for Nuclear Medicine, Geriatrics, Neurology, Psychiatric Nursing, Masters Level, Behavioral Health Professionals and Allied Health Instructors

27 ©2007 ViTAL Economy, Inc. 27 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 Vision of the Future

28 ©2007 ViTAL Economy, Inc. 28 Critical Skill Shortages Goal Setting Team Comments…

29 ©2007 ViTAL Economy, Inc. 29 Improved Health Outcomes Goal Setting Team

30 ©2007 ViTAL Economy, Inc. 30 Outcomes Goal Setting Team Our group considered, over several months, the following listed areas: m Cancer, Cardiovascular Disease, Strokes m Flu and Pneumonia, Chronic Respiratory m Substance Abuse, Depression, Severe Mental Illness, m Alzheimers, Accidents Also considered were issues of access with regard to m Oral, OB/GYN, Behavioral and other Specialists m Increased training of providers around retention m Increased education of patients around retention

31 ©2007 ViTAL Economy, Inc. 31 Final Healthy Outcome Goals 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. m Increase physical activity levels (exercise) of population m Improve eating habits m Decrease tobacco use m Increase diabetes management

32 ©2007 ViTAL Economy, Inc. 32 Outcomes Goal Setting Team Comments…

33 ©2007 ViTAL Economy, Inc. 33 Improved Connectivity Goal Setting Team

34 ©2007 ViTAL Economy, Inc. 34 Healthcare COI Goals Connectivity & Collaboration Workgroup m Prioritize Health Resource Gaps for short-term and long- term action m Identify Telehealth/Telemedicine and Health Information Technology applications to address priority areas synergistically m Increase connectivity to health care providers to effectively and affordably improve health outcomes in priority areas

35 ©2007 ViTAL Economy, Inc. 35 March 30 Goal Setting Team Objectives Identify 4-5 regional health care initiatives m High-speed telecommunications connectivity m Involve multiple health care entities Improve m Health care access m Improve health outcomes m Improve provider profitability

36 ©2007 ViTAL Economy, Inc. 36 March 30, 2007 Goal Setting Meeting Results 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: m Electronic Master Patient Index m Linking Hospitals and Physicians with Electronic Health Records m Mental Health Primary Consulting m Workforce Education and Training m Tracking System for Drug Seekers Action plan teams were assigned to work on the five priorities

37 ©2007 ViTAL Economy, Inc. 37 Connectivity Goal Setting Team Comments…

38 ©2007 ViTAL Economy, Inc. 38 Estimating The Potential Impact and Inter-Relationship of Economic Development and Healthcare COI Strategies

39 ©2007 ViTAL Economy, Inc. 39 Where we are -------- Where we are going Insured population 10% Medicaid 26% Medicare 18% Uninsured 32% Uninsured 32% >$2 Billion New Annual Wages 41,461 Existing Jobs >$5,000/Yr 27,298 New Hi-Wage Jobs $642 Million New KBE Activity 1,600+ Firms +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out Of Poverty $200 Million Information Technology Investment Note: 60% of the US population had employment based insurance in 2004 Current State 2004 Desired Future State 2012 A Far Better Payor Mix than Today Insured Medicaid Medicare Uninsured Source: Estimates based on IPLAN, and Census Bureau data

40 ©2007 ViTAL Economy, Inc. 40 Proposed Profitability Goal Potential Impacts: Recaptured DRGs, Increased Insured Patients 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 Potential direct jobs from recaptured services, select DRGs Source: Calculated using BEA RIMS II multipliers Oncology Orthopedics Cardiology

41 ©2007 ViTAL Economy, Inc. 41 Potential Critical Skills Goal Impacts: New Health Positions JobsEarningsGDPOutput Direct SI impacts4,676$214,688,145$260,284,263$469,835,750 Indirect and induced2,408$75,371,406$156,289,685$253,371,221 TOTAL7,084$282,265,193$424,506,066$688,193,978 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 ©2007 ViTAL Economy, Inc. 42 Proposed Goals: Relationship to Connect SI >$2 Billion New Annual Wages 41,461 Existing Jobs >$5,000/Yr 27,298 New Hi-Wage Jobs $642 Million New KBE Activity 1,600+ Firms +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out Of Poverty $200 Million Information Technology Investment 7,571 New Hi-Wage Jobs >$250 million New Annual Wages $20 Million Information Technology Investment How the Health COI Supports Connect SI +4500 Families with Healthcare Coverage Lift 10,000 Citizens Out of Poverty Jobs, Wages, Insurance, New Enterprises How Connect SI Supports Health Interests Connect SI Goals = Win

43 ©2007 ViTAL Economy, Inc. 43 Connect SI Physician Meetings March 1& April 19 Summary Meeting Notes

44 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 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 ©2007 ViTAL Economy, Inc. 49 What Will Make Me More Efficient? Communal knowledge - smart card. Short of that what could we do? m 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 ©2007 ViTAL Economy, Inc. 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

51 ©2007 ViTAL Economy, Inc. 51 Physicians Response to Health COI Preliminary Goals 1.Connectivity across all health enterprises will greatly improve access to care 2.Less duplication of clinical tests was cited as an important outcome of the goals 3.Ability to track and catch drug seekers was cited as a very positive feature 4.Region wide broadband connectivity of health system will be good for patients 5.Current turf battles are largely a result of a lack of a universal communication system 6.CSI perceived as a solution for bringing together the very fragmented physician community 7.CSI could enable physicians to begin acting as a cohesive unit with a regional identity 8.Suggestions for a welcome wagon incubator approach to attract/retain new physicians 9.Communal information will make patients safer 10.Desire to bring physicians and healthcare administrators together through Connect SI 11.Linkage of healthcare to economic strategy could be a major lift to healthcare priorities

52 ©2007 ViTAL Economy, Inc. 52 Connecting the Dots

53 ©2007 ViTAL Economy, Inc. 53 What Common Strategies Might Be Implemented To Leverage Accomplishment of More than One Goal Area Linking healthcare assets by connectivity in a variety of ways incl. physician support, at-home linkage, patient registry and navigation, work with Network Provider COI Central powerhouse to get things done – linked efforts improve efficiency of individuals thru focused group work Turf battles result from lack of communications – information developed has more power in a group setting. Use process to create a permanent mechanism for information gathering/repository Regional healthcare marketing strategy and common view of healthcare in southern Illinois – Improve consumer level awareness of both the quantity and quality of services in the region. Does lack of regional availability of supporting services (labs) increase likelihood of outmigration? – research gaps in supportive services areas

54 ©2007 ViTAL Economy, Inc. 54 What Common Strategies Might Be Implemented To Leverage Accomplishment of More than One Goal Area pg 2 Develop web-based personal testimonials of healthcare services received locally – rating system. – Print as well as web. Link Outcomes team with Agriculture – Field-to-table approach with nutrition strategies for getting fresh food to those in poverty – public health programs for young children – Johns Hopkins School of Public Health program for youth nutrition. – Provide information to about program to Mary Ellen Abell @ JALC

55 ©2007 ViTAL Economy, Inc. 55 Mapping The Healthcare Value Chain Quantifying Value Propositions That Drive Action

56 ©2007 ViTAL Economy, Inc. 56 Healthcare Value Chain Payers Fiscal Intermediaries ProvidersPurchasersProducers Government Employers Individuals Employer Coalitions Public Health Districts Insurers HMOs Pharmacy Benefit Managers Medicaid Medicare NGOs Hospitals Physicians Pharmacies IDNs* Pharmacies Alternate Site Facilities Community Health Sites Wholesalers Mail Order Distributors Group Purchasing Organizations Drug Mftrs Device Mftrs Medical Surgical Manufacturers Health Information System Firms Source: Wharton School Study of Healthcare Value Chain - Commissioned by The Center for Healthcare Management Research * IDN= Integrated Delivery Networks

57 ©2007 ViTAL Economy, Inc. 57 Move Up the Value Chain, Capture Greater Share of Value Chain Margins, Increase Economic Prosperity Why Value Chain Linkage Matters Friction is the Cost of Getting From P to C PC PC P=Producer & C=Customer

58 ©2007 ViTAL Economy, Inc. 58 Business Cases are Built Using The Value Linkage Process Reap Rewards and Address More Issues What will bring people together to address these issues? Issues How will the participants benefit? What are the benefits of collaborating ? What is the business case? What solutions and services are needed to address these issues? How will the solutions and services be implemented? How will results be measured?

59 ©2007 ViTAL Economy, Inc. 59 Value Linkage Template HCOI Goal Setting Team: Address Critical Skills Shortages by 2012 Strategy to Address Goal: Increase registered nurses by 55% or 1,776 by 2012 Action Plan #1:_Put Nursing Awareness program in High Schools_ Collaborators required to implement action Quantitative Benefits defined by collaborator in column #1 Qualitative benefits defined by collaborator in column #1 Key Business Case driver that calls them to collaborate now SIU E NursingIncreased Enrollment $$ Increased Applicants and an improved applicant pool mcKendreeDitto SI Community Colleges CC weed out pool before advanced, retention and succcess rates improved High Schools Career Counselors not school basedd-4h Hospitals

60 ©2007 ViTAL Economy, Inc. 60 Goal Setting Teams Breakout Session Observations Your thoughts…

61 ©2007 ViTAL Economy, Inc. 61 Establishing Milestone #5 Work Plan

62 ©2007 ViTAL Economy, Inc. 62 Milestone #5 Meeting Work Plan Agree on Milestone Meeting Date: July 18, 2007 Location for July meeting: Heartland Regional Medical Center Final Phase 1 Strategy Alignment Meeting: Wed., September 19,2007 Pre-Milestone #5 strategy meetings for each Goal Setting Group m Connectivity - m Outcomes - m Profitability - m Critical Skills -

63 ©2007 ViTAL Economy, Inc. 63 Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #3 BACKUP SLIDES May 23, 2007 Rend Lake College CONNECT SI Frank Knott, President ViTAL Economy, Inc.

64 ©2007 ViTAL Economy, Inc. 64 COI Goal Setting Challenges & Solutions Challenges Setting goals to achieve results, over which we may not have control Owning goals we cannot control, but we have to invest real resources KBE transformation of SI economy requires transforming COI goals Solutions Effective CED COI strategies require measurable Health COI goals All strategies that enable goals are not only owned by Health COI Regional COI strategies can impact Health COI Goals Goals are owned by the region not just a specific institution

65 ©2007 ViTAL Economy, Inc. 65 Our Goal… Our Compelling Objective The What = Compelling, Measurable Objective m The Hill We are Going To Take… Our Goal m Improved Profitability & Critical Skill Shortages - Top Down m Improved Healthcare Access & Outcomes- Bottom Up m 10,000 persons out of poverty - 4,500+ families with health insurance and tangible reductions in chronic diseases - Lift All Boats m SI becomes rural healthcare model for U.S. - Climate of Opportunity m Increase revenues, profitability, jobs across Connect SI Economy

66 ©2007 ViTAL Economy, Inc. 66 Healthcare COI Work Plan Prior To October 2006-1 Assign Task Completion to Leaders or Action Teams 1. Establish a leadership team to manage the work of the healthcare COI (Leaders) 2.Develop a champion and investor recruitment plan to sustain Connect SI (Team) 3. Identify healthcare industry research reports for Connect SI team 4. Clarify how Connect SI could help accelerate/benefit existing initiatives (Leaders) 5. Define what will enable and sustain regional collaboration versus competition Establish Marketing Committee to address 5 and 7 6. Clarify how the sub-regional input & involvement can be maximized by COI Sub-Region Engagement team complete this task

67 ©2007 ViTAL Economy, Inc. 67 Healthcare COI Work Plan Prior To October 2006-2 7.Establish strategies that will address challenges to regional collaboration (Marketing) 8.Complete, and prioritize issues of challenge and opportunity (Team) 9.Prioritize definition of measurable goals for COI (Team) 10.Select the issue that creates the greatest sense of urgency for the COI (Leaders) 11.Focus on collaborations that can result in short term wins linked to process (Leaders) 12.Define what makes your investment of time, talent and treasure worthwhile (Leaders)

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