Board of Trustees Retreat Update on the University of Illinois Health System July 21,2011 Joe G.N. “ Skip ” Garcia MD Vice President for Health Affairs Vice Chancellor for Research Earl M. Bane Professor of Medicine, Pharmacology & Bioengineering
History of the University of Illinois Hospital 1924 – 50 bed University of Illinois Research & 1907- 110 bed hospital at Ogden, Wolcott & Congress Educational Hospital on Polk, Wolcott and Wood First experimental gastric tube esophagoplasty (1904) First pneumonectomy in Illinois (1947) First sternotomy for open heart surgery in the world (1957) First autologous blood transfusion in the world (1963) First kidney transplant in Illinois (1968)
History of the University of Illinois Hospital 1980 - UIC Hospital opens at 1740 W. Taylor St. 1999 - Outpatient Care Center opens on Taylor First living donor kidney-pancreas & living donor bowel transplants in Illinois (1997) First robotic surgeries in the US: robotic hepatectomy (2005); renal artery aneurysm repair (2008); parathyroidectomy without neck incision (2008) First robotic surgeries in the world: donor nephrectomy (2000), liver and small bowel transplants (2004); combined living donor liver-bowel transplant (2005); kidney transplantation in obese recipient (2009), pancreatectomy & auto-islet transplant (2007) Miles Square received “Illinois Your Healthcare Plus“ award for excellent CHF care. Institute for Patient Safety Excellence-$3M federal grant to expand 7 Pillars program to 10 Chicago hospitals (2010) Full JCAHO Accreditation (2011-2014)
Academic Health S cience Center of the Futur e Boar d Retr eat Pr esentation J uly 2010 Illinois Medical District (JBVA, Stroger, Rush) Home Health – TeleHealth Networks High-tech, acute care inpatient tower Community-based Primary Care, FQHCs, Critical Access Hospitals and ERs $600M Strategic Offsite Locations, Regional Sites (Peoria, Rockford, Urbana) State Agencies Consultation & Evaluation
University of Illinois Hospital Challenges UIMC Net Income (1996-2011) $30M $25M 3% Operating Margin Target $20M State Support Allocation (in Millions) $15M 90 93 94 98 108 117 106 116 233 130 124 130 141 136 120 125 $10M $5M $0 FY96 FY97 FY98 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 FY00 (Proj.) ($5M) Anomalous confluence of: ($10M) - One time prior yr payments - Decreased expenses FY99 - Hiring freeze & furloughs ($15M) - Capital expenses not realized
University of Illinois Hospital Challenges Hospital Average Daily Census (1999-2011) 350 36.9% 33.8% 00.0% 340 34.8% = Hospital Medicaid Activity (% of Charges) Multifactorial: Nationwide outpatient trend Hospital Average Daily Census 330 Declining PSA Market share 35.0% 35.9% 320 34.2% 35.8% 33.5% 34.7% 310 37.5% 34.0% 300 37.0% 37.1% 290 Aging hospital facilities. 280 Need for improved patient satisfaction surveys. 270 Need for integrated clinical billing. Need for improved clinical academic recognition (USNWR rankings). 260 Need for improved indices of hospital quality. FY99 FY00 FY01 FY02 FY03 FY04 FY05 FY06 FY07 FY08 FY09 FY10 FY11 (Proj.)
University of Illinois Health Care System Challenges ~ 1 million community residents ~35% Hispanic/Latino ~35% African American * 5 of the 10 poorest Chicago * * * communities High acuity, elevated mortality rates for patients with diabetes, CHF, cancer and stroke Primary Service Area
University of Illinois Health Care System Challenges *
University of Illinois Health Care System Challenges * The New York Times, “Mapping America: Every City, Every block” Estimates from the Census Bureau’s American Community Survey 2005 – 2009.
Thematic Research Strengths at the University of Illinois at Chicago Diversity
Health Disparities: A Critical Issue in the United States Institute of Medicine • African Americans & Hispanic Americans have disproportionately high morbidity & mortality from preventable diseases. • “Of all the forms of inequality, injustice in health is the most shocking and the most inhumane.” Dr. Martin Luther King Jr. National Convention of the Medical Committee for Human Rights, Chicago 1966
University of Illinois Clinical Mission To provide high quality, cost-effective health care for the people of the State of Illinois. To harness University of Illinois strengths in technology & innovation to deliver “personalized medicine” to susceptible populations, particularly for medically underserved Latinos and African Americans within our primary service areas (PSA).
% Adults Diagnosed with Diabetes in Chicago Twice the US average in some communities. Low % in South Lawndale likely reflects lack of access to medical evaluation H- 48% H- 47% H- 83% H- 5% H- 1% H- 6% AA-47% AA- 9% AA-13% AA-94% AA-90% AA- 1% Southeast Northwest University of Illinois Primary Service Area Chicago Chicago
Age-Adjusted Diabetes Mortality Rate in South Lawndale & Chicago. 1981-2000
Asthma Disparities in Chicago • Chicago and New York have the highest asthma Higher % asthma in some underserved communities c/w US average . hospitalization and mortality rates in the United States (Weiss 2007) • The rates vary greatly by neighborhood in both cities Hispanic Groups: Mexican vs Puerto Rican M-24% M-25% M-73% • In Cook County, asthma mortality is 4 to 6 times higher PR-16% PR-18% PR-1% for African-Americans and Hispanics than for Caucasians H- 48% H- 47% H- 83% H- 5% H- 1% H- 6% AA-47% AA- 9% AA-13% AA-94% AA-90% AA- 1% Southeast Northwest University of Illinois Primary Service Area Chicago Chicago
Lifetime Asthma Prevalence In Racial And Ethnic Groups 26% 30% 25% 16% 20% 13% 15% 10% 10% 5% 0% Mexican Caucasian African Puerto Rican American Lara et al, 2006, National Health Interview Survey
U.S. Asthma Mortality In Racial & Ethnic Groups 1990-1995 Average Annual Rates per Million 50 40.9 40.7 40 30 ? Environment 20 ? Socioeconomic 15 11.3 ? Genetic factors 10 0 Mexican Caucasian African Puerto Rican American Homa et al. 2000
Percent Racial Admixture in Latino Ethnic Groups 100% Puerto Rican Volunteers 80% 60% 40% DNA source 20% 51% AD DNA European 0% 1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76 79 82 85 88 Amerindian 100% African 80% 60% 40% 20% Mexican Volunteers 19% AD DNA 0% 22 25 28 34 37 40 43 46 49 52 55 58 64 67 70 73 76 79 82 85 88 4 7 10 13 16 19 31 61 91 1 Individual subjects 1-90 Mexican volunteers have much higher % Native American admixture than Puerto Rican volunteers who have higher % African admixture
University of Illinois Clinical Mission To provide high quality, cost-effective health care for the people of the State of Illinois. To harness University of Illinois strengths in technology & innovation to deliver “personalized medicine” to susceptible populations, particularly for medically underserved Latinos and African Americans within our primary service areas (PSA). Does leveraging strengths in personalized medicine & community disparities improve the financial health of UI Healthcare System ?
University of Illinois Clinical Enterprise • We currently receive an enhanced reimbursement for Medicaid related services… makes fiscal sense. • Increases in our PSA Market Share will increase our clinical volumes (ADC, outpatient volumes). • Our Medicaid Accountable Care Organization (ACO) will soon be in play, resulting in increased # of Medicaid covered lives. • It is our mission and the right thing to do!
University of Illinois Clinical Enterprise How to improve the financial health of the Medical Center? Clarification of the Clinical Mission Leverage our strengths in personalized medicine and community disparities Enhance “Enterprise”-wide thinking
University of Illinois Health Care System University of Illinois UIC Health Science Affiliations Colleges Stroger Hospital College of Medicine Vanguard Hospital System University of Illinois (MacNeal/Weiss/Westlake/ Medical Center W. Suburban/Holy Cross School of Public Health University of Illinois Hospital College of Pharmacy University of Illinois Outpatient Care Regional Campuses Center College of Dentistry Peoria Mile Square FQHC & College of Nursing Community Health Network Rockford College of Applied Health Urbana-Champaign Jesse Brown Veterans Sciences Hospital Quad Cities
University of Illinois Health Care System How does “Enterprise-wide thinking” improve the financial health of the Medical Center? • Allows clarification of Mission & Brand across entire enterprise • Aligns incentives between providers and clinical enterprise • Allows improved efficiency of support services • Allows nurturing of marquee programs EXPANDS THE REVENUE STREAM!!!
University of Illinois Health Care System How to improve the financial health of the Medical Center? Clarification of the Clinical Mission Leverage our strengths in personalized medicine and community disparities Enhance Enterprise-wide thinking Rebranding
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