Response to Request for Proposal

Response to Request for Proposal March 16, 2020 HCA Healthcare As a leading provider of healthcare services and with a mission to care for and improve human life, HCA Healthcare is pleased to provide our response to the New Hanover County and the New Hanover Regional Medical Center (collectively, the “Sellers”) Request for Proposal (“RFP”). For the reasons set forth in this document, we believe that through a transaction with HCA (“Proposed Transaction”), NHRMC will both maintain and enhance its mission as well as achieve the Goals and Objectives established by the Partnership Advisory Group (“PAG”). RFP Response 1. Improving Access to Care and Wellness Programs 1.1. Describe what impact, if any, Respondent’s Proposed Strategic Partnership would have on NHRMC’s ability to further develop ambulatory and other outpatient and wellness program access points in the communities it serves. Also address how and whether Respondent’s Proposed Strategic Partnership will facilitate capitalization and growth of care and wellness sites across the Service Area, including beyond New Hanover County, understanding the current debt limitations for NHRMC that preclude this regional healthcare system from borrowing to build outside of the County. The development of ambulatory and other outpatient access points across the broader New Hanover community would be a strategic priority for HCA. We recognize that today, patients seek care through a greater variety of settings than they did in the past. Our goal is to make it easier for our patients to receive the healthcare services they need, when they need them and closer to where they live and work. HCA Healthcare has made investments in building our networks so our patients have more convenient access to care. Our networks include hospitals, ambulatory surgery centers, freestanding emergency rooms, urgent care centers, physician practices and a network of telehealth facilities and programs. Because we believe in patient-centered care, we are continually seeking new approaches and venues to provide care in order to better meet the needs of our patients. We embrace new opportunities to develop innovative approaches by delivering the right care in the right place at the right time, while never forgetting that healthcare is delivered one patient at a time. As an affiliate of HCA, the New Hanover Regional Medical Center (“NHRMC”) would not have financial limitations relative to the development of additional healthcare access points within its community. HCA generates positive cash flow from operating activities that is available for reinvestment in capital projects. We firmly believe in reinvesting in our communities as evidenced by our 2019 capital spend of $4.2 billion across the HCA organization. 2 Response to New Hanover Regional Medical Center RFP 1.1.1. Discuss Respondent’s position on NHRMC’s current plans to expand ambulatory and other outpatient and wellness program access points in the Service Area. In reviewing NHRMC’s Strategic Plan, we recognize the intent to expand NHRMC’s ambulatory footprint with investments in additional access points in Wilmington and surrounding region. In many of its communities, HCA pursues strategies similar to those that NHRMC has thoughtfully developed and conceptualized. Our organizations are strategically aligned with respect to the expansion of ambulatory and other outpatient access points. To better understand the strategy and specific approach that NHRMC has planned, HCA would welcome the opportunity to engage with NHRMC leadership to confirm community need and investment priorities. One of HCA’s key strategic initiatives is to continually look for opportunities to increase access points for patients, and HCA has a proven track record of providing additional access points in its communities. Below is one example of how HCA developed a broad network of healthcare facilities across middle Tennessee. We would expect to follow a similar approach in evaluating and executing the appropriate opportunities within Wilmington and the surrounding region. 1.1.2. Describe the scope and timing of Respondent’s commitment to adding ambulatory and other outpatient access points in the Service Area. To support the addition and expansion of ambulatory and other outpatient access points and as part of the Proposed Transaction, HCA would commit to spend $370 million in capital expenditures over the 5-year period following the closing of the Proposed Transaction to be spent on projects related to the delivery of healthcare services within Wilmington and the surrounding region. Capital investments may support the addition of ambulatory and other outpatient access points both in and outside of the Service Area. 3 Response to New Hanover Regional Medical Center RFP 1.1.3. Describe how Respondent and/or any of Respondent’s strategic partners used the same or similar strategic partnership to improve ambulatory and other access points in the communities served by Respondent and its affiliate or partner hospitals. HCA has consistently invested in ambulatory and other access points and, in total, has over 2,000 sites of care conveniently spread across each of our communities. Figures as of September 30, 2019 As one example of our investments in access points, HCA has developed an extensive urgent care strategy to address the increasing shortage of primary care providers, the aging population, and the consumer’s demand for convenient access to alternate care delivery settings. HCA’s CareNow Urgent Care has added over 160 urgent care locations across 16 operating markets since 2015 through de novo builds, joint venture relationships, and center acquisitions. We have pursued this approach because urgent care centers are efficient, economical, and convenient access points within a community. As one of the nation’s largest providers of urgent care, HCA provides patients with the latest evidence-based care complemented by technology that supplements convenience with comprehensiveness and safety in every urgent care center. HCA’s CareNow Urgent Care centers are primarily physician-led and mid-level provider supported, which results in quality, low-cost care close to patients’ homes and places of work. Our urgent care strategy is designed to make healthcare access affordable, convenient, and efficient so that patients can focus on their everyday lives. If and when higher level of emergency or acute care services are needed, we have the capability within our network to transfer patients to other, coordinated sites of care. In order to support new access points in our new communities, HCA has invested in and identified services in nearby communities. For example, after a recent acquisition, HCA has invested more than $12.5 million to purchase land in nearby counties in order to build Freestanding Emergency Departments (“FSEDs”) with the goal of ensuring that all rural communities have easy access to the highest quality healthcare when an emergency strikes. 4 Response to New Hanover Regional Medical Center RFP In addition to FSEDs and urgent care centers, HCA also has adopted sophisticated telehealth capabilities to provide virtual access for appropriate conditions. For example, Mission Health in Asheville, NC has a broad telehealth program that offers tele-stroke services for nearly every hospital in its region; another example of our telehealth capability is Mission Health’s Virtual Clinic, which offers various tele-services for common problems. Our enhanced telehealth capabilities have provided additional hospital-to-hospital expertise for outlying facilities and access to psychiatric services, genetic counseling, and other specialty care. As another example, HCA also has deep expertise in developing, planning, and operating ambulatory surgery centers (“ASCs”). ASCs have increased access and transformed the outpatient experience by providing a convenient, high quality, safe and cost-effective setting for hundreds of diagnostic and preventative procedures. ASCs boast excellent clinical outcomes and high physician and patient satisfaction levels, and ASCs represent a lower cost alternative to payers, employers, and patients, relative to other care setting options. HCA operates ASCs to complement hospital inpatient surgery capacity. These additional access points can provide consumers with a choice for surgical services. HCA’s ASCs also benefit from the day-to-day management expertise of ASD and a broader relationship with HCA and its hospitals. This strategic combination drives growth opportunities and operating efficiencies that are typically not achievable by independent surgery centers. Adding new physician office locations is another strategy that HCA utilizes to improve access. As HCA and NHRMC collaborate on recruiting new physicians and advanced practitioners, we would evaluate adding new practice locations and specialty clinics. Together, we would determine if there are needs in the community for additional physicians that could be addressed by the addition of new practice locations. 1.2. Describe what impact, if any, Respondent’s Proposed Strategic Partnership would have on improving access to primary care services in NHRMC’s Service Area. Through a collaborative strategic planning process, HCA and NHRMC would conduct a thorough analysis of the community and region to determine needs and assess existing capabilities with regard to primary care services. Together, we would evaluate different types of care settings such as physician offices, advanced practitioner support, urgent care

Load more