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LouHIE 6-23-08 Draft Case Statement

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  • 1. Draft Case StatementThe Louisville Health Information Exchange, Inc. June 18, 2008 Nice Picture Here Page 1
  • 2. The Louisville Health Information Exchange, Inc. Louisville, Kentucky The Louisville Health Information Exchange, Inc. (LouHIE) is a not-for-profit organization, governed by a healthcare community board. Its vision is toimprove quality and contain rising costs of healthcare in the Louisville area…byproviding consumers and their providers anytime, anywhere access to completehealthcare information and decision-support. This anytime, anywhere access willbe accomplished by a health record bank, developed through communitysupport.The Problem In February, 2008, John Jones was hospitalized at a Louisville areahospital for three weeks and nearly died because his physician did not haveelectronic access to his current medications list and his family couldn’t rememberthe name of one of his prescriptions. A medicine was prescribed whichadversely interacted with another, turning a minor emergency into a traumatic,and costly, life-and-death situation.1 Unfortunately, events like this happen veryday in communities across the country, including Louisville. Why? Becausemost healthcare information is still on paper or locked inside last-generationcomputer systems at hospitals and physicians offices. LouHIE has beenorganized to help address this problem for the greater Louisville area.The Problem in Context Louisville’s healthcare sector, like that of the rest of the country, has notyielded to the improvements in service, quality and efficiency made possible bythe information technology revolution. This is in part due to the sheer complexityof healthcare information. The subject matter is vastly complex and inexact, andmedical synonyms, near synonyms, nuance of language and subtleties ofphrasing resist standardization and thus computerization. In addition, healthcare information resides in numerous and There is currently no practical varied locations such as physicians’ way to gather and organize offices, hospitals and pharmacies, and patients’ health information in there are at present no developed one place before care is services to gather, organize and share this information. Finally, the software delivered. for automating healthcare has to datebeen developed using a piecemeal approach. The information systems usedacross today’s healthcare spectrum are a composite of multiple separate1 Example of situation that happens at least once every month in Louisville based on literature. Page 2
  • 3. systems that communicate imperfectly. Laboratory data is collected and stored ina laboratory system, X-rays in a radiology system and hospital charts in amedical record system, each system contributing to an incomplete and unwieldypatient record. Because of healthcare’s complexity, there presently exists nomeans to blend these diverse streams of data to form a comprehensive patientmedical record.LouHIE - Part of a Nationwide Strategy The Louisville Health Information Exchange, Inc. (“LouHIE”) is part of anationwide effort to address these challenges in healthcare. Organized in Marchof 2006, LouHIE is the greater Louisville area’s neutral, trusted, nonprofit“Regional Health Information Exchange,” and is working closely with state andnational efforts that are underway. In 2004, with Executive order 13335, the Federal Government initiated anationwide initiative to bring US healthcare into the 21st century using informationtechnology. Efforts are now underway at five levels: individual, organizational,community, state and national.- At the individual level, the federal government is encouraging healthcare related organizations across the country to work together to achieve a common vision: a patient medical record available for every American by 2014. These patient medical records would be dynamically linked to multiple physicians, hospitals, pharmacies and other providers. Once in place, each individual’s health information (with their permission) could be available anywhere in the country – much like today’s banking information is available through ATMs. In late 2007 and early 2008, organizations including Google and Microsoft announced initiatives to help support such systems.- At the organizational level, hospitals, physicians and other healthcare organizations are being encouraged to invest in modern, standards-based electronic medical record systems that can link to patient medical records. This is expensive, so efforts are also being developed to lower costs and subsidize funding for these systems. Investments in such technologies are increasing.- At the community level, Regional Health Information Organizations (RHIOs) have been asked to develop community-based services to facilitate health information exchange among and between organizations and consumers in the community. LouHIE is Louisville’s RHIO, responsible for facilitating health information exchange for the greater Louisville area.- At the state level, state health information organizations (HIOs) are forming to develop state-based standards, enable legislation, and create statewide infrastructure. In addition, states may provide funding and grants to Page 3
  • 4. communities and organizations and help bring Medicaid and state employees into the systems being developed. In 2004, Kentucky’s Senate Bill 2 established the Kentucky e-Health Network as Kentucky’s HIO.- At the national level, various efforts are underway to create e-health standards, develop national legislation and regulations, provide grants and funding for states, communities and organizations, and coordinate participation by federally funded healthcare services like Medicare (for seniors), the Veterans Administration, and the Centers for Disease Control.Because this nationwide strategy is still in its early stages, there are significantopportunities for communities and states to take leadership positions indeveloping these next generation technologies for a 21st century healthcaresystem.Introducing LouHIE As the Louisville area’s Regional Health Information Organization (RHIO),LouHIE has the potential to establish Louisville as a national leader in usingelectronic health information to improve quality and contain rising costs of carefor its 1.2 million residents. LouHIE’s development began in 2004 through a collaboration between University of Louisville’s School of Public LouHIE Health and Information Sciences, leading The RHIO for greater Louisville health organizations from across the community and the Kentucky e-Health Network. After three years of development, LouHIE is now established as the Louisville area’s “Regional Health Information Organization” (RHIO). LouHIE is recognized in the state as a part of the emerging Kentucky e-Health Network (authorized under Senate Bill 2). LouHIE is also recognized in the nation as Louisville’s RHIO, and for its innovative “health record banking” approach to community health Initially serving Jefferson, Oldham, information exchange. LouHIE is working Shelby, Spencer, Bullitt, Hardin, closely with other RHIOs in Washington Shelby, Clark, Floyd and Harrison. State, Kansas City and Oregon, who are taking a similar approach. LouHIE is organized as a not-for-profit organization, governed by a boardof community stakeholders. In 2006-2007, LouHIE raised over $170,000 incontributions, engaged an outside consultant, and conducted a community-wideresearch effort leading to development of a plan to develop LouHIE as a Page 4
  • 5. community asset. The LouHIE plan was approved by the LouHIE board in May,2008. A list of 2007 organizational sponsors is attached. A 501(c)(3) applicationis in process, but tax-deductible contributions can be made to LouHIE nowthrough the Greater Louisville Medical Society Foundation. By implementing this plan, LouHIE and greater Louisville have anopportunity to establish a national leadership position in the emerging “e-health”arena, improving healthcare for its citizens, while driving economic growth.The LouHIE Plan LouHIE’s plan is designed to address, at the community level, problems ofhealth care information fragmentation, lack of standards, ambiguity, anddisparate software. LouHIE’s plan was developed based on 2007 researchconducted with 209 participants in 26 facilitated focus group sessions plus about800 participants in phone, web and paper surveys. The results of the researchare in “The Greater Louisville e-Health Research 2007 Report” available atwww.louhie.org. The plan involves development and delivery of health record bankingservices for the entire community – including all area consumers, hospitals,physicians, healthplans, pharmacies, and health benefits sponsors such asemployers, Medicaid and Medicare. From a consumer perspective, LouHIE’s plan is to offer free services forall. LouHIE’s plan means that all 1.2 million citizens in the greater Louisvillearea, including Southern Indiana, will be offered a free health record bankaccount where their health information can be securely stored and managed –under their control. Healthcare providers will receive free access to the data withconsumer consent. See figure 1, attached. From a physician and hospital perspective, LouHIE’s plan involves astairstep approach to achieving the vision of “anytime, anywhere access tocomplete healthcare information and decision-support” for physicians and thehealthcare community. This stairstep has four stages. The first phase of the stairstep is the LouHIE launch, occurring in 2008and 2009. This phase involves development of the organization andmanagement team, engagement of a core-services vendor to provide thetechnology infrastructure, conducting a pilot operation of health record bankingservices in 1st/2nd quarter 2009, and development of non-core services which canlink to LouHIE’s infrastructure. Upon completion of the LouHIE Launch phase, LouHIE will enter itsClinical Information Exchange phase. In this phase, the technology platformdeveloped in the LouHIE launch will be activated to support clinical informationexchange. This will involve linking to hospital and physician EMRs, as well as Page 5
  • 6. other clinical data depositors and withdrawers including lab-data sources, testingcenter sources, radiology sources, and other clinical data. The third phase of LouHIE’s development is National Leadership. Bycompleting the first two phases in the timeframe noted, The greater Louisvillearea community will be positioned to be a national leader in using healthinformation technology to improve quality and contain rising costs of care. The fourth phase of LouHIE’s development, is titled Community Growth.This is because if the first three phases are successful conducted, LouHIE’sbusiness plan will lead to the potential for community growth for greater Louisvile,measured in both economic terms, and in terms of quality of life. In the LouHIE Launch phase, LouHIE plans to start simple, launchingservices focused on medications, medication reconciliation and patientdemographics. Milestones for the LouHIE Launch include:Milestone Completed ByDevelop interim management team October, 2008Engage core services vendor(s) October - December, 2008Conduct provider workflow study – to study how best December, 2008to “fit” services into existing provider workflows.Launch 1-2 non-core services. (Non-core services are December, 2008external services which can link with LouHIE (ie, e-prescribing)Pilot of health record banking service with patient January – June, 2009clinical summary containing medications, medicationreconciliation and demographic data.Roll-out services to community (assuming success of Starting July, 2009pilot)Organizational resources LouHIE’s development to date has been supported through several typesof contributions. Significant support has been provided by University ofLouisville, made possible in part with funding from the Kentucky Science andEngineering Foundation ($200,000) and the Kentucky e-Health Network($450,000). The state funding support continues. The Kentucky HospitalAssociation and the Kentucky Department of Public Health contributed anadditional $30,000 in 2006. In addition, an estimated two thousand hours ofvolunteer time from over 800 individuals and organizations have been Page 6
  • 7. contributed. Finally, LouHIE has raised direct funding of over $170,000 fromparticipating organizations. Through mid 2009, LouHIE will be managed by an interim managementteam using executives drawn from University of Louisville, major healthcareorganizations in the community, and area physicians. Thereafter, as fundingpermits, a permanent management team will be put in place. The permanentteam will include an executive director, chief financial officer, chief informationofficer, chief medical officer, chief development officer, compliance officer,benefits realization manager and administrative support.Fund-Raising GoalsTo support the LouHIE Launch in 2008-2009, LouHIE is seeking a total of$4,359,000 is sought by year-end 2009. $200,000 is sought by end of 3rdquarter, 2008, and an additional $1.25 million by end of 4th quarter, 2008. LouHIE Launch 2008-2009 Goal: $4,358,000Funds are budgeted to come from the following sources: - Underwriting - Major Gifts: $2,500,000 - Government Grants: $500,000 - Organizational Contributions: $1,440,000 - Individual Contributions: $168,000Funds will be used to develop, conduct and evaluate a community-wide pilot ofthe LouHIE Health Record Banking system. Funds will be raised by LouHIE board and committees, and the interimmanagement team, working with community organizations including the GreaterLouisville Medical Society, the Health-Services Council of Metro Louisville,Greater Louisville Inc. and Health Enterprises Network, area employers,Louisville Metro Government and the Kentucky e-Health Network.LouHIE Program Evaluation and Accountability There is clear evidence that healthcare quality can be improved, andsome healthcare costs mitigated, by making medication data available acrossthe community, especially if linked to e-prescribing systems. Medicationreconciliation, the tracking of a patient’s medicines as they traverse the variousstations of the healthcare continuum, is a national patient safety goal. Making a Page 7
  • 8. patient’s medication history more readily available can benefit hospitals andphysicians, help consumers receive safer, better care in emergencies and officevisits and help employers and health plans reduce avoidable expenses. Studiesshow that up to 1% of all hospitalizations could be avoided by making morecomplete medication information available at the point of care. In addition, overthe long-term, it has been estimated that health information technology haspotential to take to 8% of costs and inefficiencies out of the healthcare system,while significantly improving quality of care. LouHIE has built into its plan mechanisms to measure actual changes incosts and quality. LouHIE plans to use UofL, the Kentucky HealthcareInfrastructure Authority, and other research institutions to conduct and publishthis evaluation research. Research will be used to guide continual improvementin services provided to the community.LouHIE Openness and Transparency LouHIE is committed to openness and transparency. Except whereconfidentiality is needed to protect an individual’s or organization’s privacy, allLouHIE information is posted on the LouHIE website at www.louhie.org.LouHIE’s monthly board meetings are open to all committee members andguests upon request.LouHIE – Supporting Louisville’s Three Deep Drivers LouHIE’s plan positions it to catalyze economic development in Louisville.Economic development opportunities which the LouHIE plan supports include: - LouHIE Jobs - development of employees working for LouHIE and its vendors (15-30 professional/technical employees). - E-Health Research Jobs - development of new health research opportunities and jobs – created through access to LouHIE research database. - Non-Core e-Health Company Jobs - development of new non-core e- health services companies creating new products/services linked to LouHIE. - Enhancing Louisville Competitiveness - by helping Louisville offer new businesses a “21st century” healthcare system.These economic development benefits have potential to help Louisville advancein its achievement of its three deep driver goals: - New professional and technical jobs – through LouHIE, UofL and related e-health firms. - Increased education attainment – LouHIE ‘s development will increase growth of additional educational degrees and certificates in Page 8
  • 9. the healthcare sector – e.g. degrees and certifications in health informatics at the associates, bachelors and masters levels. - Strengthening Louisville’s urban core – LouHIE is open to locating downtown in the UofL “Nucleus” zone, and may encourage its vendors and linked e-health firms to do the same. In addition, LouHIE anticipates working closely with UofL to develop new health research opportunities which can be located in the Nucleus zone.Now is the time to support LouHIE LouHIE has studied benefits of moving too quickly, versus moving toslowly, in developing a community RHIO. LouHIE believes now is the time forLouisville to take the next step in moving towards a 21st century healthcaresystem. By moving now, Louisville will position itself to achieve two gains: 1.)improved healthcare for its 1.2 million citizens, and 2.) opportunities to growLouisville as a city, by making progress with the three deep drivers. The full “automation” of US healthcare is a 10-20 year project.Communities and states which lead in this effort will reap the rewards ofsubstantial grants, contracts and economic development opportunities in thelong-term. Funding provided now, to help LouHIE move forward with its plan, willalso help establish Louisville as a national leader in this emerging area. It willcreate the foundation for the long-term transformation of healthcare in Louisville,and help Louisville area continue to move up the rankings as a world-class city.Benefits from Supporting LouHIE LouHIE contributors will be recognized on LouHIE’s website, in LouHIEmaterials and community events. The tentative recognition format is: LouHIE Launch 2008-2009 Made Possible by Underwriters Underwriter 1 Underwriter 2 Etc. Organizations Organization 1 Organization 2 Individuals Individual 1 Individual 2 Page 9
  • 10. Figure 1: LouHIE Consumer View LouHIE Consumer View Louisville Health Information Exchange, Inc. Step 1: Set-up Welcome! Let me just Patient sets-up an account, MyHealth Card set up your account authorizes deposits and (optionally) gets a MyHealth Card to streamline registrations. Step 2: Deposits With patient permission, caregivers deposit copies of patient’s medical information Health Record into an electronic lockbox. Bank Step 3: Verify & Update Patient verifies the information through the internet or with caregiver. Patient can also add updates and comments. Step 4: Withdrawals With patient permission, caregiver withdraws copies of the information from the lockbox and use it to deliver better care. Page 6 © Louisville Health Information Exchange, Inc. 2007 All rights reserved Page 10
  • 11. Figure 2: LouHIE Stairstep LouHIE Stairstep Community Approach Growth Louisville A national leader National In community Leadership health research Outside funding flows increase Clinical Louisville a national leader in Information improving quality and containing Exchange rising costs of care.  Strengthen Organization  Expand HIE infrastructure (single-sign-on, etc.) LouHIE  Roll-out Health Record Bank – add labs, tests Launch  Fund EMRs; add more non-core services; research.  Develop Organization - Management Team, facilities, etc.  Engage vendor(s) – build HIE infrastructure (MPI, Terminology, etc.)  Pilot Health Record Bank – medications, demographics, med rec. Patient Clinical Summary * PHR links * Hospital/ EMR links  Develop Non-Core Services – eRX, Payor Based Health Record, PHR 2008 2009 2010 2011 2012  Page 11
  • 12. Development TeamThe team includes:Initial Meeting/BrainstormingKenny ZegartLyle GrahamBill HymesLeland Woodmansee (GLMS)Judah ThornewillDennis Riggs (Exec. Dir. Louisville Community Foundation)Case Statement Drafting TeamBill HymesLyle GrahamKenny ZegartJudah ThornewillSocial*cap1Review/Comment/EditsAbove plusJan HawleySheila AndersenNancy GalvagniLouHIE Board of Directors Page 12
  • 13. Tentative Outline for LouHIE’s Case StatementPulled from a suggested outline for a case statement – see details at end of thisdocument. I’ve attempted to put the text created so far into this format. I’veincorporated most current text from Bill/Lyle, plus Kenny’s comments on Sat AM,1. The problem (or opportunity) to be addressed • Talk about community need. Talk about the people who need and want your service.2. Trends affecting the problem (or opportunity) • Demonstrate your knowledge and insight. What is happening in the world and your community, which has produced this problem and what is happening now (and what do you anticipate happening in the future.)?3. Your response to the problem (or opportunity) • How does/will your organization respond to the community problem or opportunity. How will you respond to the trends?4. Your mission • Now is the time to weave in your mission. You exist (your mission) because you wish to respond to community situations. Explain how your response to this particular community situation fits in with your overall mission. (Please don’t just reprint your mission statement!)5. Your history, track record and marketplace position • Explain why you are the right organization to respond to this community situation. Talk about your track record. Demonstrate why the prospective donor should believe that giving money to your organization is a sound investment. Make sure you position your organization within the marketplace. How are you different than other organization doing the same or similar work? Talk about collaboration.6. Goals, strategies and objectives • Provide detail about how you will respond to the community situation. What, specifically, are you going to do? Why? When?7. Organizational resources • Justify, prove that you have the resources necessary to address this situation. Describe your staff, professional expertise, volunteer structure, operations, and so forth. Talk about money. How do you currently finance your organization? How do you propose to finance this new activity? What kind of money is necessary? How will you raise the money and who is helping you raise the money. Page 13
  • 14. 8. Accountability and evaluation • You must assure the prospective donor that you will comply with all relevance regulations and laws, and that you are a good organization, its programs and finances. Also describe how you evaluate program and institutional health.9. Future plans for your organization • Present your future organization goals and activities that will continue to help the community address the situation in the future.10. Role of the prospective donor • Engage the prospective donor. Describe how a prospective donor might participate in addressing the community problem or opportunity. Talk about how you can help the prospective donor achieve his or her own goals and dreams. Describe donor acknowledgment and recognition opportunities. Focus on target audiences and the key messages for each audience. Page 14
  • 15. Case History DefinitionDefinition:From the Assoc for Healthcare Philanthropy:"...case statement--a concise explanation telling why your organization is worthyof philanthropic support. The case statement describes specific problems facingthe community and tells how the organization is helping to solve those problems,It summarizes the mission, goals, and objectives of the organization in acompelling way and invites prospective supporters to invest in the cause. Thecase statement is not simply a statement of need. People do not (just) givemoney because your organization needs it..." Page 15
  • 16. Article: What is a case statement© Simone P. Joyaux, ACFRE • www.simonejoyaux.com • spjoyaux@aol.comTelling your story: the case statementWhat is a case statement?• “Why you do what you do and what the results are…not what you do and howyou do it.”(Tom Ahern, ABC, Ahern Communications)• “An expression of the case, or a clear, compelling statement of all the reasonswhy anyoneshould consider making a contribution in support of or to advance the cause.”• (Harold J. Seymour, Designs for Fundraising)• “Aim high, provide perspective, arouse a sense of history and continuity, conveya feeling ofimportance, relevance and urgency, and have whatever stuff is needed to warmthe heart andstir the mind.” (Ted B. Bayley, ACFRE, Fund Raiser’s Guide to SuccessfulCampaigns)The case statement (case for support) serves as your organization’scommunications document,targeted to a particular audience, in order to raise money. You communicate thecommunity need /opportunity and your organization’s response and merits. You explain thebenefits to the donor in order tostimulate a gift in return. Information to write case statement includes: historyand track record; strategicplan; community needs and trends.Tell your story with personal stories – about real people! Speak from the heart.Use “you” a lot.Engage the listener. Yes, add in some facts also. But facts should neverdominate!In summary, the case statement answers the most compelling questionsabout your organization1. Who are you?2. Why do you exist?3. What is distinctive about you?4. What is it that you want to accomplish and why does that matter?5. How do you intend to accomplish it?6. How will you hold yourself accountable?Resources to help you develop your case for support / case statementSee Joyaux’ Strategic Fund Development: Building Profitable Relationships ThatLast For tips abouthow to create your case statement. The book also talks about nurturingphilanthropic relationships. Page 16
  • 17. Read Tom Ahern’s Love Thy Reader to learn about how to write better. Get acopy on the followingwebsites: www.aherncomm.com or www.simonejoyaux.com / Resource / FreeLibrary / Fund Development.Better yet, get Tom’s book The Mercifully Brief Real World Guide to RaisingMore Money ThroughDonor Newsletters Than You Ever Thought Possible. Tom Ahern, ABC, AhernCommunications is one ofNorth America’s leading experts on fundraising communications, including casestatements, donornewsletters, and communications plan. Keep your eyes open for Tom’s nextbook from Emerson & ChurchPublishers, also about donor communications.And, Joyaux and Ahern are co-authoring a book – probably for release sometimein 2007 -- with theworking title of Nonprofit Fundraising Communications: A Practical and ProfitableApproach.Your case statement should:• Reflect your organization’s planning (e.g. mission, goals and strategies toachieve goals) and anunderstanding of your constituents needs and motivations.A case statement should be brief, compelling and demonstrate success. Thecase statement istargeted to the interests and motivations of a specific audience and describeshow the donor’sinvestment will solve a problem or meet a community need or opportunity.Key information to include in your case statement:1. The problem (or opportunity) to be addressed• Talk about community need. Talk about the people who need and want yourservice.2. Trends affecting the problem (or opportunity)• Demonstrate your knowledge and insight. What is happening in the world andyour community,which has produced this problem and what is happening now (and what do youanticipatehappening in the future.)?3. Your response to the problem (or opportunity)• How does/will your organization respond to the community problem oropportunity. How willyou respond to the trends?4. Your mission• Now is the time to weave in your mission. You exist (your mission) because youwish torespond to community situations. Explain how your response to this particularcommunity Page 17
  • 18. situation fits in with your overall mission. (Please don’t just reprint your missionstatement!)5. Your history, track record and marketplace position• Explain why you are the right organization to respond to this communitysituation. Talk aboutyour track record. Demonstrate why the prospective donor should believe thatgiving money toyour organization is a sound investment. Make sure you position yourorganization within themarketplace. How are you different than other organization doing the same orsimilar work?Talk about collaboration.6. Goals, strategies and objectives• Provide detail about how you will respond to the community situation. What,specifically, areyou going to do? Why? When?7. Organizational resources• Justify, prove that you have the resources necessary to address this situation.Describe yourstaff, professional expertise, volunteer structure, operations, and so forth. Talkabout money.How do you currently finance your organization? How do you propose to financethis newactivity? What kind of money is necessary? How will you raise the money andwho is helpingyou raise the money.8. Accountability and evaluation• You must assure the prospective donor that you will comply with all relevanceregulations andlaws, and that you are good organization, its programs and finances. Alsodescribe how youevaluate program and institutional health.9. Future plans for your organization• Present your future organization goals and activities that will continue to helpthe communityaddress the situation in the future.10. Role of the prospective donor• Engage the prospective donor. Describe how a prospective donor mightparticipate in addressingthe community problem or opportunity. Talk about how you can help theprospective donorachieve his or her own goals and dreams. Describe donor acknowledgment andrecognitionopportunities. Focus on target audiences and the key messages for eachaudience. Page 18
  • 19. Powerpoint: Writing a Case Statementhttp://www.dol.gov/cfbci/tlc/docs/SustainabilityLibrary_SectionD_4/Writing_Your_CaseStatement.ppt Page 19
  • 20. Sample “Outstanding” Case StatementThe case statement is the benefits-oriented explanation of the fund raisingcampaign. From this document, the campaign brochure, campaign prospectus,video, newsletters and other materials can be created. Taking the time to write acomprehensive case statement makes the rest of the campaign materialproduction so much easier. It is a document that the board and staff can rallyaround and keeps everyone focused on the same story.The case statement should create the vision of the campaign and explain all thedetails of the campaign and reasons why the organization is undertaking a majorbuilding project. Most important, it should highlight all of the benefits that asuccessful campaign will provide.The best way to prepare a high-quality case statement is to evaluate otherorganizations’ case statements and use the best of each. Remember, your casestatement may be very different than other organizations. What is important isthat it is concise, easy to read, and prominently features the benefits yourprospective campaign will bring about.The following is an actual case statement used during the successful $5.5 millioncapital campaign for Carondelet Health Care in Tucson, Arizona. Page 20
  • 21. CARONDELET HEALTH CARE St. Mary’s Hospital – St. Joseph’s Hospital Tucson, ArizonaHistorical PerspectiveFor 111 years, the Sisters of St. Joseph of Carondelet have been a part ofTucson in its move from pioneer, frontier medicine to modern technology with allits scientific knowledge and medical advances. Changes have occurred andexpansion has taken place, adding new areas of patient care in an ever morecomplex setting. Innovative programs, as much a part of vision as of necessity,have continually been undertaken in response to personal and community needs.In 1880 the call for medical service was answered by the physicians and thesister-nurses who cared for the injured employees of the Southern PacificRailroad, the poor and medically indigent patients, and everyone who came tothe small twelve-bed hospital named St. Mary’s. It is answered today byphysicians, nurses, therapists and technicians working on shifts that punctuatethe hospital’s twenty-four hour availability.In 1870, seven Sisters of the Congregation of the Sisters of St. Joseph ofCarondelet made an arduous journey from St. Louis, by way of San Francisco,Los Angeles, and finally through the "trek" across the desert to Tucson. Theirmission was to answer the plea of the newly appointed Vicar Apostolic ofArizona, Jean Baptiste Salpointe to teach at the Mission School in Tucson. TheSisters quickly expanded their work beyond the school to include an Indianschool at San Xavier, a hospital in Prescott for men injured in mining accidents,and a school in Yuma. By 1880, the Sisters of St. Joseph of Carondelet were anestablished part of life in Tucson.In 1877 Bishop Salpointe faced a dilemma. He was erecting a trade school forthe Indian youth of the area and, with the Indians help, the building was almostcomplete. However, there was also no questioning the need for a hospital for thecommunity and railroad workers. The painful decision was made - the tradeschool, named The Mission School, was postponed and the building was turnedinto a hospital with the Sisters agreeing to staff the new facility. St. Mary’sHospital was dedicated on April 24, 1880 and received its first eleven patients onMay 1. It is Arizona’s longest continually existing hospital.The past century has seen St. Mary’s pioneer many aspects of health care withnumerous "firsts." During the frontier days, the hospital provided such Page 21
  • 22. revolutionary services as a separate Isolation Cottage for patients withcommunicable diseases, a separate surgical area, and a Sanatorium. TheSisters also pioneered firsts for Arizona in the area of Nursing Education andProfessional Standards for Physicians. The hospital provided Arizona with its firstX-ray machine, Intensive Care Unit, and open heart surgery. St. Mary’s BurnCenter is still the only such facility in southern Arizona.Throughout the years, during wars and peace, during good times and bad, theSisters of St. Joseph of Carondelet offered the citizens of Tucson such cuttingedge technology as the first electroencephalogram (EEG) machine. From theoriginal eleven patients, St. Mary’s Hospital grew to 374 beds to be the fourthlargest hospital in Arizona and the second largest in Tucson. It offers a full rangeof medical services.In 1961, the Sisters of St. Joseph of Carondelet recognized that the city ofTucson was growing at such a rate it was difficult for the residents on the fast-growing east side to utilize the services of St. Mary’s Hospital on the west side.The Sisters then built St. Joseph’s Hospital and created a two hospital system tomaximize health care coverage and reduce expenses. Carondelet St. JosephsHospital is a 338 bed, comprehensive general, acute-care facility with a majoremphasis on ambulatory care. It offers complete OB-GYN services, O’Rielly Care(an eighteen-bed substance abuse treatment center), a comprehensive CardiacRehabilitation Center, a Diabetes Care Center, Home Health Care services and afull range of rehabilitation programs. It also provides southern Arizona’s RegionalEye Center and Regional Hand Center.Incorporated in 1983 as Carondelet Health Care Corporation, today the healthcare system includes Holy Cross Hospital in Nogales, Arizona and Holy FamilyCenter, an extended care facility in addition to St. Mary’s and St. Joseph’s.The Situation TodayToday Carondelet Health Care is the largest health care provider in southernArizona with three hospitals (Holy Cross in Nogales, Arizona and Holy FamilyCenter, a long term care facility) was added to the system in 1987), twohospices, fourteen wellness centers, and a host of outreach programs designedto meet the healthcare needs of the community. Today Carondelet Health Care: • Has 755 beds available for patient use. • Will admit over 27,000 patients this year. • Will treat an additional 50,000 people on an outpatient basis. • Will deliver over 2, 000 babies this year. • Will treat over 60,000 people through its 24-hour Emergency Departments. Page 22
  • 23. Of Carondelet Health Care’s 27,000 admissions, almost 14,000 of those will beon some type of government assistance program.Yet even with this tremendous volume, Carondelet retains the mission of theoriginal Sisters to provide quality healthcare for all the people of Tucson.St. Mary’s Hospital serves the "western corridor" of Tucson and gives specialattention to minorities and those with lower incomes. It is the only private hospitalserving the west side population. Carondelet Health Care provides over$10,000,000 per year in charitable care to persons who would not otherwise beable to afford quality healthcare.Both Carondelet St. Mary’s and Carondelet St. Joseph’s retain a commitment toproviding the most technologically advanced healthcare in Tucson. Specializedservices provided by Carondelet Health Care include: • The Burn Center: The first and only fully accredited burn center in southern Arizona serving the immediate area, surrounding states and Mexico. • Hospice: The first facility in southern Arizona serving the needs of the terminally ill and their families in a compassionate, Christian environment. • Cardiac Rehabilitation Program: Southern Arizona’s largest rehabilitation service for victims of heart problems. • Diabetes Care Center: Arizona’s only Medicare and American Diabetes Association certified care center. • Heart Surgery: Carondelet Health Care system performs more heart surgeries than any other area institution - over 325 this year. • Regional Eye Center and Low Vision Clinic: Carondelet St. Joseph’s is home to southern Arizona’s only Eye Center providing a full range of surgical, laser, ocular prosthetics and low vision services. • Regional Hand Center: Carondelet St. Joseph’s is home to southern Arizona’s only center specializing in the treatment of disorders of the hand. • O’Rielly Care: Specializing in the treatment of alcohol and substance abuse patients. • Nurse Case Management: Carondelet St. Mary’s was selected on January 1, 1991 by the General Mills Foundation to work with thirteen other hospital’s in a National Chronic Care Consortium to develop programs dealing with geriatric chronic care. • Community Health Care Centers: Are located throughout Tucson serving those who do not have ready access to healthcare providers.The Challenge Facing Carondelet Health Care Page 23
  • 24. After intense study by experts within and outside the hospital family, CarondeletHealth Care has identified the two most pressing healthcare issues which facethe citizens of southern Arizona.1) Maternity and Delivery Services: Currently Carondelet Health Care deliversapproximately 2,200 babies each year. This is the maximum number of births thepresent facilities can accommodate. Carondelet continues to provide thematernity and delivery services to the community, often despite the patientsability to pay. Carondelet Health Care provides well over $1,000,000 in charitycare to maternity patients who cannot afford this health care.Carondelet provides this service to the community, in spite of the adversefinancial effects, because of the Sisters’ commitment to Christian family values.2) Outpatient Rehabilitation and Surgical Services: Currently in Tucson andsouthern Arizona there is no comprehensive outpatient rehabilitation servicefacility. Additionally, Carondelet St. Mary’s and the west side of Tucson lacknecessary outpatient surgical facilities. This lack of outpatient services on thewest side presents a burden on the very people who are least able to acquiremedical care.One major trend in health care in the 1980’s and 1990’s is the move towardoutpatient services. A procedure performed on an outpatient basis traditionallycosts 30% less than a similar procedure on an inpatient basis. This simpleeconomic statement is the underlying reason insurers and third party payors areinsisting on more outpatient services and even refusing to reimburse the totalinpatient costs in many cases.Additionally, the project at Carondelet St. Mary’s Hospital will include a surgicalcenter that will add four inpatient and four outpatient surgical rooms and create alarger recovery room. A gastroenterology laboratory and laser treatment roomwill also be added. These additions will enable Carondelet Health Care tocontinue to meet the healthcare needs of the citizens of Southern Arizona.Because of the location chosen for the new outpatient center, a new chapel willneed to be constructed and many of the furnishings of the soon to be displacedSt. Catherine’s Chapel will be used in the construction of the new chapel.Carondelet’s Urgent ResponseThe Sisters of St. Joseph of Carondelet are still responding to the healthcarechallenges of the community. To meet the growing needs of the southern Arizonacommunity, Carondelet Health Care has committed to two exciting and importantcapital projects. For Carondelet St. Joseph’s Hospital a commitment has beenmade to reconstruct the maternity facilities to create a new Labor, Delivery,Recovery, and Post Partum (LDRP) Program. At Carondelet St. Mary’s Hospital, Page 24
  • 25. a commitment has been made to construct an entirely new ComprehensiveOutpatient Rehabilitation Facility (CORF) and Outpatient Surgery Center.Carondelet St. Joseph’s Hospital and Carondelet St. Mary’s Hospital servedistinct communities. The physicians are, for the most part, geographicallydivided between the two hospitals with less than 10 percent of the activephysicians practicing at both. Despite these differences, both hospitals aremanaged with the same commitment to quality and excellence and are governedby a single board of directors.To meet the growing need for outpatient services on the west side of Tucson,Carondelet Health Care has chosen to construct an outpatient facility on thecampus of Carondelet St. Mary’s Hospital. The facility will be the:1) Comprehensive Outpatient Rehabilitation Facility (CORF)Carondelet Health Care is the primary provider of rehabilitation services inTucson and southern Arizona.While Carondelet St. Mary’s Hospital was the first accredited rehabilitation centerin Tucson, it has, over the last 50 years, performed these services throughtraditional inpatient facilities. In effect, the outpatient services are "fit in" aroundinpatient operations, lacking adequate space and equipment to meet patientneeds.CORF will create the only comprehensive rehabilitation location in southernArizona. It will be medicare certified. It will be located on the first floor of a twostory building located next to the hospital. Included as part of the ComprehensiveOutpatient Rehabilitation Facility will be Physical Therapy, Occupational Therapy,Speech-Language-Hearing, and Psychological Counseling Services.The Comprehensive Outpatient Rehabilitation Facility (CORF) will create acenter where the treatment plan for each patient’s physical therapy, occupationaltherapy, and speech therapy will be coordinated and managed together, insteadof separately.CORF will also expand Carondelet’s rehabilitation programming to include clinicsto treat chronic diseases such as Multiple Sclerosis and arthritis. CORF will alsocreate an Educational Resource and Technology Center where patients canborrow rehabilitation equipment and receive education on their particularcondition and treatment program.The major difference between the new and the old is the comprehensive natureof CORF. Currently, other rehabilitation facilities for other hospitals are spreadthroughout the medical center campus’ or even the community. The problem thiscreates is fairly obvious. People who seek rehabilitation services (for treatment of Page 25
  • 26. stroke, head and spinal cord injuries in particular) need to attend one area forspeech therapy another area, often outside the hospital, for physical therapy, anda third area if they need occupational therapy.The rehabilitation services of Carondelet Health Care are perhaps its finestexample of commitment to maximizing the quality of a patients life and lifestyle.What good does it do a patient, and in turn society, if we save the lives of strokevictims, heart attack victims, car accident victims, and, by the very act of savingtheir life, we condemn these people to a life of uselessness and limitations to thepoint where they are reliant on other people for the basics of life such as eating,drinking, personal hygiene, and other functions we take for granted each day?Rehabilitation services are good for the patient and the community as well.Experience shows that every year one in twelve Arizona workers is involved in anoccupational injury and, on average, 19 work days are lost for each injury.Perhaps most impressive is the fact that a single dollar spent on rehabilitationsaves up to $30 in disability payments.The CORF will focus on new approaches in therapy utilizing specially designedspaces and equipment including: • the addition of biofeedback capabilities • aquatic therapy • a fully equipped apartment for those who will need to relearn the basics of living. • The CORF will consist of a variety of therapy programs that will encompass the therapy needs of virtually every patient. The CORF has been designed to optimally meet the goals of comprehensive rehabilitation. It will include: • a state-of-the-art speech-language-hearing clinic with three separate speech therapy treatment rooms • an aquatic therapy area to provide an alternative environment for exercise to benefit patients with special needs. • a large, fully carpeted conjoint occupational and physical therapy room. • a "work hardening" clinic where specialized work injury management programs will be designed to provide services to major employers. • individual treatment rooms for physical and occupational therapy with specialized areas for orthopedic and manual therapy, splinting and cognitive evaluation. • an area for specialty team programs utilizing coordinated interdisciplinary approaches for arthritis, strokes, brain injuries and other disabilities. • whirlpools for hydro-therapy • a fully equipped apartment for those people who will need to relearn the very basics of living such as cooking, cleaning, etc. Page 26
  • 27. • rooms for group and individual psychological counseling with a state of the art biofeedback program. • community education and resource center with accommodations for support groups and seminars. • "noisy" area for patients who need "work hardening" involving heavy equipment or shop-type trade skills. • a technology center with loaner adaptive equipment for the physically challenged.Perhaps the greatest benefit to the community is that the CORF is one of the fewimprovements in medical treatment that will offer better efficiency and service atlower costs.Additionally, beginning in 1992, the United States Congress has mandated,through the American Disabilities Act, that all businesses must accommodatephysically-challenged employees. Carondelet Health Care, through itsrehabilitation services, will offer to southern Arizona’s employers services that willenable the employers to be in compliance with this act.In essence, the CORF will provide southern Arizona residents with arehabilitation center that can accommodate, in one location, all the toolsnecessary to fully rehabilitate all patients to their fullest potential.As part of Carondelet’s commitment to outpatient care, plans also includeconstruction of a new Outpatient Surgical Center which will add four inpatient andfour outpatient surgical rooms, enlarge the recovery room, and add agastroenterology laboratory and laser treatment room.2) The Labor, Delivery, Recovery and Post-Partum (LDRP) ProgramThe opportunities at Carondelet St. Joseph’s Hospital are primarily familyoriented. Carondelet Health Care, in large part because of the Catholic missionof the Sisters of St. Joseph of Carondelet, is committed to providing analternative birthing facility for Carondelet’s traditional market.Meeting the expectations of our patients and their families and efficiency ofservice and staff are the guiding principles behind Carondelet St. Joseph’s newLDRP concept. Under the LDRP program, the entire maternity experience takesplace in one room with one or two nurses throughout. This concept allows themother and family to avoid the inefficiency and inconvenience of being movedfrom room to room during the birthing process. The entire process (labor,delivery, recovery, and post-partum) is done in the same room, which allows formore time for the new mother and family to learn about the care of their newbaby. Page 27
  • 28. Each room is especially designed to create a comfortable and relaxing home-likeatmosphere with the latest in technology. Included in the rooms aretelevision/VCR’s for the family to use with special educational videotapessupplied by the hospital. This concept combines the comforts of home with themedical technology and safety of the hospital environment.During fiscal year 1988-89, Carondelet St. Joseph’s hospital provided obstetricalservices for 2,200 Tucson families. Over the last several years, families selectingthe services of St. Joseph’s have grown from an average of 60 to over 200deliveries per month. The need for these services will continue to grow over theyears until Carondelet may not be able to provide maternity services to allmembers of the community regardless of their ability to pay without expansion.Carondelet St. Joseph’s provides comprehensive high technology services aswell as family centered care. These service include 24 hour coverage byanesthesiologists, neonatologists, perinatologists, neonatal nurse practitionersand clinicians, and a highly advanced special care nursery.To continue to provide this quality service, the administration and boards ofCarondelet have chosen to convert two wings of its Obstetrical Unit into 25 LDRProoms to meet growing needs. The Labor Delivery Recovery Post-Partum(LDRP) concept provides for a reduction in the cost of delivery and care ofnewborn babies. By cross-training the nursing staff the family receives the fullattention of their own personal nurse and support staff. The cost is furthercontained due to the fact that, under the LDRP concept, more deliveries can behandled in the same amount of physical space.For example, under the current delivery system, St. Joseph’s is delivering about2,200 babies per year. Under the LDRP concept, approximately 3,400 newbornscan be delivered with a minimum increase in hospital staff and no increase insquare footage. In essence, the family and baby benefit from the closerexperience and the community will have additional resources available to themthrough contained costs.Program FinancingThe cost of constructing the LDRP at Carondelet St. Joseph’s Hospital will bepaid through the Foundation for St. Joseph’s Hospital, a non-profit organizationwhich raises funds for the hospital.The primary funding for the construction of St. Mary’s Outpatient Facility will be abond issue of approximately $20,000,000. This bond issue will cover the 80% ofthe cost of constructing 1) a two-story building consisting of the CORF (first floor)and physician’s offices (second floor), 2) a 500 car parking structure forCarondelet St. Mary’s Hospital, and 3) an Outpatient Surgery Wing adjacent toCarondelet St. Mary’s Hospital. St. Mary’s Second Century Foundation will raise Page 28
  • 29. an additional $2.4 million to cover the cost of equipping the CORF and building anew chapel.Both foundations have combined efforts to launch a $5,000,000 fund raisingcampaign. The funds raised will be spent as follows: • Comprehensive Outpatient Rehab. Facility Equipment $1,900,000 • Construction of New Chapel $ 400,000 • Renovation and Construction of LDRP $1,900,000 • Creation of Endowment for Carondelet St. Mary’s Hospital $ 350,000 • Creation of Endowment for Carondelet St. Joseph’s Hospital $ 350,000A Special Financial AppealCarondelet Health Care, through the Foundations of the two hospitals, haschosen to launch a $5,000,000 capital campaign to support construction of theLDRP and purchase necessary equipment for CORF and the Outpatient SurgicalCenter.. From June, 1990 through June, 1991, executives of Carondelet HealthCare and the trustees of the foundations have conducted in-depth planning andstudy to determine both the necessity and feasibility of conducting a successfulcampaign.The feasibility of raising the money was studied. Detailed meetings andinterviews were held with community, corporate, business, foundation, andgovernment leaders. Much care and planning went into whether a campaign forCarondelet could succeed. Many obstacles needed to be overcome including aslowdown in the southern Arizona economy, the competition for charitabledollars, and the lack of major, capital fund raising experience on the part ofCarondelet Health Care. Page 29

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