1. ©2006 ViTAL Economy, Inc. 1 Southern Illinois Broadband Initiative Healthcare COI Milestone Meeting #2b March 21, 2007 Choate Mental Health Center CONNECT SI Frank Knott, President ViTAL Economy, Inc. Fknottmd@earthlink.net

2. ©2006 ViTAL Economy, Inc. 2 Agenda – Healthcare COI Meeting #2b 8:30 AM - Welcome, Introductions, Meeting Objectives, COI Leaders Update 8:45 AM - Context of Goal Setting Relative to COI and CSI Strategies 9:05 AM – Healthcare Outcomes Goal Setting Report and Discussion 9:25 AM - Healthcare Profitability Goal Setting Report and Discussion 9:50 AM – Break 10:00 AM - Healthcare Critical Skill Shortages Goal Setting, Report and Discussion 10:20 AM - Healthcare Connectivity Goal Setting Report and Discussion 10:40 AM - Healthcare Economic Impact Model Review and Discussion 11:00 AM - COI Work Plan, Short-Term Win Action Plan, Next Steps 11:30 AM - Adjourn

3. ©2006 ViTAL Economy, Inc. 3 Objectives of Healthcare COI #2b Meeting Measurable Goal Setting Progress Reports of four priority outcome areas m Information Sharing-Turning data into valuable information to set goals m Discovery-What has goal setting team learned that was unexpected m Short Term Wins-What opportunities for new collaboration have resulted m Connect the Dots-What are linkages of your work to other goal setting teams m Goal Setting Timeframe-Next steps and action agenda for work of team Review final draft of economic models impact on COI strategies & plans Agree on next steps to focus healthcare asset mapping for Milestone #3

4. ©2006 ViTAL Economy, Inc. 4 Establish Context of COI Goal Setting In Relationship to Connect SI Strategy

5. ©2006 ViTAL Economy, Inc. 5 Connect SI 20-County Phase 1 June 06-November 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 Phase 2 Reap the Rewards

6. ©2006 ViTAL Economy, Inc. 6 Southern Illinois Wages Total Wages ($Billions) $5,725m $7,481m $9,482m $2b

7. ©2006 ViTAL Economy, Inc. 7 CSI Impact on Southern Illinois Positive Feedback Loop (Economic Growth Multipliers) >$200 Million Increased Annual ICT Market Opportunity** >$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 2012 Results Current Broadband Customer Base Short-Term Win Targets Healthcare Providers COI Strategies Investment Attraction Strategies Industry Cluster Strategies 4 CED COI Strategies Actions ** Increased Information Communication Technology (ICT) Opportunity Based on MIT, OECD Multipliers of GDP

8. ©2006 ViTAL Economy, Inc. 8 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 Patients 4 - Prioritize & Define COI Connectivity Requirements May - June 07 Tele-Health Applications & Value Propositions 5- Develop & Quantify COI Economic & Jobs Strategy July 07 Connect COI Strategy to Connect SI Regional Strategy

9. ©2006 ViTAL Economy, Inc. 9 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

10. ©2006 ViTAL Economy, Inc. 10 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

11. ©2006 ViTAL Economy, Inc. 11 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

12. ©2006 ViTAL Economy, Inc. 12 Our Goal… Our Compelling Objective The When = Measurable Time Frame m The Defined Time We Need to Achieve Our Goal m Our Target is 2012 Connect SI Goals Are Achieved The Where = Measurable Strategies m The Paths/Routes We Choose to Achieve our Goal The How = Measurable Action Plans m Each step we take along the the path to implement our strategies, achieve our goal…our compelling objective The Why = Sense of Urgency m What We Will Overcome m No longer #1 in 15 of 18 indicators of poverty 4 4 4 = CSI Phase 1 ˙ = The Next 18 Months ˙ ˙

13. ©2006 ViTAL Economy, Inc. 13 Goal Setting Action Team Reports

14. ©2006 ViTAL Economy, Inc. 14 Critical Skill Shortages Goal Setting Team Areas of Critical Skill Shortages 2004 Employee Levels 8-Year Change Based on COI 2012 Goal% Change Registered Nurses32491776502535% Nursing Aides, Orderlies …2210672288223% Licensed Practical Nurses794272106626% Medical Assistants33624057642% Pharmacists27419246641% Med & Clinical Lab Technologists 27816043837% All Target Occupations970844921420032%

15. ©2006 ViTAL Economy, Inc. 15 Outcomes Goals Source: IPLAN SIILDifference10-Yr Goal Coronary Heart Disease Mortality incidence per 100,000 21516134% Malignant Neoplasm % of deaths 22%24%-2% Mental Health Alcohol/Drug Outcome Targets

16. ©2006 ViTAL Economy, Inc. 16 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

17. ©2006 ViTAL Economy, Inc. 17 Connectivity Goal Setting Team Discovery: many aspects to healthcare could be affected by connectivity. Need to focus investment for the most impact. Short -Term Wins: First regional collaboration -- aligned efforts to evaluate the new FCC trial healthcare opportunity Connect the Dots: The medical outcomes, profit and skills teams will likely drive applications that must be supported by the connectivity team Timeframes: meeting on march 30th to consider 20 applications and evaluate priorities.

18. ©2006 ViTAL Economy, Inc. 18 Healthcare Economic Model

19. ©2006 ViTAL Economy, Inc. 19 Critical Skills Carry: Limited data available for Connect SI region. Need info on specific occupations. Working with IDES to improve information. With occupations demand, need to consider families who will care for the elderly. They require ancillary and managerial support. Short term wins: Developing a critical skills shortage grant proposal for nursing and feeder system, but awaiting information from the State. The State has promised money. Will focus on community based nursing. Leveraged over $270,000 in two weeks but did not win grant. Next Steps and Action Plans

20. ©2006 ViTAL Economy, Inc. 20 m Critical Skills: m Track New Services requirements and developments m Decrease out-migration of skilled workers m Need more information on m Physician assistants m Doctor specializations m Nurses m Behavior specialists m Allied Health instructions m Pediatric dentists and dental assistants m Dentists who accept Medicaid Next Steps and Action Plans

21. ©2006 ViTAL Economy, Inc. 21 Outcomes Frank: Health COI could work with large employers, colleges and public employers. Identify early adopters. Phil Summers, publisher of Daily Register in Mt. Carmel is a potential ally. Kathy said that Greater Egypt is discussing holding a forum of elected officials to examine issues. Bob: health administrators extremely creative to provide services with what they have. Need to move to preventive medicine to avoid sickest people with least funding. Frank: Community groups are realizing they can do something to control their health destiny. Doug: public health and hospitals can work together to encourage preventative medicine. Admissions might reduce, but profitability should increase in this case. Bob: By increasing preventative medicine, make increase capacity for other procedures in area hospitals. Next Steps and Action Plans

22. ©2006 ViTAL Economy, Inc. 22 Next Steps and Action Plans m Health Outcomes: Focus on a Healthy SI Strategy, based on the US Healthy People 2010 Initiative m Encourage with Critical Mass of participation, providing more leverage m Reduce sickness by encouraging health m Examine American Heart Association Start Program as a model m For measurements, return to existing data sources: link as a composite for review of progress m Overlay common strategies from health departments on top of each region/county

23. ©2006 ViTAL Economy, Inc. 23 Outcomes continued m Jacki: Tom Robbins at SIU wants cancer centre satellites in IL. m Woody: We have a healthy living problem, not a cancer problem. m Jacki: SIU stopped offering psychiatric nursing program because few applicants. Would like to reestablish. m Connie to pull together team to look at psychiatric nurse practitioners. She said psychiatrists are hesitant to work with nurses because of liability concerns. m Frank: Finance cluster will look at creative responses to liability issues. Next Steps and Action Plans

24. ©2006 ViTAL Economy, Inc. 24 Profitability m Bob: Analysis of DRGs shows we are losing procedures outside the region and state. If we brought these patients back, we may have a capacity issue. m Eldorado out-migration goes in Indianna. Region wants to bring specialists to Eldorado. Need information on what public health groups do and how they might help. Need to recognize hospitals have different sizes and objectives. m Bob: Goal of profitability group is lets keep patients here and compete amongst ourselves. m Woody: Need goals within a month. Need to look at profitability of FQHCs and private centres. Next Steps and Action Plans

25. ©2006 ViTAL Economy, Inc. 25 Frank: We need initial goals now. When we move to the strategy, we can come back and modify the goals as needed. Connectivity m Meeting is being set up to coordinate IT people and healthcare leaders. Need to review IT issues. Plan to use a six sigma process. Next Steps and Action Plans

26. ©2006 ViTAL Economy, Inc. 26 Work Plan Review and Action Team Task Assignments

27. ©2006 ViTAL Economy, Inc. 27 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

28. ©2006 ViTAL Economy, Inc. 28 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)