miami childrens health system...proprietary and confidential miami childrens health system | 6 goal...

Miami Children’s Health SystemStrategic Planning and DevelopmentProprietary and Confidential

Miami Children’s Health SystemSystem-Wide Strategic PlanStrategic Plan Framework and Three Year Goals

February 2016

Proprietary and Confidential

Page

Strategic Planning Objectives 3

Goal Setting Framework 5

Executive Summary 9

Deep Dive of 2016 Goals 15

Three Year Goal Plan 60

Table of Contents

Miami Children’s Health System | 2

Strategic Planning Objectives

01 02 03


04 05


The objectives of the planning effort are the following:

› Develop a focused 3-year strategic plan and roadmap for MCHS

› The plan will systematically evaluate and monitor all ongoing health system efforts and serve as the organizational blueprint, appropriately allocating resources to each of the four OpCos based on MCHS’s long-term objectives

› The plan will be supported by and inform the long-range financial forecast and the priorities of the OpCos

› Align implementation of strategies and goals with leadership goals and annual budget (operating calendar)

Planning Objectives


Goal Setting Framework

01 02 03


04 05

Proprietary and Confidential Miami Children’s Health System | 6

Goal Setting Framework

› Organizational priorities, imperatives and goals were developed through the strategic planning process and incorporate the pillars of people, service, growth, margin, quality and innovation

› The purpose of the strategic plan is to align all goals and projects across the system with the organizational priorities


Organizational Priorities

› Priorities address industry wide trends in response to the changing reimbursement landscape and serve as guiding framework for plan development

› Priorities unified around providing holistic care to patients and families

› Achievement of priorities will enhance MCHS’s brand nationally and internationally as the premier, independent children’s health system


MCHS Organizational Priorities Corresponding Organizational Imperatives

Improve quality outcomes (quality, innovation) #1: Develop centers of excellence around key service lines for common, and rare and complex diseases#2: Develop foundational services to support hallmark service lines #8: Increase focus on research and develop outreach/education programs

Excel in customer service and experience by delivering compassionate care, affordability and access (people, service, innovation)

#5. Enhance ambulatory services#6. Exponentially grow and develop global health to drive tertiary and quaternary volumes #7. Focused marketing around outreach, education and communication internally (staff and physicians) and externally (patients) to improve delivery of patient care and patient engagement

Manage provision of care along care continuum (people, service, quality, innovation)

#3. Enable complete management of patient across care settings via interdisciplinary collaboration #4. Create infrastructure to operationalize and scale CIN

Enhance breadth and depth of care (quality, service, growth, innovation)

#1. Develop centers of excellence around key service lines for common, and rare and complex diseases#2. Develop foundational services to support hallmark service lines #8: Increase focus on research and develop outreach/education programs

Advance the engagement and empowerment of our people (people, service)

#11. Develop culture of empowerment and engagement to achieve strong recruits and employee retention and high performing leaders

Develop appropriate payor models and alternative revenue streams to manage risk and optimize margin (margin)

#9. Adopt vision driven philanthropy#10. Develop value based payor models and identify, quantify and budget alternative revenue streams

Develop interoperable data analytics & IT capabilities to produce real time, actionable information (quality, innovation)

#12. Utilize data analytics to improve clinical outcomes and achieve customized approach to clinical care

Organizational Priorities and Corresponding Imperatives

Executive Summary

01 02 03


04 05


Executive SummaryStrategic goals by year and alignment with organizational priorities


Organizational Priority 2016 Goals 2017 Goals 2018 Goals

Improve quality outcomes / enhance breadth and depth of care

• Brain wellness/Neuro home programs*• Movement disorders COE*• Adult congenital heart disease program*• Maternal/fetal program*• Cardiac specialty outpatient clinics*• Hip Program*• Ortho Hub in Broward*• Spine COE*• Limb Lengthening & Deformity Program* • Phase I/II clinical trial program*• Defined outpatient center for oncology

and hematology*• Development of Oncology service line

P&L*• Diabetes COE*• Gastroenterology COE*• Acquisition of 3 geographic practices and

one new CIN partner*• Plastics / Beckwith Wiedemann /

Peripheral Nerve COE*• Chronic care prototype*• Explore academic and research affiliations

to complement or enhance research capabilities/services, provide support/internships to a breadth of services

• Personalized medicine*

• Stroke and cerebrovascular clinic*

• Neuro oncology services*• Solid organ transplant

services (heart failure/heart transplant, kidney and liver)*

• Non operative ortho clinics*• Expand fracture care

services offsite*• Dedicated outpatient

oncology clinic*• Strategic alignment with

radiation oncology provider*

• Human milk depot• High risk labor and delivery

unit*

• Achieve CoC accreditation with commendation (Oncology)*

• Vaccine therapy program (Oncology)*

• Achieve national designationsfor services lines / COEs

*Identified by SLT as a brand enhancing strategic goal





Excel in customer service and experience by delivering compassionate care, affordability and access

• Expand Telehealth capabilities• Expand outpatient services/locations in

conjunction with physician distribution planning

• Develop global health affiliations and increase international patient admissions*

• Develop customer relationship management tools to facilitate and streamline access, engagement, education, communication and experience

• Smart Hospital capabilities

• Develop one stop shop MOB• Scale concierge services• Develop on site guest

accommodations• Creation of a system wide

education plan and yearly calendar of events

Manage provision of care along care continuum

• Development of case management and patient care teams*

• Operationalize and scale CIN

Advance the engagement and empowerment of our people

• Improve staff development• Emphasize active recruiting and best fit for

position practices; enhance onboarding• Drive empowerment among staff

increasing • Improve staff engagement






Develop appropriate payormodels to manage risk and optimize margin

• Promote growth and development of internal fundraising infrastructure

• Align donor campaigns to foster clinical, research and education enhancements around centers of excellence and special projects to achieve tiered growth in annual campaign targets over time

• Elevate level of engagement of all board members: foundation, hospital and system to actively support the philanthropic initiatives

• Achieve revenue neutral transition to MSDRG

• Develop office of sponsored programs to increase revenue from external sources, including grants and awards

• Identify and systematically plan for investments in projects that will yield alternative sources of revenue

• Transition any remaining commercial charges to MSDRG

• Progressively increase the unrestricted cash flow by 2-3% per year until 50% is achieved

Develop interoperable data analytics & IT capabilities to produce real time, actionable information

• Enterprise Resource Planning • Business Intelligence



Tying it All TogetherWhat will we accomplish through all of this?


• Provision of organ transplant

• Development of COEs for common and rare and complex diseases

• Creation of High Risk Labor and Delivery Unit

• Precision and personalized medical management

Enhance breadth and depth of subspecialty

services

•Alignment with maternal/fetal partners to feed clinical services

•Development of CIN to expand network of PCPs and subspecialists

•Provision of care to medically complex patients through PCMH

•Creation of supportive care team infrastructure to own and manage patients along care continuum

•Provision of collocated, interdisciplinary services in a one stop shop medical office building model to enhance coordination of care

Develop innovative care delivery model to achieve patient engagement and

satisfaction

•Distribution of resources to appropriate sites of services at optimal locations within the region through acquisition of practices or recruitment of subspecialists (PSA Expansion)

•Global Health

Expand our geographic footprint

Local, regional and international brand

recognition and market dominance in

our primary and outer service areas

The following three-pronged approach represents brand enhancing initiatives which encompass all of the organizational priorities to effectuate our vision for what we want to achieve as an organization


Summary of FTE Needs

FTEs Brain Cardiac Oncology OrthoPSA (2016-

2018) Other programmatic initiatives Total

RevenueGenerating

(Y/N)

Admin support1 0.5 (Survivorship) 16 1 research admin

18.5N

Care coordinator/patient navigator

1 clinical care coordinator

1.0 Clinical RN

coordinator all programs

4.5 (global health); 1.5 pre admit case managers (2016), 3 service line specific case managers (2016), 2 IP case managers (2017), 2 pre and

post discharge case managers (2017), 1 fellowship coordinator 6.5 Y

Clinical research coordinator

1 shared 2 for GI IBD research, data coordinator

3 N

Genetic counselor 1 (research) 1 N

Nurses1 research nurse

2 RN's to support outpatient at NCH & NOC/PSL (shared)

0.5 oncology nurse, 1 research nurse

26.5 Y

Nutritionist 0.5 (shared) 1 OP clinics (shared) 1 2.5 Y

Fellows 1 neurosurgery fellow 1 N

Pharmacy1 research pharmacy

FTE (phase I trials)1 FTE research pharmacy (support clinical trial

growth) 2 N

Physicians

1 neuroscientist(1.27) .79 cardiologist and .48

interventional cardiologist

Ass. Medical Director of Clinical Research

Oncology

18.8 (excluding neuro and

cardiac recruits)

22 Y

Physician assistant

1.59 for outpatient/specialty clinics

2 ARNPs

12 (excluding neuro and

cardiac recruits) 15.5 N

Practice Manager

.79 shared in Palm Beach & Port St Lucie & Aventura (multi

specialty shared support) 0.79 N

Psychology 0.25 psychologist 0.25 Y

Social Worker 0.5 (shared) 1.28 1.7 N

Other

0.13 neuropsychologist

3.43 EKG technicians sonographers Outpatient

locations at NCH, Aventura, NOC and Port St Lucie

1 Certified Teacher

1.0 orthocast tech, 2

licensed athletic trainers

1FTE coordinator for research and fellows, 1 marketing content specialist, 1 marketing data

analyst, 6 TM&E FTEs (recruiter, sourcer and support), 1 grant coordinator, 1 grant writer, 1

regulatory FTE 14.5

6.4 11.1 9.3 4 48.8 20.5 100

Source: PSA approved FTEs, goal leaders’ FTE listing per goal slides Miami Children’s Health System | 14

Deep dive into 2016 organizational imperatives and goals; one slide per goal depicting the following:• Alignment between imperatives and corresponding organizational priority(ies)

• SLT champion(s) for the organizational imperatives

• Goal lead(s)

• If the goal is strategic or operational in nature or requires capital

• Specific metrics or measures of success to achieve in 2016

• Implementation steps/milestones by quarter assigned to responsible team member(s) to track progress

2016 Goals


01 02 03 04 05


2016 Goal SettingCascade goal setting with leadership responsibilities


Improve Quality

Outcomes

Enhance Breadth and

Depth of Care

= Capital project= Operational Goal= Strategic Goal

Organizational PrioritiesImprove Quality Outcomes

Enhance Breadth and Depth of Care

Organizational Imperative (Tim Birkenstock)

Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Brain)

Goal (Sara Widing, Dr. Jayakar)

In pursuit of statewide market dominance by 2018, develop the infrastructure and implement Brain Wellness programs including Rare Chromosomal Clinic, Pediatric Brain Index, Retail Offerings, Cognitive, Motor & Behavioral Medicine Integration for patients and families served by the Brain Institute by 2018.

2016 Measurable Outcome 150 Polysomnograms; 50 EEGs/ERPs; 30 fMRI; 105 neuropsych screens; 25 TMS tests

Foundational,Service

Providers, Infrastructure

Implementation Milestones & Action Items

2016 Timeline

Responsible Team Member(s) Capital Cost(s)

Salaries &

Benefits

Operating Expense/

OtherPrincipal Supporting

Foundational Recruit key positions to build foundation & program platform:A. Recruit ARNP for program development for both Brain Wellness and

Neuro Home*B. Recruit clinical coordinator for Brain Wellness and Neuro Home

Q1 TME Barba & Soto, Widing, Heckathorn, LegalMarlenne, Evelyn, Nancy, Widing, Cheryl Gimenez, Darren Dase

$190K

Service Providers

.25 FTE contract onboarding from FIU. Includes pending hospital privileges and credentialing.

Q1 TME Widing, Azaret, Jayakar, PSA $29k

Recruit & onboard Neuroscientist Q1 TME Widing, Jayakar $146K

Recruit and onboard social worker for Brain Wellness, Neuro Home & OP Q1 TME Barba, Bell-Taylor $78k

Recruit and onboard nutritionist for Brain Wellness & OP needs Q1 TME Barba, Corrigan $70K

Recruit and onboard patient navigator for Brain Wellness and Brain Institute Q1 TME Widing, Barba $86K

Recruit and hire post doc neuropsychologist. Q3 TME Neuropsychologist Hire $41K

Infrastructure Brain Wellness Program Development & Implementation - Cognitive, Behavioral and Motor

Q2/Q3 ARNP New Hire Above

Cognitive Lead TBD, Behavioral Lead, Azaret, Motor Lead TBD

$25k

Capital Purchase & Implementation Radio Frequency Ablation (RFA) Device Q2/Q3 Purchasing Widing, Jayakar, Clinical Engineering, Legal, Finance

$24k

Develop & Implement 2 Brain Wellness Program Offerings including medical and retail models– including neurorehab such as Autism.

Q2/Q3 Widing Schleifer, Terrell, Jessica Thomas, ARNP/RN Hire, Finance, IT

$25k




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Sara Widing, Dr. Jayakar)

Develop and implement Neuro Home program to provide 24 hours, 7 days per week availability of Brain Institute experts to all Brain Institute families who elect to participate by 2018; provider portal and network to achieve statewide market dominance and beyond by 2018.

2016 Measurable Outcome Maintain market dominance in Dade & Palm Beach County; solidify market growth in Lee & Collier counties; Grow dominance in Broward with 15 incremental neurosurgical cases.




2016 Timeline


Salaries &

Benefits

Operating Expense/


Foundational Recruit key positions to build foundation & program platform:A. Recruit ARNP for program development for both Brain Wellness and

Neuro Home*B. Recruit clinical coordinator for Brain Wellness and Neuro Home

Q1 TME Barba & Soto

Widing, Heckathorn, Legal

$165K

Service Providers

Recruit and onboard social worker for Brain Wellness, Neuro Home & OP Q1 TME Barba, Bell-Taylor $78k

Infrastructure Develop & Implement statewide Marketing & Communication Plan Q1/Q2 Marketing Widing, Jayakar, Ragheb $35k

On call model for ARNP to cover 24/7 family portal Q1/Q2Soto

New ARNP/RN Hire, Karacaoglu,TME, Call Infrastructure

$225k

Develop provider network • Secure 2 new relationships • Go live (will include online/data sharing, linking protocols and pathways.)

Q2 & Q3Q4

Widing, Jayakar, Ragheb

IT, Marketing, Legal, PSA$30k

Develop family portal – Start with Epilepsy Population in 2016• Program development (Development includes online portals, online

family chat rooms, processes, procedures, etc.)• Go live (pending hiring of ARNP & Coordinator in Q2)

Q2

Q3

IT, ARNP/RN Hire

Dean, Rodriguez, Marketing Support; Perhaps Legal

$30k




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Sara Widing, Trevor Resnick, John Ragheb)

Develop and implement a Movement Disorders Center of Excellence to leverage market differentiators and treatment offerings for Movement Disorder patients in the State of Florida and Nationally/Internationally by 2018.

2016 Measurable Outcome 1-3 incremental cases in 2016 (Selective Dorsal Rhizotomy or Deep Brain Stimulation)




2016 Timeline


Salaries &

Benefits

Operating Expense/


Foundational Define Rehab/Therapy Network Opportunities to help drive referrals -include protocol development and alignment for spasticity patient screening and standards of care

Q1/Q2 Terrell Sara Widing, Cheryl GimenezJennifer Perez

Finalize outcome measures for both medical and surgical patients in Movement Disorders. Work with IT to build distinct fields in PEDS; implement; begin measuring.

Q1 Monduy, Niazi

Smit, IT

Infrastructure Create, finalize and implement marketing and communications plan specific to movement disorders

Q1/Q2 Marketing Monduy, Niazi, Rehab $30k

Ongoing business development and roll out rehab/therapy network opportunities. Identify and implement at least 2 new partners/opportunities.

Q2 Rehab TBD,Widing

Widing, Monduy, Niazi, Legal,Marketing

Continue discussions with SLT regarding IP Rehab Component - this is a limitation for program growth

Q1-Q4 Widing, Ragheb

Ragheb, Resnick




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Tim Birkenstock, Dr. Granado, Dr. Feld, Jackie Gonzalez)

Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Cardiac)

Goal (Erika Vila)

Formalize partnership with CCF for provision of ACHD services at NCH and OP clinics by end of 2016.

2016 Measurable Outcome Achieve 67 cath/EP cases; 61 Cardiac MRIs; 302 echos; and 647 office visits (adult defined as > 17)

Foundational, Service Providers,

Infrastructure

Implementation Milestones Timeline Responsible Team Member(s) Capital Cost(s)

Salaries & Benefits

Operating Expense(s)

Principal Supporting

Foundational 1. Credential 4 NCH employed cardiologists to perform ACHD at CCF

Q1 Medical Staff Office

Dr. RhodesErika Vila

Foundational 2. Establish network of adult subspecialists to support IP ACHD care (privileges at NCH)

Q4 Erika Vila Dr. Granado

Service Providers 3. Recruit, Identify, and On-board Program Director for Adult Congenital Program

Q1 – Q3 Dr. Rhodes Dr. Feld Erika Vila

$366,000

Infrastructure 4. Education and training of current nursing staff to manage these capabilities

Q3 – Q4 Erika Vila Jamie Wiggins, Erika Vila

PotentialOT/Educational Costs

Foundational 5. Identify, secure, and operationalize bed space for adult patients in tower (or potential backfill location)

Q1 – Q2 Erika Vila John Rhodes, Erika Vila,FacilitiesNursing

Infrastructure 6. Document policies and procedures, including standards, quality outcomes and measures, track, report, and monitor clinical outcomes through recruitment and on-boarding of Database Quality Coordinator.

Q1 – Q4 John Rhodes, Erika Vila, Anthony Rossi, Robert Hannan

Erika Vila $100,000




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Tim Birkenstock, Dr. Feld)


Goal (Erika Vila)

Develop a comprehensive Fetal Program through increased access to fetal-diagnostic providers in the tri-county market and enhanced referral relationship with Maternal/Fetal Medicine by end of year 2016

2016 Measurable Outcome2015a – 39 Neonatal Pump Cases | 2016 Goal: 50 Neonatal Pump Cases

2015a – 115 Fetal Echos | 2016 Goal: 200 Fetal Echos

Responsible Team Member(s)

Capital Cost(s)

Salaries & Benefits


Foundational, Service Providers, Infrastructure Implementation Milestones Timeline Principal Supporting

Service Providers 1. Recruit an ambulatory cardiologist to join Dr. Drossner in performing fetal services in Stuart, Port St. Lucie, Boynton/Del Ray (Palm Beach Market)

Q2 Dr.Rhodes

Dr. Feld, TMEErika VilaDr. Drossner

1 Echo Machine($200k)

$332,500 Office Space

Service Providers 2. Transition and on-board Nao Sasaki from Quality/Education Administrator role to Attending Physician with focus on cardiac MRI (50%) and Fetal Echo (50%)

Q1 Dr. Feld Erika VilaDr. Rhodes

Cardiac MRI capability at DMC ($100k)

2 Echo Machines ($300k)

$332,500




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Erika Vila)

Development of outpatient clinics to achieve clinical differentiation in the following programs: Roadmap, NeuroCardiac, Electrophysiology, Single Ventricle Survivorship, ACHD & Transition

2016 Measurable Outcome Operationalize and deploy 5 subspecialty clinics in the community by end of 2016.

Foundational, Service Providers, & Infrastructure

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Salaries &Benefits



Infrastructure 1. Deploy physicians and sub-specialty clinic (i.e., NeuroCardiac) in Aventura rehab component

2. Deploy Port St Lucie/Stuart sub-specialty clinic (Fetal/ACHD/EP capability)

3. Deploy Boynton/Del Ray sub-specialty clinic through strategic affiliation/potential acquisition of community cardiologist

4. Deploy Weston sub-specialty clinic in collaboration with other service lines

Q1 2016

Q1 – Q2 2016

Q2 – Q3 2016

Q3 – Q4 2016

Erika VilaDr. RhodesDr. FeldDr. DrossnerNancy HumbertTim BirkenstockACC Team Member

(Aventura Pro Forma)

(Previous Slide)

(Previous Slide)

Echo, and Supporting Equip

$200k (duplicate)

(Previous Slide)

$365,750

$352,450

(Aventura Pro Forma)

(Previous Slide)

Leased Office Space

Leased Office Space




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Armando Llechu)

Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Ortho)

Goal (Janel Grover)

Development of Hip Program in 2016

2016 Measurable Outcome 35 surgical Hip cases =$175K CM




2016 Timeline


Salaries &

Benefits

Operating Expense/


Foundational Develop & execute marketing and outreach campaign to increase physician referrals to Hip program & differentiate ourselves from competing programs.

Q1 J. Grover Carmen Pages, Olga Laurenti $30K

Foundational Complete physician distribution strategy for Hip program. Q1 J.Grover Elizabeth Algarra

Infrastructure Partner with OR management to ensure appropriate block allocation for all physicians.

Q1 J.Grover Zoila Araica

Foundational Obtain & evaluate Market share analysis for Broward & Miami-Dade Ortho services, as well as zip code analysis for patients seeing Dr. Horowitz.

Q2 J.Grover Business Intelligence team

Foundational Evaluate impact of marketing and outreach efforts; Assess the need for additional campaigns.

Q4 J.Grover Carmen Pages, Olga Laurenti




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Janel Grover)

Develop Ortho Hub in Broward by 2017

2016 Measurable Outcome 1,500 new office visits/yr in Miramar; 1,100 new office visits/yr in Aventura




2016 Timeline


Salaries & Benefits

Operating Expense/


Foundational Develop and execute aggressive marketing and outreach campaign in Broward Co and Aventura.

Q1 Marketing / Outreach

J.Grover, Carmen Pages, Olga Laurenti

$40K

Foundational Complete/monitor physician distribution strategy for comprehensive Ortho services in Broward market.

Q1 J.Grover Elizabeth Algarra

Foundational Obtain & evaluate Market share analysis for Broward, as well as zip code analysis for patients being seen at Miramar and Aventura.


Foundational Fully operationalize Aventura with Ortho presence 3 days/week Q3 J.Grover Elizabeth Algarra

Infrastructure Complete Miramar clinic shelled space (2,134 SQ FT) to increase Ortho presence in Miramar/Broward by adding additional exam rooms/availability for Ortho clinics.

Q4 Construction J.Grover, Marlenne Burt, Katherine Aranda

$527K

Service Providers

1.0 clinical RN coordinator FTE for case management and care coordination of non spine patients to support general program growth; 1 Ortho cast tech for fracture care in in Aventura, Miramar, West Kendall and main; 2.0 licensed athletic trainers as physician extenders to support sports program at Pinecrest

Q2-Q4 TME J. Grover $203,840($62,400, 49,920, $91,520 for 2)




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Janel Grover)

Expand Spine Center footprint in Broward/N.Miami Dade in 2016

2016 Measurable Outcome 10 incremental surgical spine cases = $750K CM




2016 Timeline


Salaries &

Benefits

Operating Expense/Ot

herPrincipal Supporting

Foundational Develop and execute aggressive marketing and outreach campaign inBroward, and Aventura (if applicable) around Spine program.

Q1 Marketing / Outreach

J.Grover, Carmen Pages, Olga Laurenti

$40K (duplicate)

Foundational Obtain & evaluate Spine-specific Market share analysis for Broward, as well as zip code analysis for Spine patients being seen at Miramar and Aventura.


Foundational Fully operationalize Aventura with Spine presence 1 day/week. Q3 Ambulatory Manager

J. Grover Elizabeth Algarra

Infrastructure Secure distribution of EOS Xray machine to Miramar (major market/Joe D. differentiator). To be placed in conjunction w/ completion of shelled space.

Q3 J.Grover Sheryl Selinsky $775K incl room prep

Infrastructure Complete Miramar clinic shelled space (2,134 SQ FT) to increase Ortho presence in Miramar/Broward by adding additional exam rooms/availability for Ortho clinics.

Q4 Construction J.Grover, Marlenne Burt, Katherine Aranda

$527K(duplicate)




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Janel Grover)

Develop Limb Lengthening & Deformity Program in 2016

2016 Measurable Outcome 35 surgical Limb cases =$150K CM




2016 Timeline


Salaries &

Benefits

Operating Expense/


Foundational Develop & execute marketing & outreach campaign to increase physician referrals to Limb program & differentiate ourselves from competing programs.

Q1 J.Grover Carmen Pages, Olga Laurenti $30K

Foundational Complete physician distribution strategy for Limb program. Q1 J.Grover Elizabeth Algarra

Infrastructure Partner with OR management to ensure appropriate block allocation for all physicians.

Q1 J.Grover Zoila Araica

Foundational Obtain & evaluate Market share analysis for Broward & Miami-Dade Ortho services, as well as zip code analysis for patients seeing Dr. Schoenleber.


Foundational Evaluate impact of marketing and outreach efforts; Assess the need for additional campaigns.

Q4 J.Grover Carmen Pages, Olga Laurenti




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Jose Perdomo, Jackie Gonzalez, Dr. Granado)

Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Oncology)

Goal (Dr. McCafferty + Oncologist)

Phase I /II Clinical Trial Program

2016 Measurable OutcomeDevelop business plan and programmatic initiatives for phase I clinical program, identify and recruit clinical lead



Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Salary & Wages



Foundational 1. Designate phase I working group (pharmacy, nursing, lab & pathology, social work and oncology leadership)

Q1 Dr. McCafferty John Girard

Foundational 2. Identify a clinical lead from oncology to pursue phase I and phase IItrials

Q1 John Girard Dr. McCafferty, Dr. Granado

$500k

Service Provider 3. Need clinical research coordinator Q2 TME John Girard $50k

Foundational 4. Identify physical space requirements for defined program in the inpatient space for clinical practice + administrative/ancillary support space + dedicated research pharmacy?

Q2 Construction Working group TBD

Infrastructure 5. Define the short & long term programmatic research goals with a proforma and 5 year business plan

Q2-Q3 John Girard Clinical Lead, Dr. McCafferty, consultants

TBD $50k

6. Identify pharmaceutical partners to guide/advise development of program

Q3 John Girard Working group TBD




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Jackie Gonzalez)


Goal (John Girard)

Defined OP Center for cancer and blood disorders including key clinical programs (survivorship, genetics, education, palliative care and late effects clinics) Execute on strategy for oncology program either through alignment with physician partner or academic institution; Find common outpatient clinic space out of the confine of the private office (Sickle Cell Clinic, Coagulopathy Clinic, Late Effects, etc…)

2016 Measurable OutcomeDevelop a long term treatment plan (survivorship plan) for every patient completing a course of treatment

Foundational,Service Providers,

Infrastructure

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Salariesand Wages



Foundational 1. Recruit key staff members to staff key outpatient clinics. (Physician Leader Palliative Care), 2 ARNPs, 2 social workers, 1 certified teacher, 2 RNs)

Q1 TM&E/PSA John Girard, Janet Bell-Taylor, Kara Marante, Peggy Townsend

n/a ~$600k

Infrastructure 2. Identify and purchase navigation software for survivorship (including late effects and other post acute therapeutic treatments clinics) to track patients internally and enable patients to keep track of records, appoints, etc.

Q1 John Girard John Girard, Peggy Townsend, IT, Dr. Orces

$10k $0 $10k (2017)

Foundational 3. Identify space/location of outpatient center of excellence for cancer and blood disorders. Relocate infusion area from 3N to collocation with outpatient clinic space. Provide physician offices proximal to cancer center/clinic.

Q1-Q2 Space PlanningConstruction

Service Line leaders,consultants, etc.

TBD n/a

Foundational 4. Identify/Define/purchase standardized treatment protocols [clinical pathways] by histology and age at diagnosis ( + define long term treatment plan for patients)

Q3 Peggy Townsend

Physicians, Nurses, IT, Dr. Granado,Jackie Gonzalez

n/a

Service Providers 5. Identify training and certification modules for Hem/Onc Nurses to meet and exceed accreditation and industry (USNWR) standards.

Q1 Regina Fritz Peggy Townsend n/a $5,000




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Jackie Gonzalez, Michael Durr)


Goal (John Girard)

Understanding the book of business: Oncology service line P&L EXPANSION OF CAPABILITY BY NEW Partnerships and alliances

2016 Measurable OutcomeFinancial reporting of full service line (IP/OP and ancillaries), capability to break out by tumor site or department

Foundational, Service Providers, Infrastructure

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Salaries & Wages Operating Expense(s)


Foundational Extrapolate data set to include patient encounters by oncology diagnosis code for all departments (lab, radiology, op infusion, IP, etc)

Q1 Finance BI, John Girard n/a n/a $0

Foundational Implementation of Insight to Oncology, I2O, CHAMPS’ data analytics software that merges clinical and billing data to measure out-migration, disease trends, heat maps, etc. and associated costs/savings.

Q1 Girard Rev Cycle, BI, IT (interface)

n/a Included in current contract




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Dr. Feld, Dr. Granado)

Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Common Diseases)

Goal (Peter Heckathorn, Paul Westhoff)

Endocrinology / Diabetes COE Realign with Secondary strategy

2016 Measurable Outcome 276 new cases per doc * $360K CM per new doc *4-$1.4M value of new FTEs (276 is benchmark)

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Included in CapitalBudget (Y/N)



1. Finalize sub-market areas to target Peter Heckathorn

2. Contract broker to identify and lease space Nichole L Construction

3. Recruit and hire (physicians and support staff) TME $480,000 (2 physiciansand 6 support)

4. Commence practices (somewhat standardized; includes IT, revenue cycle, training and education, process and procedures, among other elements)

Aaron Williams

5. Marketing Marketing $100k

6. Planning for group session space (unique ENDO COE element)

Construction




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Dr. Feld, Nancy Humbert, Michael Davis)

Develop Key Service Expansion through acquisition and CIN strategy

Goal (Peter Heckathorn, Paul Westhoff et al.)

Acquisition of 3 “geographical practices” and one new CIN partner

2016 Measurable Outcome

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Included in Capital Budget

(Y/N)



1. Identify practices to target 3/31/16 L. Feld /Peter Heckathorn

2. Reassess NCH and MOB/satellite locations Nichole L Construction, Service Line leaders for PSA & practice manager, ACC team can support as needed

3. Contract (physicians and support staff) Legal $3.4M (16 physicians and 26 support staff)


Aaron Williams


6. Planning for space allocation Construction




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care






Goal (Peter Heckathorn, Paul Westhoff)

Gastroenterology COE CONSIDER REGIONAL EXPANSION BY ACQUISITIONS and RECRUITMENTS; ALIGNMENT WITH BOCA, BROWARD AND PALM BEACH PEDS GIs AND LINK TO ASCs IN THE AREAS

2016 Measurable Outcome $1,478 CM per case * 80 cases/doc/year =$118K contribution/year


(Y/N)



1. Finalize sub-market areas to target Peter Heckathorn


3. Recruit and hire (physicians and support staff TME $180K (1 totalphysician FTE

and 1 total support FTE)


Aaron Williams

5. Marketing Marketing $100K

6. Planning for on-campus exam rooms, staff offices, conference room, etc(unique IBD COE element)

Construction Osnyl Cruz




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Dr. Granado, Tim Birkenstock, Jackie Gonzalez, Nancy Humbert)


Goal (Dr. Granado)

Chronic Care Protoype

2016 Measurable Outcome Achieve horizontal organization of services for medically fragile patients

Responsible Team Member(s) Capital Costs

Included in CapitalBudget (Y/N)


Implementation Milestones Timeline Principal Supporting

1. Build comprehensive program roadmap for completely integrated care system for the management of medically fragile (chronic patients)

Q1 Dr. Rosa Olivares

Jamie Wiggins, Dr. Biehler, Michael Durr, Evelyn Terrell, Susan Churchill, Ivette Roldan, Dr. Reyes, Janet Bell-Taylor, Jamie Tarshis

2. Operationalize preventative maintenance component – organization of medical home Q2-Q4 Dr. Rosa Olivares

3. Operationalize IP component – interdisciplinary coordination of care and patient navigation through discharge

Q2-Q4Philicity

Tinnie-Wilson

4. Operationalize outpatient component – specialty clinics and prescribed pediatric extended care (PPEC), home health, school support and rehab, post acute care partners

Q2-Q4Janet Bell

Taylor

5. Standardize inpatient care of medically fragile patientsQ2-Q4

Dr. Biehler




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care





Develop Centers of Excellence around Key Service Lines for Common, and Rare and Complex Diseases (Rare and Complex Diseases)

Goal (Dr. Granado, Peter Heckathorn, Paul Westhoff)

Plastics / Beckwith Wiedemann / Peripheral Nerve COE COUPLE WITH OTHER SURGICAL (ENT)

2016 Measurable Outcome $146K contribution margin (12maxillofacial cases in 2016); + $263 CM per hand surgery case


(Y/N)



1. Finalize sub-market areas to target ?? Peter Heckathorn


3. Recruit and hire (physicians and support staff) TME $450K (1 physician and

support)


Aaron Williams


6. Find space for, acquire, and train appropriate people on a hand scanner and additional 3D printer (unique Plastics COE element)

Jeff Friedman Nestor Ventura

$450K C-Arm + $71K 3D printer




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care




Organizational Imperative (Jose Perdomo)

Increase focus on research and develop outreach/education programs

Goal (Dr. McCafferty, Dr. Gereige)

Explore academic and research affiliations to complement or enhance research capabilities/services, provide support/internships to a breadth of services

2016 Measurable Outcome Execute one new research or academic affiliation




1. Work with medical education and research stakeholders to identify opportunities for new affiliations

Q1-Q4 Dr. Gereige Dr. McCafferty, GME Committee & Scientific Advisory Committee

2. Identify partner/thought leader at new affiliate organization

Q2 Dr. Gereige Dr. McCafferty, GME Committee & Scientific Advisory Committee

$5,000 travel expenses

3. Develop and execute an agreement with one new affiliate organization

Q4 Dr. Gereige Dr. McCafferty, GME Committee & Scientific Advisory Committee

TBD [Ex. $50,000 (basedon 5 trainees completing 2 semesters of graduate work at FIU @ $10,000 each) 2017 earliest




Improve Quality

Outcomes

Enhance Breadth and

Depth of Care





Increase focus on research and develop outreach/education programs

Goal (Dr. McCafferty)

Build a research infrastructure to support research in personalized medicine and health outcomes by recruiting experts in genomics and population health

2016 Measurable OutcomeOnboard experts in epidemiology, biostatistics, and research data management to provide research support services for the Patient Centered Outcomes Research Institute (PCORI) Clinical Data Network and facilitate the personalized medicine projects, including CYP2D6.

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs Included in Capital

Budget (Y/N)



1. Complete onboarding for epidemiologist, biostatistician and data manager

Q1 Dr. McCafferty New hires approved in FY2015

2. Implement infrastructure to support PCORI reporting Q1 Dr. McCafferty TBD Epidemiologist, TBD Data Manager, TBD DataCoordinator

$1M personalizedmedicine IT

$56,000 for data coordinator (25%comp from grant); 75% dedicated to registry growth per US News methodology

3. Get CYP2D6 protocol open for enrollment Q3 Dr. McCafferty Study team $225,000 (total costs of executing the protocol )

4. Complete PCORI reporting Q2-Q4 TBD Data Manager TBD Data Coordinator

5. Facilitate ID next areas of opportunity for outcomes research, including expertise and staffing

Q2-Q4 Dr. McCafferty TBD Epidemiologist, TBD internal subject matter experts, Dr. Granado

$25 ,000 consulting

6. Include outcomes with actionable genetic results in patient medical record (operationalize outcomes in system)

Q4 Dr. Orces Dr. McCafferty, Pharmacy IT build might be required - TBD

7. ID next areas of need and opportunity for personalized medicine including expertise and infrastructure for biobanking

Q2 Dr. McCafferty Pharmacy, Lab, PSA

8. Develop project plan around next opportunity for personalized medicine including staffing and expertise requirements

Q4 Dr. McCafferty TBD PM Med Dir, SME for next opportunity, Pharmacy, Lab, Dr. Orces, Strategy

$25,000 consulting



Miami Children’s Health System | 36= Capital project= Operational Goal= Strategic Goal

Organizational Priorities Excel in customer service and experience by delivering compassionate care, affordability and access

Organizational Imperative (Nancy Humbert)

Enhance Ambulatory Services

Goal (Evelyn Terrell)

Expand telehealth capabilities within ambulatory network & among JMC affiliation


(1) 2 international contracts signed and operationalized (2) 4 School Health deployments operationalized (3) 1 Home Health program operationalized (4) 1 Telehealth mobile unit (5) Telehealth Service Line international consult volume growth by 5% over PY (6) Telehealth Service Line domestic pediatric consult volume growth by 5% over PY(7) Telehealth Service Line affiliation Jupiter Medical Center encounter/ consult volume by 50% PY

Implementation Milestones Timeline Responsible Team Member(s) Capital Costs




International: 1. 2 international contracts signed 2. Project/program planning, activation, and deployment

Q1, Q2Q3, Q4

Evelyn TerrellLucienne Wallner, Dr. Maggioni, Anita Wilson, Edwit Tironi, William Manzie

Domestic- School Health1. 1 School Board contract signed 2. Project/program planning, activation, and 4 deployments (locations)

Q1, Q2Q3, Q4

Evelyn TerrellCindy Harrah, Susan Churchill, Jill Tahmooressi, Anita Wilson, Edwit Tironi, William Manzie. Others TBD

Domestic- Home Health1. 1 Home Health contract signed 2. Project/program planning, activation, and deployment

Q1, Q2Q3, Q4

Evelyn TerrellMark Llorente, Jamie Wiggins, Anita Wilson, Edwit Tironi, William Manzie. Others TBD

Domestic- Telehealth Mobile Unit 1. Project/program planning, activation, and deployment

Q1, Q2Q3, Q4 Evelyn Terrell

Dr. Roldan, Anita Wilson, Edwit Tironi, William Manzie, Others TBD

Tele-Intervention ExpansionSustain and grow tele-intervention services in Monroe County. Expand tele-intervention services to Miami-Dade County by end of Q2 2016, gaining Early Steps State Office approval and contracting with three (3) new community partners.

Q2 Marc Welsh Keylsa Lee

Telehealth Expansion Among Affiliations – Jupiter Medical Center Evelyn Terrell Carla Salvatore-Bimmler, Jill Tahmooressi, Karen Sinclair, Linda Foley, Genevieve Sierra

Excel in customer service and experience

by delivering compassionate care,

affordability and access





Organizational Imperative (Nancy Humbert, Armando Llechu)

Enhance Ambulatory Services

Goal (Marlenne Burt)

Target high concentration population areas to expand the organizational footprint through the delivery of OP services and programs in alignment with physician distribution

2016 Measurable OutcomeOperationalize Pinecrest UCC, Pinecrest Sports Destination Center, UCC Main Campus, requires Capital Budget approval: Expand Dental Services in Doral, Telehealth Dental Mobile Service, Orthopedic Services in Broward at the Miramar OC Planning process for Aventura UCC;


(Y/N)



Pinecrest UCC 1. Project planning 2. Project activation3. Project Implementation” 4. Project “go-live”

Q1, Q2Q3, Q4

Josie Diaz & Marlenne Burt

Entire activation team: Construction, Marketing, Lourdes Nieves, Monica Ruiz-Valls

$5,053,256 (combined UCC/Sports)

Sports Destination Center1. Project planning 2. Project activation3. Project Implementation” 4. Project “go-live”

Q1, Q2Q3, Q4

Josie Diaz & Marlenne Burt

Entire activation team: Construction, Nursing Manager and Director, marketing, Operations and clinical leaders

See above

Planning for the Aventura UCC, Homestead, Southern Broward (Coral Springs – within 35 mile radius from MC)1. Identify location 2. Project planning3. Project activation and implementation

Q1, Q2Q3, Q4

Josie Diaz & Marlenne Burt (Untilnew Regional Dir on board)

Ambulatory network leadership TBD

Ortho Services in Broward – Miramar Shell Space Expansion (CapitalRequest)1. Project planning 2. Project activation3. Project Implementation” 4. Project “go-live”

Q1, Q2Q3, Q4

Janel Grover Marlenne Burt (or may be Regional Director TBD) (other team members TBD)

Proforma in progress –approx. $527,000 – build out costs ONLY

Dental Telehealth Mobile Unit Services Commencement 1. Project planning 2. Project activation3. Project Implementation” 4. Project “go-live”

Q1, Q2Q3, Q4

Dr. Rosie Roldan Evelyn Terrell Grant – Proforma

available from Merry Pargas








Organizational Imperative (Nancy Humbert, Dr. Granado, Michael Durr)

Exponentially grow and develop global health to drive tertiary and quaternary volumes

Goal (Lucienne Wallner)

Secure additional international Global Health affiliations

2016 Measurable Outcome Achieve 10 additional Global Health affiliations by year end




Implementation Milestones Timeline

Responsible Team Member(s) Capital Costs




1. Identify target countries to establish affiliations

Q1 LucienneWallner

Dr. Maggioni

2. Contact identified countries to deploy medical/business team

Q1 LucienneWallner

Dr. Maggioni

3. Assess needs in targeted country to customize affiliation program

Q1 LucienneWallner

Dr. Maggioni

4. Develop competitive material/prices for targeted affiliation programs

Q2 Lucienne Wallner,

Rebecca France, Carolina Cervera, Georgette Alfau

5. Develop international templates and legal documentation necessary for agreements

Q2 Legal Dr. Maggioni, Lucienne Wallner, Michael Sisti

6. Market GH services to targeted audience Q3 Marketing Lucienne Wallner, Teresita Lopez, Dr. Maggioni

7. Execute affiliation agreements with targeted countries

Q3 LucienneWallner

Dr. Maggioni

8. Assess outcome by monitoring increase in patient volume growth referred by affiliation agreements

Q4 LucienneWallner

Dr. Maggioni, Teresita Lopez





Organizational Imperative (Nancy Humbert, Dr. Granado, Tim Birkenstock, Ed Martinez, Michael Durr)

Exponentially grow and develop global health to drive tertiary and quaternary volumes

Goal (Lucienne Wallner, Teresita Lopez)

Increase total number of international patient admissions

2016 Measurable Outcome Achieve 5%+ annual growth in international patient admissions





Included in Capital

Budget (Y/N)



1. Establish Automated Daily Admissions Monitoring Report:• Use BI Reports as source for daily admissions• Perform audits of reports to ensure that 100% of global patients are being captured

Q1 Teresita Lopez

Maylee Sanchez, Juan Lopez

2. Establish Global Health Registration Process:• Hire and train new registrar designated for GH Patients in order to more accurately register

patients and capture 100% of global admissions with corresponding international addresses and international referring physician information

• Improve access and turn-around-time for patients at admission

Q1 Teresita Lopez

Julia Rodriguez, Lourdes Castro

3. Intake:• Create automated process for registering new GH patient requests received via the Nicklaus

Children's Global Health website link in order to reduce TAT and the potential for the patient/admission to a competing hospital

Q1 Teresita Lopez

Georgette Alfau

4. Access:• Meet with individual sub-specialty practices in order establish turn-around times for appts. & POC

for possible admissions. • Provide 2 educational lunch and learns to physician practices and GH Stakeholders in order to

emphasize "same day" culture for global patients

Q1-Q2 Lucienne Wallner

Teresita Lopez, GH Practice Lead

$250K

5. Finance:• Establish competitive pricing for targeted diagnosis based on demand established from previous

admissions volumes

Q3 Michael Sisti Lucienne Wallner

6. Admissions resulting from signed Affiliation Agreements• Work closely with GH affiliations goal team to secure additional admissions from newly signed

affiliation agreements

Q4 Lucienne Wallner

Dr. Maggioni, Teresita Lopez





Organizational Imperative (Michael Kushner, Ed Martinez)

Focused marketing around outreach, education and communication internally (staff and physicians) and externally (patients) to improve delivery of patient care and patient engagement

Goal (Marcia Diaz de Villegas, Melissa Moreira, Maylee Sanchez, Janet Bell, Ana Rodriguez, Loubna Noureddin, David Bratt)

Develop data-driven, user-friendly, consumer-centric tools (such as customer relationship management) and information to facilitate and streamline access, engagement, education, communication and experience

2016 Measurable Outcome 15% yoy growth in new patient volume








1. Hire a marketing data analyst (to be shared with the Strategy team) to provide insight and reporting across all digital marketing initiatives

Q1 Marcia Diaz De Villegas

RecruitmentRobert Prieto

1 FTE ($80K)

2. Launch MCHS way, Customer Service, and New Values integration training into one and deploy campaign Q1 Loubna Noureddin

Ana RodriguezJanet B.T.,Oscar Mesa, Scott Gallimore,Suly Prieto

3. Consolidate all Community Education resources and initiatives under Learning & Development Services Q1 Loubna Noureddin

Wendy Johnson

4. Retain content specialist to develop branded content, including web content update, and patient education and engagement content. Physician enterprise marketing position and freelance writer will support this.

Q1 Rachel Perry Carmen Pages 1 FTE ($80K)

5. Support increased signage production Q1 Juan Rabionette

Supplies ($75K)

6. Create new way finding support system (using medical maps). Q2 Patricia Kane Marcia Diaz de Villegas, Ana Rodriguez, Juan Rabionet

7. Establish/pilot a family faculty initiative Q3 Ana Rodriguez Janet Bell-Taylor





Organizational Imperative (Michael Kushner, Ed Martinez)


Goal (Marcia Diaz de Villegas, Melissa Moreira, Maylee Sanchez, Janet Bell, Ana Rodriguez, Loubna Noureddin, David Bratt)

Develop data-driven, user-friendly, consumer-centric tools (such as customer relationship management) and information to facilitate and streamline access, engagement, education, communication and experience

2016 Measurable Outcome 15% yoy growth in new patient volume








8. Establish a consolidated call center operation for all front end patient activities (Phase I physician referral, scheduling, pre-registration, operator) (Phase II PFS)

Q1 Ana Rodriguez Marcia Diaz de Villegas, Melissa Moreira

$200K Y

9. Lead the operational move and collaborate with IT to ensure system functionality (if approved) Q1- Q2 Angel Sepulveda

IT, plant ops, Construction

10. Develop book of knowledge and scripts for the call center Q1 – Q2 Rachel Perry

11. Complete implementation of CRM (Customer Relationship Management) system across Marketing, Patient Access, Customer Services, TM&E, Finance, Research Institute, Physician Outreach and MCHF

Q2 Marcia Diaz De Villegas

Robert Prieto,David BrattAna Rodriguez, Maylee Sanchez

$650K IT

12. Lead Customer Service component of the CRM, including process flow and Call tree and solutions Q2 Idolidia Paula PMO. Servicearea leaders and staff

13. Deploy CRM Database to childlife specialist to gather increased analytics on patient preferences. Increasing patie3nt sat, align programming/orders/delivery of services to better meet the individualized needs of the patient

Q1 Q2 Kara Marante Marketing, IT





Organizational Imperative (Ed Martinez, Dr. Kini, Dr. Granado, Jackie Gonzalez)


Goal (David Bratt, Anita Wilson, Ed Tironi)

Develop Smart Hospital capabilities (integrated vital sign monitors, infusion pumps, RFID recognition of team members) including alerting clinicians and care teams of changes in patient condition

2016 Measurable Outcome15% yoy growth in new patient volume; Completion of Large pump Integration and Successful deployment of Small Pump Integration




Responsible Team Member(s) Capital Costs Included in CapitalBudget (Y/N)


Implementation Milestones Timeline Principal Supporting

1. Infusion pumps integration by unit. The order of the units to be implemented during 2016 will be determined in January 2016. 100% go live in quarter 4

Q1-Q4 Ed Tironi Anita Wilson, Irvin Alfonso

2. Build RFID infrastructure Q1-Q2 David Bratt Aleida Gavallas $700K IT

3. Define RFID workflow for assets and patients Q3 David Bratt Aleida Gavallas

4. Go live Q4 David Bratt Aleida Gavallas







Implementation Milestones Timeline Responsible Team Member(s) Operating Expense(s)


1. Case management training through ACMA program, inter rater reliability training for both clinical guidelines (InterQual and MCG) Q1 Philicity Tinnie-Wilson Rebecca France

2. Provide statistics for 3-year historical trending of ALOS to develop baseline Q1 IT

3. Establish target for actual v. expected LOS to expand coverage for case managers to include weekends and holidays Q1 Philicity Tinnie-Wilson Rebecca France,

4. 50% completion of case management dashboard Q1 IT

5. Comparison of medicaid v. commercial payorsto reduce denials for medical necessity Q1 Philicity Tinnie-Wilson Rebecca France

6. 100% admission reviews completed (for all patients) for clinical medical necessity Q1-Q4 Philicity Tinnie-Wilson Rebecca France

7. 100% completion of case management dashboard Q2 IT

8. Rollout case management dashboard and report performance Q2 IT Rebecca France, Philicity Tinnie-Wilson

9. Optimize post discharge call program throughout system to curb readmissions, increase patient satisfaction and control LOS Q2 Philicity Tinnie-Wilson Rebecca France, unit leads

10. Establish case management policies and procedures Q2 Philicity Tinnie-Wilson

11. Optimize preventable readmissions including 30, 60 and 90 days and avoidable days which contribute to discharge delays and higher LOS Q3 Michael Gagnon Philicity Tinnie-Wilson, Josh Sumarll

12. Establish pre admission case management for planned procedures Q3 Philicity Tinnie-Wilson

13. Recruit 1.5 FTE for pre admit case management specific to surgical services Q3 TME Rebecca France, Philicity Tinnie-Wilson, Ana Ruiz

$150K

14. Provision of iPhones for case management team Q3 TME Rebecca France, Philicity Tinnie-Wilson

$2K

15. Identify space for case management team Q3 Construction Rebecca France, Philicity Tinnie-Wilson

16. Include achievement of top box percentile patient satisfaction in annual evaluations Q4 Ana Rodriguez Rebecca France, Philicity Tinnie-Wilson

17. IT integration with Cerner for care management module to fully support case management program Q4 IT

Manage provision of care along care

continuum

Organizational Priorities Manage provision of care along care continuum Organizational Imperative (Tim Birkenstock, Michael Davis, Ed Martinez)

Achieve complete management of patient across care settings via interdisciplinary collaboration

Goal (Philicity Tinnie-Wilson)

Development of case management team to optimize transition of care (pre, concurrent and post discharge) to improve patient satisfaction and outcomes


1-2% / year reduction in ALOS based on evaluating causes for preventable readmissions, ED case management, discharge control, one day stays, extended day admissions and observations stays, hospital acquired conditions and increased focus on pediatric medicine to manage chronic conditions




Implementation Milestones Timeline Responsible Team Member(s) Operating Expense(s)


1. Complete transition of care plan across system with case managers and service line care teams (case management to look at scheduled procedures up to one month in advance, complete pre assessment call 2 weeks prior to admission, one week prior to admission follow up call and documentation of assessment, confirm authorizations, confirm patient status [IP, OP]), assignment of responsibility to service line care teams

Q1 PhilicityTinnie-Wilson

Rebecca France and service line leaders, Marlenne Burt

2. Design pre assessment and post discharge follow up tool Q2 IT

3. Recruit 3 service line specific case managers (pre admission, concurrent and post discharge follow up) Q3 TME Philicity Tinnie-Wilson, Rebecca France and service line leaders

$300K

4. Combo case management and service line training for teams Q3 PhilicityTinnie-Wilson

Rebecca France and service line leaders

5. 100% Tracking of readmissions for all service lines Q4 PhilicityTinnie-Wilson


6. Include achievement of top box percentile score for patient satisfaction in annual evaluation Q4 PhilicityTinnie-Wilson



continuum

Organizational Priorities Manage provision of care along care continuum

Organizational Imperative (Tim Birkenstock, Michael Davis, Ed Martinez, Dr. Granado)

Achieve complete management of patient across care settings via interdisciplinary collaboration

Goal (Philicity Tinnie-Wilson)

Dedicated patient care team and support resources for key service lines to include patient care coordinator/nurse navigator, social worker, financial counselor, patient advocate, behavioral and mental health, etc..

2016 Measurable Outcome 1-2% / year reduction in ALOS, top decile score for patient satisfaction





Organizational Imperative (Michael Davis, April Andrews)

Create infrastructure to operationalize and scale CIN

Goal (Michael Sisti)

Integrate community primary care, subspecialty physicians and other health organizations into CIN population health model; develop standard physician rounding and needs based physician distribution

2016 Measurable OutcomeSecure base of aligned PCPs and employed specialists, begin moving them through phases 1 and 2 (of 5 phases) of the practice transformation plan, and begin executing on its contacting strategy that aligns incentives with improved outcomes





Included in Capital Budget

(Y/N)



PCP CIN Enrollment1. Enroll 54 CIN Participation Agreements of Existing Aligned PCP's2. Enroll 100% of employed specialists in CIN3. Enroll 25% of Hospital-Based NON-employed specialists in CIN

Q1,Q2,Q3Q1

Q1,Q3

Kara Marante

PSA, Legal

Contracting/Managed Care1. Commence deployment 3 year contracting strategy for CIN (initiate conversations with 5 big insurers and 3 Medicaid plans2. Run analytics on three plans for partnership, decide optimal contract model, negotiate competitive Medicaid PCP capitation

agreement for aligned physicians3. Enter negotiations for 3 plans (2 commercial and one Medicaid)4. Execute 2 contracts, evaluate remaining plans, create reports with results to distribute to CIN members, achieve goal of 50K lives

under management

Q1

Q2

Q3Q4

Michael Sisti

Education1. Hold 1 town halls and 10 lunch & learns at physician practices Q1-Q4

Michael Sisti

Practice Transformation1. 108 PCPs Complete Phase 12. 100% of Employed Specialists Complete Phase 1; 50% of NON-Employed Specialists Complete Phase 13. 162 PCPs Complete Practice Transformation Phases (Phase 1: 54; Phase 2: 108) 4. 100% of Employed Specialists Complete Phase 2; 25% of NON-Employed Specialists Complete Phase 1; 25% of NON-Employed

Specialists Complete Phase 2

Q2Q2Q4Q4

PSA

Kara Marante, Physician Liaisons, Dr. Rosa Olivares, Carlos Allyon


continuum






Organizational Imperative (Dr. Granado, Michael Davis)


Goal (Dr. Biehler, Quality Administrator Dr. Orces)

Establish the use of evidence-based IP/OP best practices in collaboration with community physicians

2016 Measurable OutcomeAll employed/aligned physicians trained on best practices, achieving the following:• 45% of practices reporting results•45% adherence to best practice thresholds







1. Finalize best practices, based on the following criteria:• High cost, high frequency• High cost, low frequency• Low cost, high frequency• Low cost, low frequency

Q1 Dr. Biehler Quality Administrator, Dr. Granado

2. Develop best practices checklist to enable office adherence Q1 Dr. Biehler Quality Administrator, Dr. Granado, Michael Gagnon, Dr. Orces

3. Establish and capture baseline measures for participating practices Q2 Quality Administrator

Physician Liaison Team

4. Train participating CIN practices on best practice adherence and reporting (phase 1 of practice transformation)

Q2 Dr. Biehler Dr. Granado, Physician Liaison Team

5. Deploy via Cerner and health fusion EMRs and/or Cerner HealthE Registries platform. Develop manual entry report for non EMR practices and non Health Fusion or Cerner EMR users

Q3 Dr. Orces Dr. Granado, Ed Martinez

6. All employed/aligned physicians trained on best practices, achieving the following: • 50% of practices reporting results• 60% adherence to best practice thresholds

Q4 Dr. Biehler Dr. Granado, Quality Administrator, Dr. Orces, Adam Stoller, EdMartinez


continuum





Organizational Imperative (Ed Martinez)


Goal (Anita Wilson)

ESTABLISH data and technology infrastructure to equip physicians to provide continuous care - ensure access to patient info and transferability across care settings

2016 Measurable Outcome Complete clinically integrated decision model to examine practices as a whole







1. Establish bi directional flow of data to patient

Maylee Sanchez $1M IT

2. Establish bi directional flow of data to physician

Maylee Sanchez

3. Develop data repository Maylee Sanchez


continuum





Organizational Priorities Advance the engagement and empowerment of our people

Organizational Imperative (Michael Kushner)

Develop culture of empowerment and engagement to achieve strong recruits, employee retention and high performing leaders

Goal (Magaly Barroso)

Improve staff development and groom appointed successors by increasing their authority, responsibilities and mentorship

2016 Measurable Outcome Reduce leader transition to 15% for those that undergo the cross functional process






(Y/N)



1a. Create a 6 months onboarding program for new leaders (hired and promoted). 1b. Ensure that prior to recruiting that there is agreement on competencies and skills that are required1c. Agree on compensation range/arrangements for critical positions before recruitment process begins

Q1-Q4 Margaret Gibson, IT.Janet Lara Vital, MagalyBarrosoand Karla Alvarado

Increased supplies $25K)

2. Target areas to create a ladder approach and develop depth of succession within areas of critical talent needs and hard to find talent. Create layers for areas that currently do not have.

Q1-Q4 Magy Barroso

3. Create a targeted program for performance to sit in on QPCs, annual appraisals and crucial conversations for identified leaders that need assistance with providing feedback and improving employee relations

Q1-Q4 Ilene Fedyniack IT 1 FTE (additional TM) $90K

4. Create fellowship style programs for some of the key hard to fill identified leader roles

Q3-Q4 Magy Barroso $75k


continuum

Advance the engagement and empowerment of

our people






Organizational Imperative (Michael Kushner, Dr. Feld, Dr. Granado)



Emphasize active recruiting and determine best fit defined for each position; enhance on boarding.

2016 Measurable Outcome Fill high level key strategic positions within labor market time or less.






Operating Expense(s


1. Support PSA: Realign JB to solely Physician. Shepard candidates thru PSA recruitment process. 2016 hiring 58 docs and 20 extenders. Meeting monthly with Dr. Feld ensuring quality and timely execution. Lead process improvement initiatives.

Q1 LonayBostic

Magy & PSA leadership

2 FTE (Recruitment coordinator $50K and sourcer $70K)

2. Support hiring Expansion: Support effective quality hire thru launching a mystery shopper type programs where a 3rd party will interview potential hires and new hires on their applicant experience.

Q1 CarlaBiltres

Margaret, Magy, UCC leaders

4 FTE (1 Recruiter $75K, 2 Sourcer $120K and 2 support $90K)


continuum


our people





Organizational Imperative (Michael Kushner, Dr. Feld, Dr. Granado)



Emphasize active recruiting and determine best fit defined for each position; enhance on boarding.

2016 Measurable Outcome Fill high level key strategic positions within labor market time or less.





Operating Expense(s


3. Pilot video recorded interviewing to share recorded initial interviews with leader prior to initial interviews and pilot texting component for positions for applicants. And realign Taleo applicants with different applications in different categories. Further enhance true panel interview format.

Q2 Magy It, Francis $45K Y

4. Develop and deploy mobile versions of recognition apps to be used by families, staff and leaders thru nominations and tokens, create more visible venues

Q2 Magy IT Francis

5. Look for and implement Taleo overlay with scheduling capabilities to automate for more efficient process the interview scheduling process and realign the scheduling process using VP admin to schedule vp/Docs interviews (TM&E does not have access to calendars process takes 2 – 3 days finding availabilities

Q2 Magy IT, Marcia (call center), Janet (HRIS)

$35K y

6. Development of strategy of affiliation for enhancing the academic programing of the Nicklaus child life team creating a internship program for best recruit of hard to find specialist.

Q1 Kara Marante

Volunteer Services


continuum


our people







Goal (Loubna Noureddin)

Drive empowerment among staff increasing service levels.

2016 Measurable Outcome 80% of departments using the program effectively. 3% HCAP-specific Qs rating improvement overall.






(Y/N)



1. To support employee empowerment, work with task force, leaders and champions to develop and implement a service recovery program.

Q1 LoubnaNoureddin

Suly Prieto, Michael Gagnon, Ming Far, Jamie Wiggins, Elena Ortega, Hortensia Cesar, Janet B., Taylor, Christine Serrano

$50,000

2. Pilot program in 3 areas – Radiology, ED, OR Q2 LoubnaNoureddin

Jamie Wiggins, Scott Gallimore, Elena Ortega, Janet Bell Taylor, Christine Serano

$10,000

3. Increase effectiveness of staff onboarding process by including a buddy for 100% of employees. Revisit program elements to simplify bonus review process and improve overall assessment review process.

Q2 LoubnaNoureddin

Scott Gallimore $27,000

4. Integrate Service recovery program into all patient-related departments Q3 Loubna Noureddin

Same as item 1

5. Evaluate program and monitor progress. Identify effectiveness measures and monitor employee feedback regarding recurring issues.

Q4 LoubnaNoureddin

Same as item 2


continuum


our people







Goal (Janet Bell Taylor)

Engage employees by incentivizing quality ideas, expanding benefits and appreciation initiatives and increasing focus on employee wellness

2016 Measurable Outcome Reduce number of unfavorable responses regarding compensation in employee engagement survey








1. Establish a pool of salary dollars for recruitment & retention of key employees and leaders

Q1 Janet Lara Vital

TM’s, IT support, Legal

2. Review organization bonus structure and Leader hierarchy and recommend changes based on market demands and growth of the organization.

Q2 Michael Kushner

Janet Lara Vital, legal, IT

3. Create a performance management structure for all employed physicians Q2-3 Lonay Bostic IT, Dr. Feld & PSA leadership team

4. Complete comprehensive benefit study to comply with Affordable Care Act reform and implement recommendations

Q2 - 3 Jacqueline Vacquer

Legal, IT

5. Execute on the new Employee Wellness Pilot to include the TOP test and employees’ children. Prepare for commercialization phase of TOP.

Q2 - 4 Janet Lara Vital

Michael Davis, Michael Kushner, Emp communications,

6. Expand convenient care clinic to corporate office building (including tenants). Use telehealth to expand employee health services to ambulatory sites.

Q4 Lucy Castellanos

Janet, IT, Evelyn for Telemedicine, Construction, Marketing, Legal


continuum


our people




Organizational Priorities Develop appropriate payor models and alternative revenue streams to manage risk and optimize margin

Organizational Imperative (Lucy Morillo)

Adopt vision driven philanthropy

Goal (Meschelle Huether, Nancy Castleman-Dion, Flavia Llizo)

Promote growth and development of internal fundraising infrastructure (development officers, physician leaders, volunteers and senior leaders)

2016 Measurable Outcome Increase annual targets to an average of $1.15M for Directors of Major Gifts





continuum


our people

Develop appropriate payor models and

alternative revenue streams to manage risk and optimize

margin





1. Increase access to technology (i.e. iPads) Q1 Richard Perez IT Department $15,000

2. Increase Foundation involvement with affinity membership organizations (i.e. ballet, opera, yacht clubs etc.)

Q1-Q2 Lucy Morillo Flavia Llizo, Rebecca Interian $15,000

3. Targeted, industry-specific development training Q1-Q4 Flavia Llizo Education and Development $56,000

4. High level prospect management efforts focused on leadership gifts

Q1-Q4 Meschelle Huether Nancy Castleman-Dion, Michael Mowatt, Joe Deary, Pietro Bonacossa, Jacky Donate, Betty Galan, Kate Meenan, Harold Robaina, Alex Salcedo, Melissa Wetzel, Patricia Alonso, Sofia Durkee

n/a







Goal (Meschelle Huether, Nancy Castleman-Dion, Flavia Llizo)

Align donor campaigns to foster clinical, research and education enhancements around centers of excellence and special projects to achieve tiered growth in annual campaign targets over time

2016 Measurable Outcome Raise a minimum of $25M





continuum


our people



margin




1. Finalize components of campaign priorities (i.e. final naming & programmatic opportunities, bricks & mortar, etc.)

Q1 Hospital SLT & OLT Nancy Castleman-Dion n/a

2. Hire new planned giving coordinator Q1 TM&E Richard Perez, Joe Deary $64,000

3. Hire 5 senior development officers (local and regional) and appropriate support staff

Q3 TM&E Richard Perez, Flavia Llizo $400,000

4. Expand fundraising efforts. to outside markets (i.e. Northeast, Collier , Palm Beach etc.)

Q4 Flavia Llizo, Meschelle Huether

Morgana Nieves, Lisbet Fernandez-Vina, Maria Moldes, Julie Katz, Adolfo Lopez, Cristina Guerrero, Monica Diaz , Yesenia Rodriguez

$150,000







Goal (Dr. Narendra Kini, Lucy Morillo)

Elevate level of engagement of all board members: foundation, hospital and system to actively support the philanthropic initiatives

2016 Measurable Outcome All system-wide boards to meet philanthropic support minimums for membership





continuum


our people



margin


Operating Expense(s


1. Standardize philanthropic support for individual board members of System entities at minimum of $50k annually

Q1 Dr. Narendra Kini, Lucy Morillo

Legal Department n/a

2. Ensure System board individual philanthropic support exceeds 7-figures

Q1 Dr. Narendra Kini, Lucy Morillo

Legal Department n/a

3. Increase volunteer leadership with addition of five new volunteer leaders that have the capacity to make 7-figure gifts

Q1-Q4 Lucy Morillo Dr. Narendra Kini n/a

4. Develop tiered approach for board membership from Foundation to Hospital; Hospital to System based on philanthropic support (modeled after top leading hospital systems)

Q2-Q3 Dr. Narendra Kini Lucy Morillo, Tim Birkenstock and Legal Department

n/a





Organizational Imperative (Tim Birkenstock, Michael Davis, Michael Durr, April Andrews)

Develop value based payor models and identify, quantify and budget alternative revenue streams

Goal (Michael Sisti)

Achieve revenue neutral transition to MSDRG

2016 Measurable OutcomeConversion of 3 additional major commercial payors to MSDRG (following 2 in 2015) with opportunity for additional margin through incentivized case management for NCH's total book of business





Operating Expense(s


1. Analyze financial impact of proposals, and develop counter proposals to optimize margin

Q1-Q4 Carolina Cervera Michael Sisti

2. Develop amendment language Q1-Q4 Andre Susla Michael Sisti

3. Monitor actual collected to expected (through the revenue realization report - MedAssests)

Q1-Q4 Carolina Cervera Michael Sisti

4. Ensure contractual flexibility to allow for new value-based provisions where applicable

Q1-Q4 Michael Sisti Andre Susla


continuum


our people



margin







Goal (Dr. McCafferty)

Develop office of sponsored programs to increase revenue from external sources, including grants and awards

2016 Measurable OutcomeEstablish Office of Sponsored Programs with an initial focus on developing processes and policies, tracking existing sponsored activities, and supporting proposal development and submission from central office.








1. Review sponsored programs policies and processes and identify gaps, including current sponsored activities and proposal development and submission

Q1 Dr. McCafferty Dr. McCafferty, Post Award, Finance, Foundation

$45,000 ops (contract grant writer ,supplies, educationand certifications

2. Revise or develop policies and process per the gap analyses Q1 TBD Manager Dr. McCafferty, Post Award, Finance, Foundation

$10,000 consulting fees

3. Engage external experts and internal stakeholders in review of gap analyses to determine information infrastructure (supporting platform) to create central repository

Q2 Dr. McCafferty TBD Manager, Post Award, IT, Cindy Harrah, Evelyn Terrell, Marc Welsh, Dr. Gereige

$25,000 consulting fees

4. Develop education and communication plans for new policies and processes, including current award management and proposal development and submission

Q2 TBD Manager Dr. McCafferty, Post Award

5. Execute education and communication plans, including current awardmanagement and proposal development and submission

Q3 TBD Manager Dr. McCafferty, Post Award

6. Design processes for proposal tracking and submission and identify IT solutions for 2017 implementation

Q4 TBD Manager Dr. McCafferty, TBD Pre-award, IT FTE (FY2016 $30,374 + CFB) Grant Coordinator 6/1 hire)

7. Work with units which are managing sponsored programs to determine pain points

Q4 TBD Manager Dr. McCafferty, Post award, TBD Pre Award


continuum


our people



margin





Organizational Imperative (Michael Davis, April Andrews, Jose Perdomo, Tim Birkenstock, Ed Martinez)


Goal (Michael Davis)

Identify and systematically plan for investments in projects that will yield alternative sources of revenue

2016 Measurable Outcome Develop MCHS's venture portfolio to have a strong positive outlook and healthy distribution of conservative to risky investments, spanning straightforward healthcare, products, pharmaceuticals, biomed, and services industries.





Included in Capital

Budget (Y/N)

Operating Expense(s


1. Create a prospectus of existing investments, and metrics for success on future investments (risk, % likelihood of ROI, etc.)

Q1 Liam Kelly

2. Establish governing processes, due diligence, and standard contracting terms Q1-Q2 Elizabeth Lopez Legal

3. Set direction for investments (% reinvestment & % return to the hospital/system) Q2 Michael Davis

4. Invoy: Accounts Management (monitor, maintain and support or exit) - Relationship with Jumpstart- Organizational structure (people and infrastructure)

Q1 Jose Perdomo

5. Emergency Medical Drone Response: Accounts Management (monitor, maintain, support or exit)- Pilot

Q1 Peter Carr

6. Next Galaxy: Accounts Management (monitor, maintain and support or exit)- Technical functionality (set-up) & pilot CPR training

Q1 Peter Carr

7. TMMC: Accounts Management (monitor, maintain and support or exit)- Go-live with new facility (key metric OB unit % referral)- MCHS employed neonatology to support TMMC- Actual to budget (at the level of both the Hospital Board and holding company)- Other Ventures with Nueterra

Q1 Michael Davis

Narendra Kini, Andre Susla, Tim Birkenstock, Ed Martinez

8. Internal Startup Operations: KidzStuff Ongoing Debbie Da Silva

9. Internal Startup Operations: KidzStuff- E2E Project Management

Q1 Debbie Da Silva

10. Internal Startup Operations: App Development to promote patient/family engagement and/or facilitate clinician ease-of-use (Mobile Apps, Discharge Apps, CareNotify, CareNarrative, CareDocuments)

Ongoing Peter Carr

11. Internal Startup Operations: TOPs Program with Interactive Health Ongoing Peter Carr


continuum


our people



margin

Appendix


Three Year Goal Plan


01 02 03 04 05


Improve quality outcomes; Enhance breadth and depth of careDevelop centers of excellence around key service lines for common, and rare and complex diseases (Brain)

Develop the infrastructure and implement Brain Wellness programs including Rare Chromosomal Clinic, Pediatric Brain Index, Retail Offerings, Cognitive, Motor & Behavioral Medicine Integration for patients and families served by the Brain Institute by 2018.

Neuro Home

Spasticity/movement disorders

Stroke & cerebrovascular

Neuro Oncology

Description of Goal Interdependencies 2016 2017 2018 Costs(exclude FTE salaries)

Business Impact

FTEs

24/7 virtual, at home care, results in less ED visits and admission

Neurophysiology testing, behavioral & cognitive therapies

5.25 FTEsOptimize neuro-development potential during first decade guided by personalized biomarkers

Personalized wellness clinic, diagnostics (MRgFUS, wireless EEG, neuromodulation (TMS)

$1M/year equipment lease

5 FTEs

Develop COE for congenital/vascular malformation, support OR backfill

Construction of angiosuite

205 cases by 2018 with $500K+ incremental operating income

2.3 FTEs

Provision of deep brain stimulation for patient, streamline clinical protocols

Neurology CP volumes to drive surgical cases

Provision of subspecialty services to patients

Collaboration among providers

Gait lab $155K

1-3 incremental cases/yr; 2 cases = $122k in net revenue ($61K net revenue per case)

No additional equipment

Year 1:150 Polysomnograms; 50 EEGs/ERPs; 30 fMRI; 105 neuropsychscreens; 25 TMS tests. 10 n/s cases. ~$856k

$805K total - 2 wireless EEG $50k; $50K in operations for TMS machine lease; $25K for gait lab; FTE salaries;MRgFUS included in ‘15 budget, TMS covered by Foundation funds

$16K contribution margin/case

Notes: Brain Wellness/Neuro: 0.5 social worker, 0.5 child life, 0.5 radiology neuroscientist, 1 neurodiagnostics specialist, 0.25 psychologist, 1 ARNP, 1 Pt. navigator, 0.5 nutritionist;Stroke and cerebrovascular; 5 FTEs by 2018 (1 physicians, 1 PA, 1 ARNP, Secretary and Procedural tech)Neuro Oncology: oncologist with brain tumor focus/neuro oncologist with research interest (hired by NNP so not included here), 0.3 neuropsychologist, 1 clinical research coordinator, 1 dedicated research nurse -study funds available external funds from current methotrexate study to cover part of the research nurse hire

Note: Costs and FTEs are spread over timeframe of implementation of Goal except otherwise noted


Improve quality outcomes; Enhance breadth and depth of careDevelop centers of excellence around key service lines for common, and rare and complex diseases (Cardiac)

Description of Goal Interdependencies 2016 2017 2018Business Impact FTEs

The inability to care for heart failure patients limits the scope and perception of the program to the community, the country and the world

Fills up CICU, occupies OR13.5 FTEs*

Provide lifelong continuum of care for complex pediatric patients to maintain within NCH revenue stream which results in significant downstream ancillary services

Strong fetal program as feeder and multidisciplinary complement of cardiac services to manage complex patients with comorbidities

15 FTEs

Fetal program preempts NICU to feed cardiac program

L&D program

Not expanding will result in “closing” the referral base in this market with significant loss of downstream revenue from tertiary care

Expansion into west coast at Golisano, West Palm and Aventura

$250K for EKG equipment and build out at Cleveland Clinic to include echo and office equipment

$360k in equipment (2 echo machines @ $180K each

Revenue loss of ($5M) in 2016, 8 new cases in 2017, annual income of $1.5MM 2017-18 results in net loss of ($2MM) total

$1.1M (year 1; included in kidney/heart transplant program)

6 incremental cases from new physicians = $120K contribution margin in 2016 + (5*$30k additional CM per year)

Kidney and heart failure: 2 transplant coordinators to provide shared coverage, 2 shared admin support, 0.5 genetic counselor, 1 heart surgeon, 1 kidney surgeon, 1 nephrologist, 1 pathologist, 1 immunologist, 1 psychologist, 1 pharmacy, 1 social worker, 1 medical assistant Adult congenital: 0.5 FTE adult congenital physician leader (20% admin); 2 RNs, 1 patient care coordinatorHeart: $1.1MM capital for dedicated heart unit basic remodeling. Equipment; OR slush machine and VAD-2 ($1MM) all in 2016. Year 1 expense is $5.3MM (including $400K transplant surgeon per year), net loss is ($2.5MM) by 2018.Fetal program/OP clinics: 2 FTE ambulatory cardiologists, 2 PAs, 4 sonographers, 2 admin support, 1 nutritionist (for all programs), 2 RNs, 1 practice manager to be shared across other services at West Palm, 1 clinical research coordinator; $30k cm per neonate case after first year for subsequent five years

Adult congenital heart disease (started in 2014)

Heart failure/heart transplant

Fetal program (started in 2014)

Development of outpatient clinics to achieve clinical differentiation in following programs:

neuro cardiac, electrophysiology, adult congenital, single ventricle survivorship,

transition, congenital valve, coronary health

By 2018 - secure 50% of pediatric ACHD cases into adulthood, 50% of our current cases will stay with NCH at an adult for their care

3.5 FTEs


Costs(exclude FTE salaries)


Improve quality outcomes; Enhance breadth and depth of careDevelop centers of excellence around key service lines for common, and rare and complex diseases (Ortho)

Description of Goal Interdependencies 2016 2017 2018Business Impact

FTEs

Expand sports program into Broward

Lease space in conjunction with ASC

Redirect cases to non-operative clinic to relieve pressure from surgeons allowing them to focus on high acuity patients

Hired non-op pediatric ortho specialist

3.5-4 FTEsPerfect fracture care model, expand services within OP centers

Cast techs, or orthotechs, PA, mobile cast carts

Expand spine service in Broward. Low dose radiation x-ray provides competitive advantage as Joe D. doesn’t have this, also increases efficiency faster imaging

Dedicated MRI block time, additional OR block time, EOS technology


EOS ($775K includes room prep) + $527K shell space build out at Miramar

2,600 new office visits/year in Aventura/Miramar combined

$527K shell space build out at Miramar

TBD

Note: Ortho Hub: 2 licensed trainers, 1 clinical coordinator, 1 cast tech; Fracture care: 2-2.5 cast techs or ortho techs and 1.5 PAs to expand to two locations. Spine market share in Broward was 33% for 2014, target of 50% for 2018; contribution margin per surgical spine case of $76K. Contribution margin of $76k per case for ortho surgical procedures;

Spine Center

Ortho hub in

Broward

Limb lengthening program

Hip program

Non-operative

clinics (back pain, feet,

intoeing and out-toeing)

Expand fracture care services off site

Develop hip preservation program Develop current surgeon

Further expansion of limb lengthening service

Develop current surgeon




Increase surgical spine by 24 cases in Broward by 2018 resulting in total contribution margin of $1.8M

n/a

n/a

n/a

n/a



4 FTEs

2016-35 cases =$175K CM

2016-35 cases =$150K


Improve quality outcomes; Enhance breadth and depth of careDevelop centers of excellence around key service lines for common, and rare and complex diseases(Oncology)


FTEs

This is required to compete nationally and will have impact on USNWR rankings;

Potential for increased sponsored activity if we have the phase I capability

5 FTEs

Improved space to enhance patient experience

Roll up IP/OP oncology procedures and downstream ancillaries by tumor site to demonstrate comprehensive service line view

Provision of radiation therapy services to patients

Additional IT infrastructure, hardware/software TBD


$600K/annual operating budget

Phase I clinical trials: 2 FTEs - research nurse, 1 clinical coordinatorsDefined OP oncology cancer center and program: Associate Medical Director of Clinical Oncology Research in Oncology (60% research/40% clinical, oversees phase I clinical trial program); 1 physician leader palliative care, 2 ARNPs, 2 social worker, 1 certified teacher, 2 RNs; $6.2M in costs = $400/sf * 15,550 sf in KIDZ Medical hallway; Vaccine therapy-research nurse or clinical coordinator

Expanded hours for RNs for OP cancer services

Improve national prestige, impact on USNWR rankings

Partnership collaboration with lab for tissue transfer and vaccine development

$6.2M renovation costs for dedicated cancer center



9 FTEs

n/a

n/a

1 FTE

Dedicated OP infusion clinic

Phase I clinical trial program

Achieve CoCaccreditation

with commendation

Defined OP cancer center and clinical program to include

survivorship and late effects clinic

Strategic alignment with rad onc provider/program

Oncology S/L P&L

Vaccine therapy program

Dedicated oncology space with collocated services and multidisciplinary approach to care yields enhanced patient experience

Relocation to cancer center

Improve national prestige, impact on USNWR rankings


n/a

n/a




$2,830 CM per case * 60 cases/doc/year = $340K in contribution/year

Improve quality outcomes; Enhance breadth and depth of careDevelop centers of excellence around key service lines for common, and rare and complex diseases (Common Diseases)


FTEs

Profitable service which drives its own patients and produces downstream ancillary volumes, is currently at capacity

Diabetes center

Provide care for chronic patients in appropriate community setting to reduce frequent flier ED visits

276 new cases per doc * $360K CM per new doc *4-$1.4M value of new FTEs

2 FTEs + (6 support staff for clinicians)

Gastroenterology COE

Endocrinology-Diabetes COE

Chronic care model

rehab/OT, PPEC and home health

Development of Inflammatory bowel disease program

1 FTEs + 1.5 support staff for clinicians

$520k

$280K

Profitable service which drives its own patients and produces downstream ancillary volumes, is currently at capacity

Note: PSA recruitment plan through 2018. Diabetes Center: Year 1 revenue of $459k, net loss of ($28k); Year 2 revenue of $603k, net income of $107K. Business Impact: CM per case and caseload per doc for all patient type and payor class from Finance based on 2014 service line report. Endocrinology downstream value stream CM per case based on 2013 revenues for hospital encounters=$1,305 CM per encounter, benchmark of 276 new patients per FTE per year = $360K total value a new FTE will bring in terms of downstream ancillaries for new patients




Improve quality outcomes; Enhance breadth and depth of care Develop centers of excellence around key service lines for common, and rare and complex diseases (Rare and Complex)


FTEs

Provide subspecialty services to enhance clinical care capabilities; enhance NCH prestige nationally and internationally

Glassoplasty for treatment of Beckwith Widerman syndrome

$1M total op. margin by 2018 + $146K contribution margin (12maxillofacial cases/year); + $263 CM per hand surgery case

Plastics COE: 1 hand surgeon and 1 FTE maxillofacial surgeon. Business Impact assumes 12 maxillofacial cases/year based on Dr. Perlyn’s 25 cases in 2014 with CM of $12,189 per case.

2 FTEs +(2*1.5 support staff for clinicians)

Plastics COE

$575k (C-Arm, 3D printer and marketing)




Improve quality outcomes; Enhance breadth and depth of careDevelop foundational services to support hallmark service lines

Description of Goal Interdependencies 2016 2017 2018 Business Impact

FTEs

Provide subspecialty services to enhance national reputation

Development of lab services

Heart: ($2.5M) total net loss by 2018; Kidney: ($1.4M) total net loss by 2018

Kidney and heart: 2 transplant coordinators to provide shared coverage, 2 shared admin support, 0.5 genetic counselor, 1 heart surgeon, 2 kidney surgeons, 1 liver surgeon, 1 nephrologist, 1 pathologist, 1 immunologist, 1 psychologist, 1 pharmacy, 1 social worker, 1 medical assistant; human milk depot: 2 formula techs.Fellowship assumes 2 fellows per year per specialty; professional development and education: $15k annually for monthly speakers for faculty development. Kidney: capital costs: No construction for OR, slush machine ($70K) and kidney unit construction of $30K; operating costs are for transplant surgeon ($225k/per year) and drugs. Net loss is ($1.4M) by 2018. Heart: $1.1MM capital for dedicated heart unit basic remodeling. Equipment; OR slush machine and VAD-2 ($1MM) all in 2016. Year 1 expense is $5.3MM (including $400K transplant surgeon per year), net loss is ($2.5MM) by 2018.Maternal/fetal partnership: $26M contribution margin assumes 30 referral cases for 161 PCPs within MSO and Vital at CM per case of $5,385 (CM per case for existing docs based on data for surgical procedures for IP, OP and observation units). Existing referrals total 4,830, incremental opportunity is 2,756 totaling 4,830 surgical procedure referrals

$100k kidney/$1.1MHeart +$530K for legal and consulting fees for each; $475K for liver

Develop depot for human milk

Identify solid organ transplant opportunities (kidney, heart

and liver)14.5 FTEs

Nutrition services($500K) total net loss

$105K2 FTEs

Expand lactation services

($5M) net loss by 2018

L&D unit: 2016: $1.2MM, 2017: $11M, 2018: 143K

Split admin/clinicalOB/GYN

partner, CIN



Align with maternal/fetal

physician partners and

develop high risk labor and

delivery unit

Solidify referral volumes from existing physician partners and increase referral volumes from physicians currently referring elsewhere; incremental referrals have halo effect on OP and ED visits; Operationalize adult (OBGYN) services to feed referrals to NCH

Achieve coveted quality

designations/accreditations

n/aOutcomes reporting

National/international prestige

$60-70K annually for site surveys


Manage provision of care along care continuum Achieve complete management of patient across care settings via interdisciplinary collaboration


FTEs

Improve readmission rates, decrease length of stay, achieve cost savings, as well as improve patient satisfaction

Development of case management team, LACE and BOOST readmission tools

Case Management Development resources: 1.5 pre admit case managers + 3 service line specific case managers (pre admission, concurrent and post discharge follow up) in 2016, 2 IP case managers in 2017, 2 case managers for pre & post discharge across care continuum by 2017 (1.5 for neuro services, 0.5 for oncology and 1 for ortho)

n/a

Development of case management team to optimize

transition of care (pre, concurrent and post discharge) to improve

patient satisfaction and outcomes

Develop cross continuum care pathways to connect across settings (includes post acute care provider

partnerships)

Dedicated patient care team and support resources for key service

lines to include patient care coordinator/nurse navigator, social worker, financial counselor, patient

advocate, behavioral and mental health, etc..

8.5 FTEsCollaboration with service lines and case management to develop cross functional care teams, ambulatory planning

n/aProvide patient centered care, apply multidisciplinary approach to care

n/a n/a

Implement services across care continuum to maintain patients in house

Provider collaboration, workforce model to address shift from IP to OP

1-2%/year reduction in ALOS




Manage provision of care along care continuum Create infrastructure to operationalize and scale CIN


FTEs

Increase patient lives under management, achieve interdisciplinary approach to patient care, manage patients along care continuum; Acquisition of four geographic practices and one CIN partner; Improve access to care close to home

PCP network, ambulatory strategy

Included in population health IT initiative ($1m/year) +$3.5M for practice acquisition (estimate)

Enhance data and technology to equip physicians to provide continuous care - ensure access to patient info

and transferability across care settings

Integrate community primary care, subspecialty physicians and other health organizations into CIN

population health model through alignment or acquisition of practices; develop standard physician

rounding and needs based physician distribution

16 physicians + 26 supporting FTEs (3 geographic practices)

Collaboration with providers

TBD TBDApply multidisciplinary approach to care and implement best practices to improve quality outcomes and cost reduction

TBDImprove IT infrastructure

TBDEstablish the use

of evidence-based IP/OP best

practices in collaboration

with community physicians

TBD





Excel in customer service and experience by delivering compassionate care, affordability and access Enhance ambulatory services


FTEs

Target high concentration population areas to a). provide early intervention (prevention and treatment) and b).

capture high acuity inpatient admissions In conjunction with development of OP centers and

physician distribution strategy

Complete planning and feasibility analyses

Apply multidisciplinary, patient centered approach to care

$3M net margin by 2018; $100K net income in 2016, $800k in 2017, $1M in 2018 for ASC)

$21M aggregate by 2018Add $7.7M for ASC in 2017

Achieve formalized approach to development of ambulatory network

Optimize physician distribution, identify strategic partners or develop new facilities: (OP centers, big box, ASCs UCC, specialty practices); physician recruitment plan identified space needs of 90k sf

TBD

Expand telehealth capabilities within ambulatory network

Develop one stop shop center (MOB style facility) to provide holistic, comprehensive service offerings to

achieve enhanced patient experience and economies of scale through aggregated physician practices and

centralized support

Collaboration with providers (JMC), Early steps program in FL. Keys

TBDTBD

TBD5% annual telehealthservice line domestic/international consult volume growth

Improve access to care close to home, grow international and domestic consults

TBD



Note: pro-formas developed by ambulatory team for OP future projects and includes development of new ED, one ASC in 2017, 4 small boxes and incorporating fracture care at UCCs; Measures of success: $1.4 M net margin by end of 2016 (Pinecrest location – UCC and Sports Destination Center & Aventura location – UCC only) Aventura proforma will need to be refreshed with “actual” location. Proforma utilized previous site being considered


Excel in customer service and experience by delivering compassionate care, affordability and access Exponentially grow and develop global health to drive tertiary and quaternary volumes


FTEs

Collaboration with quality, finance, legal

5 FTEs

Develop competitive material/prices for targeted countries to form collaboration, execute affiliation agreements

Achieve 5%+ annual growth in international patient admissions

n/a

Achieve 10 additional Global Health affiliations by year end

Optimize registration and intake process to improve turn around times and prevent leakage, emphasize “same day” culture for global patients

Dedicated space within main building to be used as a welcome center for international families and to accommodate staff expansion with conference

$250K

n/aSecure additional

international Global Health

affiliations

Activate alumni network, expand telehealth services globally, increase presence in local markets and engage international physicians via continuing

education and teaching seminars to grow international volumes




TBD

Excel in customer service and experience by delivering compassionate care, affordability and access Focused marketing around outreach, education and communication internally (staff and physicians) and externally (patients) to improve delivery of patient care and patient engagement


FTEs

Sponsorship by charities

4 FTEs

Improved satisfaction scores; 15% yoy growth in patient volume

Centralized scheduling, consolidated/online billing, mHealth

$650K/year IT patient engagement

Scale concierge services utilizing shared infrastructure with global

health

Development of on-site 3 floor guest accommodations in

conjunction with Live Like Bella and Ronald McDonald House

campaigns

Develop data-driven, user-friendly, consumer-centric tools (such as customer relationship management) and information to facilitate and streamline access,

engagement, education, communication and experience

Develop Smart Hospital capabilities (integrated vital sign monitors, infusion pumps, RFID recognition of

team members) including alerting clinicians and care teams of changes in patient condition

Utilize IT capabilities to improve patient care and engagement

Collaboration among providers, global health infrastructure

Improve patient experience

Improve patient experience



Note: Costs derived from IT strategic priorities budget; Note: Marketing FTEs: marketing analyst, web content developer, multimedia producer, PSA marketing specialist, resources cross functional for patient engagement as well

$700K/year IT Smart Hospitals

Quality

Utilize IT capabilities to improve patient care, quality and safety

Collaboration with service lines and marketing/medical education designated space in centers for community education rooms

Patient and community outreach and education

Additional budget for publications

n/a

Improved satisfaction scores; 15% yoy growth in patient volume

Integrate marketing and education capabilities to develop a

collaborative, system-wide education plan including a system-wide yearly

calendar of events in each center (with physician presence) and

corresponding monthly publications to highlight educational topics and

promote awareness and community engagement

TBD TBD

TBD TBD TBD

TBD


Quality and personalized care; Enhance breadth and depth of careIncrease focus on research and develop outreach/education programs


FTEs

1 FTEn/aService line advanced clinical care needs

$55k in program expenses

9FTEs$300K in recurring infrastructure expenses (excluding project costs) + $1M/year for personalized medicine IT initiative

Interdisciplinary teams comprised of service line leaders, genetics, pharmacy and biostatistics

Enhance clinical care capabilities

Tailor medical care to the individual characteristics, needs, and preferences of a patient during all stages of care, including prevention, diagnosis, treatment, and follow-up.

Emphasize precision and personalized medical management and customized medical interventions by

hiring experts in genomics and population health outcomes and utilizing data to customize medical

interventions

Explore academic and research affiliations to

complement or enhance clinical

capabilities/services, provide

support/internships to a breadth of

services

Note: Precision and personalize management: 9 total FTEs 2 Epidemiologists; RedCAP Data Manager; 2 Post Docs; Data Coordinator; Genetic Counselor; Biostatistician; Admin, will be covered in part by sponsored activity - we already have pending grants for 2-3 of these positions; academic and research affiliations: 1 FTE; Coordinator for internships and Fellows. Population health IT initiative: Facilitate bi-directional flow of patient information from disparate systems to create a collaborative and cohesive model. Incorporate predictive modeling to determine financial risk and prevent readmissionsPrecision and personalized medicine IT initiative: Design medical interventions customized to the patient; implement genomics analytics platform; offer remote biomedical device solutions through MCHAnywhere apps




Enhance revenue streams, manage risk and optimize marginAdopt vision driven philanthropy

Description of GoalInterdependencies 2016 2017 2018

Business Impact

FTEs

Engrain a philanthropic mentality within our culture

Increase unrestricted funds

MCHS programs and services


$86K

Promote growth and development of internal fundraising infrastructure (development officers,

physician leaders, volunteers and senior leaders) to increase annual targets of $1.15M for development

officers

Align donor campaigns to foster clinical, research and education enhancements around centers of

excellence and special projects to achieve tiered growth in annual campaign targets over time ($25M

annually, increasing from there)

Elevate level of engagement of all board members: foundation, hospital and system to actively support

the philanthropic initiatives

Progressively increase the unrestricted cash flow by

2-3% per year until

50% is achieved


$1.15 annual target per development officer

6

$25M annual campaign target

$614K

n/a

n/a n/a n/a







Enhance revenue streams, manage risk and optimize margin Develop value based payor models and identify, quantify and budget alternative revenue streams


FTEs

Increase the efficiency and volume of sponsored projects, increase sponsored funding and address a compliance issue from prior audit outcomes.

Development of case management, demonstration of clinical quality outcomes

Achieve value based payormodels

n/a

Quantify and budget alternative revenue streams

Revenue neutral

7 FTEs

$500K in recurring expenses ($260K recurring comp + space + $190K in admin expenses)

n/a 3 FTEs

n/a n/a n/a

Sponsored programs IT system, confirm which platform to use: InfoEd or Click


Identify and systematically plan for investments in projects that will yield alternative sources of revenue

Develop sponsored programs department to increase revenue

from grants

Achieve revenue neutral transition of 20-

40% of commercial charges to

MSDRG

Transition any

remaining commercial charges to

MSDRG

Note: Transition of commercial payor contracts to MSDRG: Case Management Development resources: 2 ED case managers in 2016, 2 IP case managers in 2017, 2 case managers for pre & post discharge across care continuum by 2017 (1.5 for neuro services, 0.5 for oncology and 1 for ortho), 1 managed care FTE in 2016Sponsored programs FTEs: Grants Manager; Pre award Coordinator; Post Award Coordinator; 1 Managed care FTE




Advance the engagement and empowerment of our people Develop culture of empowerment and engagement to achieve strong recruits, employee retention and high performing leaders


FTEs

Compensation and benefits

n/a

n/a

Employee appreciation and benefits, Idea Machine

Enhance recurring training &

development for professional conduct,

MCH Way, & leadership protégés through experiential

training and simulation

Engage employees by incentivizing quality

ideas, expanding benefits and appreciation

initiatives and increasing focus on employee wellness

Crisis management/conflict resolution, emotional intelligence, appointment of role models; sponsor certifications/training programs

Improve staff development and groom appointed successors by increasing their authority, responsibilities and mentorship

Drive empowerment / engagement among staff at every level

$190k annually

1 FTE

$90k

Incentive comp tied to organization’s goals to promote empowerment and engagement



Note: Cost saving of achieving 95% retention: 2 VPs-$1.2M, 15 Director/Managers-$$427k, 293 Supervisor/employees - $2.9M based on Bersin Consulting and ATD salary benchmarks; 1 FTE to manage/facilitate all training @$70k/year. Cost of training hourly employees 500 employees x 3 hours x$25 = $37,500 annually

Personal connections, MCHS alumni network, university/alumni associations, social media

Focus on recruitment of top talent and expand geographic reach of recruiting efforts

$405K

Emphasize active recruiting and determine best fit based on psychometrics defined for

each position; Enhance onboarding through experiential training

6

n/a

Reduce leader transition to 15% for those that undergo the cross functional process; 3% HCAP-specific Qs rating improvement overall

Drive empowerment among staff increasing service levels -ensure that executive actions are consistent with MCHS’ mission and

values; leadership promotes communication, accountability and transparency; Develop career pathways aligning employees’ goals,

skills and aspirations, align incentive compensation with organization’s goals


Develop interoperable data analytics & IT capabilities to produce real time, actionable information Utilize data analytics to improve clinical outcomes and achieve customized approach to clinical care


FTEs

Convert systems to improve functionality; Focus on data accuracy and visualization, distribute data internally to promote transparency and cross check for errors, provide decision support and outcomes reporting

n/a n/aEnterprise Resource Planning

$2M/yrFinancial reporting



Note: Costs derived from IT strategic priorities budget. Patient experience and satisfaction captures other two IT initiatives: Patient Engagement through mHealth ($650K/year) and Smart Hospitals ($700k/year)

Business Intelligence $2M/yr n/a n/a

Predictive and prescriptive analytics; incorporate big data solutions to produce quality outcomes reporting

USNWR reporting, research, payormodels, population health