Board Strategic & Facilities Planning Committee

* MONDAY, MARCH 19, 2018 BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE 12:00 Noon Meeting Palomar Medical Center Escondido, 2185 Citracado Parkway, Escondido, CA Buffet lunch for Board members & invited guests Raymond Family Conference Center, 2nd Floor1  1 PLEASE TURN OFF CELL PHONES OR SET THEM TO SILENT MODE UPON ENTERING THE MEETING ROOM Time Form A Target CALL TO ORDER ...... 12:00  Public Comments2 ...... 15 ...... 12:15  Information Item(s) ...... 5 ...... 12:20 1. Board Strategic & Facilities Planning (S&FP) Committee Follow‐up a. Facilities Update – scheduled within the agenda ...... 0 ...... 12:20 2. * Approval: Minutes – Monday, January 15, 2018 (ADD A –Pp18‐45) ...... 2 ...... 2 12:22 3. * Approval: Annual Review of S&FP Committee Bylaws (Clean–Pp4‐5) (Redline–Pp6‐7) ...... 5 ...... 3‐7 12:27 4. * Approval: Annual Review of Board Responsibilities Policy: §G Board S&FP Committee (Clean–P9) (Redline–P10) ...... 5 ...... 8‐10 12:32 5. * Approval: Resolution No. 04.09.18(08)‐01 Establishing the Date, Time and Location for the Regular Meetings of the Board S&FP Committee for Calendar Year 2018 ...... 3 ...... 11‐12 12:35 6. * Review/Approval: Facilities Projects (ADD B – Pp46‐75) ...... 30 ...... 13 1:05 a. Palomar Medical Center Escondido Campus – New Structures, Buildouts and Services b. Palomar Medical Center Poway Campus – Hospital Improvements & Upgrades, New Services c. Other Palomar Health Facilities – Relocations of Services d. Palomar Medical Center Downtown Escondido Campus – Relocations of Services 7. * Review/Approval: Behavioral Health Program Update (ADD C – Pp76‐87) ...... 20 ...... 14 1:25 8. * Review/Approval: Resolution No. 04.09.18(09)‐02Authorizing Management to Take the Actions ...... 15 ...... 15‐17 1:40 Necessary to Negotiate and Execute the Documents Necessary for a Parking Structure to be Constructed and Operated on Property Owned by the District within the Escondido Regional Technology Center (ADD D – Pp88‐94) ...... ADJOURNMENT TO EXECUTIVE SESSION...... 1:40  Report Involving Trade Secret, Pursuant to Health & Safety Code §32106 – Concerns Potential New Services 1. Service #1 – Estimated Disclosure Date: TBD ...... 30 ...... 2:10 2. Service #2 – Estimated Disclosure Date: TBD 3. Service #3 – Estimated Disclosure Date: TBD RESUMPTION OF OPEN SESSION...... 2:10  Action Resulting From Closed Session Discussion, IF ANY ...... 5 ...... 2:15  Public Comments2 ...... 15 ...... 2:30 FINAL ADJOURNMENT ...... 2:30

NOTE: The agenda—without public comments—is scheduled to last 120 minutes, starting at 12:00 noon, with adjournment at 2:00 p.m.

Board Strategic & Facilities Planning Committee – Voting Members Doug Moir, MD, Director – Chair Jerry Kaufman, PT MA, Director Jeff Griffith, EMT‐P – Interim Director Frank Martin, MD, CoS Charles Callery, MD Diane Hansen, Interim President & CEO Palomar Medical Centers Escondido & Downtown Escondido CoS Palomar Medical Center Poway Board Strategic & Facilities Planning Committee – Alternate Voting Members Interim Board Alternate CoS Alternate – Palomar Medical Centers Escondido & Downtown Escondido CoS Alternate – Palomar Medical Center Poway Dara Czerwonka, MSW To be designated by CoS To be designated by CoS Board Strategic & Facilities Planning Committee – Non‐Voting Members Hugh King, CFO Sheila Brown, RN, COO Pam Sime, CHRO Larry LaBossiere, CNO Palomar Medical Centers Downtown Omar Khawaja, MD, CMO Karen Buckley, CNO Palomar Medical Center Escondido Escondido & Poway Ron Mirenda, Interim Executive Dan Farrow, VP Hospitality & Facilities Legal Counsel Palomar Health Foundation Board Member Director Palomar Health Foundation

NOTE: If you have a disability, please notify us 72 hours prior to the event so that we may provide reasonable accommodations .

 Asterisks indicate anticipated action. Action is not limited to those designated items. 1 Maps with directions to the Palomar Medical Center and to the Raymond Family Conference Center are attached as Agenda Pp i‐iii 2 5 minutes allowed per speaker with a cumulative total of 15 minutes per group. For further details & policy, see Request for Public Comment notices available in meeting room. 1

Minutes Strategic & Facilities Planning Committee – Monday, January 15, 2018

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Monday, March 19, 2018

FROM: Tanya Howell, Assistant

BY: Hubert U. King, Chief Financial Officer

Background: The minutes of the Board Strategic & Facilities Planning Committee meeting held on Monday, January 15, 2018, are respectfully submitted for approval (Addendum A).

Budget Impact: N/A

Staff Recommendation: Staff recommends approval of the Monday, January 15, 2018, Board Strategic & Facilities Planning Committee minutes.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

1 Form A ‐ Minutes.doc 2

Annual Review of Board Strategic & Facilities Planning Committee Bylaws

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Wednesday, January 24, 2018

FROM: Hubert U. King, Chief Financial Officer

Background: Annually, the Board Strategic & Facilities Planning Committee is required to review the Bylaws of Palomar Health as they relate to the Committee and recommend any necessary revisions. The following edits are being recommended via the attached excerpt (presented both in clean and redline):

 Voting Membership o Change in title to add “Interim” to President & CEO o Updated language regarding the Board and the Chief of Staff alternates, edited to reflect the same verbiage as that used in the Finance Committee’s section of the Bylaws  Non‐Voting Membership & Duties o Updated language regarding numerous executive titles o Minor grammatical corrections

Budget Impact: None.

Staff Recommendation: Approval

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

3 6.2.5 Strategic and Facilities Planning Committee.

(a) Voting Membership. The Committee shall consist of six voting members: Three members of the Board, the Interim President and Chief Executive Officer, and the Chief of Staff from each hospital. There shall be three alternate Committee members:

(i) One alternate shall be a member of the Board, also appointed by the Chairperson of the Board, who shall attend Committee meetings and enjoy voting rights on the Committee only when serving as an alternate for a voting Board Committee member;

(ii) The second and third alternate Committee members shall be the Chiefs of Staff Elect from each hospital, who shall attend Committee meetings and enjoy voting rights on the Committee only when serving as an alternate for their respective Chief of Staff.

(b) Non‐Voting Membership. The Chief Financial Officer, the Chief Operations Officer, the Chief Human Resources Officer, the Chief Medical Officer, the Chief Nursing Officer Palomar Medical Center Escondido, the Chief Nursing Officer Palomar Medical Centers Downtown Escondido and Poway, the Vice President Hospitality & Facilities, the Interim Executive Director of the Foundation, Legal Counsel and a board member of the Palomar Health Foundation, recommended by the Foundation and approved by the Committee Chairperson. As needed, other appropriate relevant staff in facilities, planning and compliance, and a Physician Advisory Committee member may be requested to attend to facilitate the work of the Committee.

Regarding the Strategic Function:

(i) Review and make recommendations to the Board regarding the District’s short and long range strategic plans, master and facility plans, physician development plans and strategic collaborative relationships;

(ii) Review annually those policies within the Committee’s purview and report the results of such review to the full Board. Such reports shall include recommendations regarding the modification of existing, or creation of new, policies;

(iii) Undertake planning regarding physician recruitment and retention and program development of new and enhanced services and Facilities;

(iv) Monitor new initiatives and programs; and

(v) Perform such other duties as may be assigned by the Board.

Regardinge th Facilities Function:

(i) Review construction estimates and expenses for accuracy and architectural plans for completeness and effectiveness;

4 (ii) Approve construction project change orders in accordance with applicable district law and Palomar Health policies;

(iii) Receive reports from the Vice President Hospitality and Facilities; recommend action to the Board regarding facilities design and maintenance;

(iv) Review regulations and reports regarding facilities and grounds from external agencies, accrediting bodies and insurance carriers, and make recommendations for appropriate action regarding the same to the Board;

(v) Approve the annual Facilities Development Plan and regularly review updates on implementation of plan;

(vi) Receive a biannual Environment of Care report; and

(vii) Perform such other duties as may be assigned by the Board.

5 6.2.5 Strategic and Facilities Planning Committee.

(a) Voting Membership. The Committee shall consist of six voting members: , including three members of the Board and one alternate who shall attend Committee meetings and enjoy voting rights on the Committee only when serving as an alternate for a voting Committee member, the President and Chief Executive Officer, and the Chiefs of Staff of the Hospitals or the designees of the Chiefs of Staff, as approved by the Committee Chairperson.Three members of the Board, the Interim President and Chief Executive Officer, and the Chief of Staff from each hospital. There shall be three alternate Committee members:

(i)(ii) The second and third alternate Committee members shall be the Chiefs of Staff Elect from each hospital, who shall attend Committee meetings and enjoy voting rights on the Committee only when serving as an alternate for their respective Chief of Staff.

(b) Non‐Voting Membership. The Executive Vice President Strategy, the Executive Vice President FinanceChief Financial Officer, the Executive Vice President Chief Operations Officer, the Executive Vice President Chief Human Resources Officer, the Executive Vice President Physician AlignmentChief Medical Officer, the Vice President Palomar Medical Center, the Vice President Palomar Health Downtown Campus/Pomerado Hospital, General Counsel, a nurse representative from Palomar Medical Center or Pomerado Hospital, the Chief Nursing Officer Palomar Medical Center Escondido, the Chief Nursing Officer Palomar Medical Centers Downtown Escondido and Poway, the Associate Vice President Hospitality & Facilities, the Interim Executive Director of the Foundation Philanthropy Officer, Legal Counsel and a board member of the Palomar Health Foundation, recommended by the Foundation and approved by the Committee Chairperson. As needed, other appropriate relevant staff in engineering, architectural, facilities, planning and compliance, and a Physician Advisory Committee member may be requested to attend along with Palomar Health staff to facilitate the work of the Committee.

Regarding the Strategic Function:

6 (ii) Review annually those policies within the Committee’s purview and report the results of such review to the full Board. Such reports shall include recommendations regarding the modification of existing, or creation of new, policies; and

(iii) Undertake planning regarding physician recruitment and retention and program development of new and enhanced services and Facilities; and

(iv) Monitor new initiatives and programs; and

(v) Perform such other duties as may be assigned by the Board.

Regarding the Facilities Function: Comment [tlhd1]: Have any of these actions been taken in the past several years? Specifically items (v) and (vi)??? (i) Review construction estimates and expenses for accuracy and architectural plans for completeness and effectiveness;

(ii) Approve construction project change orders in accordance with applicable district law and Palomar Health policies;

(iii) Receive reports from the Construction Manager and the Director of Facilities Planning and DevelopmentVice President Hospitality and Facilities; recommend action to the Board regarding facilities design and maintenance;

(iv) Review regulations and reports regarding facilities and grounds from external agencies, accrediting bodies and insurance carriers;, and make recommendations for appropriate action regarding the same to the Board;

(v) Approve the annual Facilities Development Plan and regularly review updates on implementation of plan;

(vi) Receive a biannual Environment of Care report; and

(vii) Perform such other duties as may be assigned by the Board.

Review of Lucidoc Policy 26952 Board Responsibilities for Board Strategic & Facilities Planning Committee

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Monday, March 19, 2018

FROM: Hubert U. King, Chief Financial Officer

Background: The Board Strategic & Facilities Planning Committee is required to periodically review Lucidoc Procedure 26952 Board Responsibilities as it relates to the Committee and recommend/approve any revisions. §G.3.b. was deleted based on information that section had been deleted in 2015, said deletion having never made it into Lucidoc (see attached, presented both in clean and redline versions).

Budget Impact: N/A

Staff Recommendation: Staff recommends approval of §G Board Strategic & Facilities Planning Committee as corrected.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

3 Form A ‐ Board Responsibilities ‐ SFPC.docx 8 G. Board Strategic Facilities and Planning Committee: 1. Strategic Planning Function: It is the responsibility of the Board Member to ensure that the mission and vision of the Board are implemented in an effective and meaningful manner through the establishment and implementation of plans and programs that enhance the well-being of the citizens of the District. a. Responsibilities: i. To review and make recommendations to the Board regarding the District's short and long range plans and strategic collaborative relationships. ii. Review and approve physician development plans and. oversee the implementation of physician recruitment and retention programs on an annual basis. iii. Monitor completion of annual goals in order to ensure their effective completion on behalf of the system. iv. Recommend educational programs and enhance Board members understanding of trends in the local, State and National health care arena and issues affecting the system. v. Review the development of new programs and system initiatives to ensure their direction is in accordance with the mission and vision of the organization and support the strategic plans of the District. vi. Perform other duties as may be assigned by the Committee Chair. vii. Interest and willingness to commit the time and energy necessary to meet committee responsibilities in meeting requirements. 2. Facilities Planning Function: It is the responsibility of the Board Member to provide oversight for the development, expansion, modernization and replacement of the Health System facilities and grounds in order to promote the physical life of the assets belonging to the District; and to ensure the safety and well-being of those working in and being served in the facilities and on the grounds. a. Responsibilities: i. To ensure that a long-term facility plan is developed and updated regularly. ii. To provide oversight regarding the maintenance of facilities and grounds and implementation of improvement projects. iii. To ensure that the District is in compliance with governmental agency and accreditation requirements with respect to earthquake and disaster preparedness, fire and safety codes, environmental standards and physical security needs, etc. iv. Provide guidance in the selection of architects, and general construction vendors. v. To advise the Finance Committee with respect to the need of adequate projects funding. vi. Complete other duties to be assigned by the Chair of the Committee vii. Interest and willingness to commit the time and energy to provide input to the committee membership. 3. Requirements: a. A general knowledge of healthcare issues and trends affecting Healthcare organizations and medical staffs; a willingness to actively expand ones knowledge in this arena. b. Compliance with other Board member position description requirements.

9 G. Board Strategic Facilities and Planning Committee: 1. Strategic Planning Function: It is the responsibility of the Board Member to ensure that the mission and vision of the Board are implemented in an effective and meaningful manner through the establishment and implementation of plans and programs that enhance the well-being of the citizens of the District. a. Responsibilities: i. To review and make recommendations to the Board regarding the District's short and long range plans and strategic collaborative relationships. ii. Review and approve physician development plans and. oversee the implementation of physician recruitment and retention programs on an annual basis. iii. Monitor completion of annual goals in order to ensure their effective completion on behalf of the system. iv. Recommend educational programs and enhance Board members understanding of trends in the local, State and National health care arena and issues affecting the system. v. Review the development of new programs and system initiatives to ensure their direction is in accordance with the mission and vision of the organization and support the strategic plans of the District. vi. Perform other duties as may be assigned by the Committee Chair. vii. Interest and willingness to commit the time and energy necessary to meet committee responsibilities in meeting requirements. 2. Facilities Planning Function: It is the responsibility of the Board Member to provide oversight for the development, expansion, modernization and replacement of the Health System facilities and grounds in order to promote the physical life of the assets belonging to the District; and to ensure the safety and well-being of those working in and being served in the facilities and on the grounds. a. Responsibilities: i. To ensure that a long-term facility plan is developed and updated regularly. ii. To provide oversight regarding the maintenance of facilities and grounds and implementation of improvement projects. iii. To ensure that the District is in compliance with governmental agency and accreditation requirements with respect to earthquake and disaster preparedness, fire and safety codes, environmental standards and physical security needs, etc. iv. Provide guidance in the selection of architects, and general construction vendors. v. To advise the Finance Committee with respect to the need of adequate projects funding. vi. Complete other duties to be assigned by the Chair of the Committee vii. Interest and willingness to commit the time and energy to provide input to the committee membership. 3. Requirements: a. A general knowledge of healthcare issues and trends affecting Healthcare organizations and medical staffs; a willingness to actively expand ones knowledge in this arena. b. A background or interest in design, construction, financing of projects and / or facilities is preferred. Comment [tlhd1]: This requirement was c.b. Compliance with other Board member position description requirements. deleted by the Committee in 2015, but was apparently never removed from Lucidoc

10 Board Strategic & Facilities Planning Committee Meeting Schedule Calendar Year 2018

TO: Board Strategic & Facilities Planning Committee MEETING DATE: Monday, March 19, 2018 FROM: Tanya Howell, Assistant BY: Hubert U. King, Chief Financial Officer

Background: Based on the calendars of the Board members on the Committee, Board Strategic & Facilities Planning Committee meetings for the 2017 calendar year were held at 12:00 noon on the third Wednesday of the month. It is recommended that the schedule for the 2018 calendar year be the same, with all regular meetings to be held in the Raymond Family Conference Center on the 2nd Floor of Palomar Medical Center Escondido at 2185 Citracado Parkway in Escondido. Resolution No. 04.19.18(08)‐01 presenting the recommended schedule is attached for the Committee’s review and approval.

Budget Impact: N/A

Staff Recommendation: Meeting schedule as per discussion at meeting and resulting Board Strategic & Facilities Planning Committee approval.

Committee Questions:

COMMITTEE RECOMMENDATION: Motion: Individual Action: Information: Required Time:

4 Form A ‐ Calendar .docx 11 RESOLUTION NO. 04.19.18(08)‐01

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH ESTABLISHING THE DATE, TIME AND LOCATION FOR THE REGULAR MEETINGS OF THE BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE FOR CALENDAR YEAR 2018

WHEREAS, Palomar Health (the "District") is a local health care district duly organized and existing under The Local Health Care District Law, constituting Division 23 of the Health and Safety Code of the State of California (the "District Act"); and, WHEREAS, the Board of Directors (the "Board") is required, pursuant to Section 54954 of the California Government Code and Section 5.7.2 of the Palomar Health Bylaws, to pass a resolution adopting the time, place and location of the regular Board meetings; and, WHEREAS, the Board Strategic & Facilities Planning Committee (the “Committee”) has been counseled by the Board to comply with Section 5.7.2 of the Palomar Health Bylaws when adopting the time, place and location of the regular Committee meetings for the remainder of Calendar Year 2018; and, WHEREAS, the Committee is required, pursuant to Lucidoc Policy 21793: Establishing Board Meeting Dates to establish by Resolution the regular meetings ofe th Committee;

NOW, THEREFORE, BE IT RESOLVED by the Committee that the following schedule of regular meetings will apply for the remainder of Calendar Year 2018: 2018 BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING SCHEDULE Monday Monday March 19, 2018 August 20, 2018 Monday Monday April 16, 2018 September 17, 2018 Monday Monday May 21, 2018 October 15, 2018 Monday Monday June 18, 2018 November 19, 2018 Monday Monday July 16, 2018 December 17, 2018 NOW, THEREFORE, BE IT FURTHER RESOLVED by the Committee that each meeting will begin at 12:00 noon and will be held in the Raymond Family Conference Room at Palomar Medical Center Escondido, 2185 Citracado Parkway, Escondido, California 92029.

PASSED AND ADOPTED at a meeting of the Board of Directors of Palomar Health held on March 19, 2018, by the following vote:

AYES: NOES: ABSTAINING: ABSENT:

Dated: March 19, 2018

ATTESTED: BY: Joy Gorzeman, RN Chair, Board of Directors

Raymond McCune, RN Secretary, Board of Directors

Facilities Project Status Update

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Monday, March 19, 2018

FROM: Hubert U. King, Chief Financial Officer

Background: Information regarding the status of the following planned or ongoing projects planned within the District will be presented (See Addendum B):

 Palomar Medical Center Escondido Campus – New Structures, Buildouts & Services  Palomar Medical Center Poway Campus – Hospital Improvements & Upgrades, New Services  Other Palomar Health Facilities – Relocations of Services  Palomar Medical Center Downtown Escondido Campus – Relocations of Services

Budget Impact: N/A at this time

Staff Recommendation: Information Only.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

5 Form A ‐ Facilities.docx 13

Behavioral Health Services Update

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Monday, March 19, 2018

FROM: Sheila Brown, RN, MBA, FACHE, Chief Operations Officer Hubert U. King, Chief Financial Officer

Background: Information regarding the state of Behavioral Health services around the County and the Management’s plans to meet the needs within the District will be presented.

Budget Impact: N/A at this time

Staff Recommendation: Information Only.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

6 Form A ‐ BHS.docx 14

Parking Structure Update

TO: Board Strategic & Facilities Planning Committee

MEETING DATE: Monday, March 19, 2018

FROM: Hubert U. King, Chief Financial Officer Dan Farrow, VP Hospitality & Facilities

Background: A request for approval to finalize negotiations regarding the construction and operation of a parking structure on property owned by the District was presented and tabled at the March 12, 2018, Board meeting. The Board cited a need for more information before making a decision and requested another presentation at the next Board meeting. The request for approval is being resubmitted through this Committee as a venue for an additional educational opportunity on this topic prior to the Board meeting. The attached Resolution has been updated to reflect the date of the April Board meeting, but all other documentation as presented is unchanged (See Addendum D).

Budget Impact: N/A at this time

Staff Recommendation: Recommendation to the Board for approval of Resolution No. 04.09.18(09)‐02, Authorizing Management to Take the Actions Necessary to Negotiate and Execute the Documents Necessary for a Parking Structure to be Constructed and Operated on Property Owned by the District within the Escondido Regional Technology Center.

Committee Questions:

COMMITTEE RECOMMENDATION:

Motion:

Individual Action:

Information:

Required Time:

7 Parking Structure.docx 15

RESOLUTION NO. 04.09.18(09)‐02

RESOLUTION OF THE BOARD OF DIRECTORS OF PALOMAR HEALTH AUTHORIZING MANAGEMENT TO TAKE THE ACTIONS NECESSARY TO NEGOTIATE AND EXECUTE THE DOCUMENTS NECESSARY FOR A PARKING STRUCTURE TO BE CONSTRUCTED AND OPERATED ON PROPERTY OWNED BY THE DISTRICT WITHIN THE ESCONDIDO REGIONAL TECHNOLOGY CENTER

WHEREAS, the Board has determined that Palomar Medical Center‐Escondido (“PMC‐E”) has a current need for Convenient and adjacent parking for patients, visitors and staff;

WHEREAS, the need for parking at the PMC‐E campus will likely increase substantially with the pending completion of the on campus Medical Office Building, Rehabilitation Hospital, and Crisis Stabilization Unit facility, and the buildout of PMC‐E floors 9, 10, and 11 are completed within the next four (4) years;

WHEREAS, the District has identified a parcel of undeveloped land which is a part of the PMC‐E campus (“the Subject Property”) which is suitable for the construction of a five‐level, 1,907‐space parking structure (“the parking structure”);

WHEREAS, the cost of constructing a parking structure on the Subject property is currently estimated to be approximately $25,000,000 to $27,000,000;

WHEREAS, Administration has identified a funding mechanism which would allow for construction of a multi‐level parking facility on the Subject Property, which would be the subject of a long term Ground Lease to the National Healthcare Research and Education Finance Corporation a 501(c)(3) nonprofit corporation and financier/developer (“NHREFCO”) of healthcare facilities for nonprofit healthcare organizations like the District;

WHEREAS, NHREFCO would, at its expense and risk, design and construct the parking structure (with a targeted starting date in the early summer of 2018), and, when completed (with a targeted completion date of late summer of 2019), lease the parking structure to the District for a period of 300 months (25 years);

WHEREAS, the District would make payments on the structure lease of the completed parking structure through the revenues generated by parking fees in the Structure;

WHEREAS, the ground lease/parking structure lease arrangement would provide, inter alia, the District with a fair market value purchase option at the end of the term of the lease; and,

WHEREAS, the Ground Lease/Structure Lease funding arrangement would provide benefit to the residents of the District by enabling the District to address the current and increasing parking need at PMC‐E without encumbering available District funds for capital expenditures.

NOW THEREFORE, BE IT RESOLVED AS FOLLOWS:

1. The Board of Directors hereby authorizes its President and Chief Executive Officer to negotiate with and develop a Ground Lease and Structure Lease Arrangement to be executed by and between the District and NHREFCO, to include a District ground lease of the Subject Property, and an agreement by NHREFCO to design and construct the Parking Structure on the Subject Property, on terms which are favorable to the residents of the District;

2. The Board of Directors also authorizes the President and Chief Executive Officer to negotiate and execute a Structure Lease Agreement with NHREFCO for the completed parking structure, for use by PMC‐E patients, visitors, and staff, at an approximate monthly lease payment of $117,000.00, on terms which are favorable to the residents of the District;

3. The Board of Directors also authorizes the President and Chief Executive Officer to negotiate and execute an operating/management agreement with Ace Parking, for the latter to operate and manage the parking structure once it is completed, on terms which are favorable to the residents of the District.

PASSED AND ADOPTED at a meeting of the Board of Directors of Palomar Health held on April 9, 2018, by the following vote:

AYES: NOES: ABSTAINING: ABSENT:

Dated: April 9, 2018 BY: Joy Gorzeman, RN Chair, Board of Directors ATTESTED:

Ray McCune, RN Secretary, Board of Directors

B O A R D S TRATEGIC &FA C I L I T I E S P L A N N I N G C O M M I T T E E M EETING A T T E N D A N C E R OSTER - C A L E N D A R Y E A R 2 0 1 8 /

MEETING DATES:

2/19/18 1/15/18 3/19/18 4/16/18 5/21/18 6/18/18 7/16/18 8/20/18 9/17/18 10/15/18 11/19/18 12/17/18 CANCELED MEMBERS DIRECTOR DOUG MOIR – COMMITTEE CHAIR X DIRECTOR JERRY KAUFMAN X DIRECTOR RAY MCCUNE DIRECTOR HANS SISON - BOARD ALTERNATE DIANE HANSEN, INTERIM PRESIDENT & CEO X FRANKLIN MARTIN, MD, COS PMCE CHARLES CALLERY, MD, COS PMCP DELLA SHAW, EVP STRATEGY X HUGH KING, INTERIM EVP FINANCE X FRANK BEIRNE, EVP OPERATIONS X PHF PHILANTHROPY OFFICER X PH FOUNDATION BOARD MEMBER JEANETTE SKINNER, VP PMCP, PMCDE X MARIA SUDAK, VP PMCE X PAM SIME, IVP HUMAN RESOURCES ALAN CONRAD, MD, EVP PHYSICIAN ALIGNMENT X DAN STEEBER, GENERAL COUNSEL X DAN FARROW, AVP HOSPITALITY / FACILITIES X RN REPRESENTATIVE PMCE OR PMCP DEBBIE HOLLICK – COMMITTEE SECRETARY X INVITED GUESTS SEE TEXT OF MINUTES FOR NAMES OF GUEST PRESENTERS

BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, JANUARY 15, 2018

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY

DISCUSSION

CALL TO ORDER

The meeting – held in the Palomar Medical Center Raymond Family Conference Center, 2185 Citracado Parkway, Escondido, CA 92029 – was called to order at 12:01 p.m. by Committee Chair Moir

ESTABLISHMENT OF QUORUM

 Quorum comprised of Directors Moir, Kaufman, McCune  Excused Absences: None

NOTICE OF MEETING

Notice of Meeting was posted at the Palomar Health Administrative office; also posted with full agenda packet on the Palomar Health website on Wednesday, January 10, 2018 which is consistent with legal requirements

PUBLIC COMMENTS

There were no public comments

*INFORMATION ITEMS

1. * Board Strategic & Facilities Planning Committee Meeting Minutes – Monday, October 16, 2017

011518 Board Strategic & Facilities Planning Committee Minutes 19

BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, JANUARY 15, 2018

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY

DISCUSSION

There was no discussion MOTION: by Director N/A Y Kaufman, 2nd by Director Moir and carried to approve the Monday, October 16, 2017 Board Strategic & Facilities Planning Committee meeting minutes as presented. All in favor. None opposed. No abstentions

2. Board Meeting Follow Up Information only

Board Committee Follow Up Tracking Tool

 None from last meeting

3. Strategic Plan Review Information only

 At committee Chair Moir’s request, Executive Vice President Strategy Della Shaw utilized the attached presentation and executive summary to begin an ongoing, comprehensive review of the 5-year Strategic Plan, to include the two key Strategic Priorities; Population Health and Strong Physician Alignment and Networks. This report out also included discussion of the Clinically Integrated Network (CIN) in relation to both Strategic Initiatives

o Director Kaufman queried as to whether the data warehouse could track disease metrics by physician group; Ms. Shaw stated that it can and that she would forward this information to the board members

o Director Gorzeman noted that the work being done by the Community Action Councils could be connect to continuum of care through the CIN

o Committee requested a 10-minute closed session on the Clinically Integrated network and an updated on Facilities Planning at the February 2018 Board of Director’s meeting

011518 Board Strategic & Facilities Planning Committee Minutes 2 20

BOARD STRATEGIC & FACILITIES PLANNING COMMITTEE MEETING MINUTES – MONDAY, OCTOBER 16, 2017

AGENDA ITEM CONCLUSION/ACTION FOLLOW UP / FINAL? RESPONSIBLE PARTY

DISCUSSION

PUBLIC COMMENTS

There were no public comments

ADJOURNMENT

Meeting adjourned at 1:01 p.m. by Chair Moir

COMMITTEE CHAIR Doug Moir, M.D.

SIGNATURES:

Debbie Hollick COMMITTEE SECRETARY

011518 Board Strategic & Facilities Planning Committee Minutes 3 21 Passion. People. Purpose.TM

Board of Directors Strategy and Facilities Planning Committee

Strategic Plan Review

Della K. Shaw EVP Strategy & Interim Chief Philanthropy Officer January 15, 2018

1 1

Palomar Health will be recognized as the dominant Strategy provider of integrated health services as measured by market position and value-based metrics of care.

Mission Sustaining Financial Performance

Customer Value Outcomes Quality | Cost | Experience| Brand

Operational Excellence Clinical Integration | Efficiency & Effectiveness Process Hassle Free Experience | Consumerism

Organizational Capabilities World-class Workforce | Technology People Patient First Culture 2 22 2017 – 2022 Strategic Priorities

Effective and Efficient Care Strong Physician Alignment and Networks

Develop effective and efficient systems that support Build physician-hospital alignment and physician achievement of the Quadruple Aim to enhance patient engagement as the foundation of a high-value network experience, improve population health, reduce costs, that will meet the Population Heath Management and improve the life of health care providers, including needs of our community and ensure that Palomar clinicians and staff. Health is the preferred provider of care in North County.

Create and Maintain Customer Value Population Health

Attract, create, and retain loyal customers – where We will serve as providers, coordinators, collaborators, customers are defined as our patients and their and aggregators in population health and population families, physicians, payers, and our community – by health management for our employees and the achieving the Triple Aim initiatives of enhancing communities we serve – our population. customer experience, improving population health, and reducing costs.

North County Network Collaborations, Partnerships and Alignments

Through collaborations, partnerships, and affiliations in the region, Palomar Health will build aligned networks that ensure community access to comprehensive, clinically integrated, value-based care that will meet the needs of the population we serve for generations to come.

Focus | Population Health & Physician Networks

Population Health Strong Physician Alignment and Networks

We will serve as providers, Build physician-hospital alignment and coordinators, collaborators, and physician engagement as the aggregators in population health and foundation of a high-value network that population health management for our employees and the communities will meet the Population Heath we serve – our population. Management needs of our community and ensure that Palomar Health is the preferred provider of care in North County.

4 23 Setting the Stage | 2016 Community Health Needs Assessment (CHNA)

2016 CHNA

“Designed to provide a deeper understanding of barriers to health improvement in San Diego County.”

Report included “an analysis of health outcomes and associated social determinants of health which create health inequities – ‘the unfair and avoidable differences in health status seen within and between counties and communities – with the understanding that to the burden of illness, premature death, and disability disproportionately affects racial and minority population groups and other underserved populations”.

Insights were meant to “help hospitals identify effective strategies to address the most prevalent and challenging health needs in the community.”

6 24 2016 CHNA | San Diego Statistics

Nearly 15% of San Greater proportion of Approximately 1 in 7 Latinos, African Diegans live in San Diegans are food Americans, Native insecure. households with income Americans, and below 100% of the individuals of other race Federal Poverty level live in poverty compared to the overall San Diego population.

Almost 15% of San Approximately 46% of Approximately 10% of Diegans aged 25 and households in San Diego San Diegans aged 5 and older have no high have housing costs that older have limited school diploma or exceed 30% of their English proficiency and equivalency income. 8.5% are linguistically isolated.

2016 CHNA | San Diego Geographic Regions

2013 Community Need Index Scores 4.2 to 5.0 = High Need

Central East North Central Min 3.0 – Max 5.0 Min 2.6 – Max 4.8 Min 2.0 – Max 4.4

North Coastal North Inland South Min 1.8 – Max 4.6 Min 2.4 – Max 4.4 Min 2.2 – Max 5.0

8 25 2016 CHNA | San Diego Geographic Regions

2013 Community Need Index (CNI) Scores Zip Codes with a Score of 4.2 or Higher North County

Escondido Pala San Marcos 92025, 92027 92059 92069

North Coastal

Oceanside Vista 92054 92083, 92084

9 Behavioral Health –Behavioral North Inland

26 Cardiovascular Disease – North Inland Behavioral Health – North Coastal 27 Diabetes Mellitus – North Inland Cardiovascular Disease – North Coastal 28 .Obesity 4. Diabetes (Type2) 3. Cardiovascular Disease 2. Behavioral Health 1. Needs (alphabetical) CHNA Diabetes Mellitus – North Coastal | San Diego Top CommunityHealth 16 29 CHNA | Ranking Results

30 Who Takes Which Group? Segmenting Patients and Interventions Managing Three Distinct Patient Populations

5% of patients; Trade high-cost usually with complex services for low-cost High- Risk disease(s), management Patients comorbidities

15-35% of patients; Avoid unnecessary higher-acuity, higher- Rising-Risk Patients may have conditions not under control cost spending

60-80% of patients; Keep patient healthy, Low-Risk Patients any minor conditions loyal to the system are easily managed

What Do you Really Want to Own? Defining our Core Competencies Bricks and Mortar Components of Population Health

Prevention Worksite Clinics Schools

Primary Care Retail Clinics Pharmacy Medical Home

Urgent Care Urgent Center Primary Care Acute Care Long-Term Management Post-Acute Care Emergency Care Hospital Freestanding

Acute Care Hospitals Affiliate Hospitals Palliative Care

Ambulatory Care Surgery

Post-Acute Care Home Health SNF Hospice Primary Care Acute Care Long-Term Management

Long-Term Care LTAC Source: Population Health Advisor interviews and analysis.

20 31 The First Line of Tactical Management

• Contact Center Functions Supporting Population Health

Source: Population Health Advisor interviews and analysis.

Care Management as Connective Tissue of Population Health

Physician Practice Problem: Case Management Care management models are developed Medical Home independently, resulting in conflicting approaches and gaps in care Discharge Planning ACO Patient Placement ED Question: Do we have an overarching care Acute Care management model to control how PCP Follow-up methodologies are deployed in each area Home Health of the health system? LT Care Planning

SNF Need: Transitional Care Nursing Home A strong, centrally-managed, and continuum-wide care management System Navigation LTAC structure.

22 32 Organizing the Basket of Community Assets Surfacing, Addressing Social Needs Critical to Care

Social and Environmental Social, Environmental Factors Influencing Health: • Income and employment status 20% Individual • Housing and transportation Behaviors 40% 10% Health Care • Literacy and language • Hunger and access to healthy food options • Social integration and support 30% Safety Genetics •

80-90% 85% 20% Health status attributed Physicians reporting unmet social Physicians who believe they to non-clinical care factors needs lead directly to poorer have the ability to address social health outcomes needs

Source: “Powering Healthier Communities: Community Health Centers Address the Social Determinants of Health,” National Association of Community Health Centers, 2012, http://www.nachc.com/client/documents/SDOH1.pdf; B Booske et al, “Different Perspectives for Assigning Weights to Determinants of Health,” University of Wisconsin Population Health Institute, 2010, http://www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf; Population Health Advisor research and analysis.

Drivers of High-Risk MediCal Healthcare Costs

Based on results of over 4,000 assessments of high-risk patients conducted at Montefiore CMO

24 24 33 Passage to Population Health Management Sustainable, Population-Centered, Data-Driven, Coordinated Care

Network Care Model Economics Assemble a strong Establish ambitious Craft a sustainable value- provider network aligned clinical standards for based payment strategy with system-wide delivery system redesign with a solid financial performance goals and and care management foundation for engaged in health care resources profitability and growth improvement

Technology that supports delivery system redesign, provider accountability, value-based quality monitoring, and patient engagement

Advisory Board Company content

One-Stop Call Centers Co-locate Patient Information Central Platform Coordinates, Personalizes Care

Linking CRM and EMR Systems to Resolve Multiple Needs in One Call Case in Brief: Centura Health Emergency department • 16-hospital health system based in Englewood, Colorado • Moved multidisciplinary navigators Physician office Urgent care to single “CenturaConnect” platform clinic to manage care coordination pathways and increase collaboration Care coordination across care sites platform • Worked with Salesforce and Diagnostic Pharmacy TriageLogic to document every testing patient interaction in centralized EHR/CRM platform and offer seamless triage Health Information Exchange • Platform includes all patient information, including non-clinical Platform offers comprehensive patient information; nurses triage factors related to health care, make appointments Encounter triggers alert for nurse to follow up

Source: Centura Connect, available at: https://www.centura.org/our-network/centura-connect; Rogers J, “Working on the Edge: Integrating New Technology and Communication Platforms into Your Call Center,” CenturaConnect Virtual Resource Center, 2015; “TriageLogic Call Center Software Integrates with Centura Connect’s Salesforce Platform,” PRweb, Dec 2014, available at: http://www.prweb.com/releases/2014/12/prweb12383396.htm;26 Source: Population Health Advisor interviews and analysis. 34 Technology Platforms and Capabilities • Data Sources | EMRs, Payer Claims, Patient-Reported Data • Reporting and Analytics – Required Measures – Costs/Utilization – Predictive Analytics – Quality Improvement • Practice Management • Program Measures | ACO, HEDIS, MACRA, MU Specialty Registry, etc. • Contract Alignment (Current & Potential) • Provider Analytics • Hierarchical Condition Category (HCC) Analytic

Mission POPULATION Vision Enhanced Operational Strategic Planning MANAGEMENT Practices Efficiency Skilled Patient-Centered Enterprise Ambulatory Acute Long Market Position Nursing Centers of Medical Homes Unified Behavioral Term Urgent Care Excellence Strategy Health Care Referral Operations Management Home Health Clear Retail Recruiting Rehab Transitions Utilization Relationship Managment Management Clinical Integration Physician At-Risk Alignment Care Management & Financial Model Bundled Contracting Coordination Resource Payments Disbursement Utilization Pool Funding ACO Contract Patient Community Healthth Margin ManagementMa CapitationCap Activation Needs Assessmentent Enhancement Provider Programs Reimbursement Person, Patient, Member Serivce Line P2 + M Business Model Optimization Shift Lean Six Sigma Performance Wellness Diseasee Improvement Operational Managementment Member Transformation Experience Interoperability InfrastructureInfrastruc Provider Insurance Analytics Descriptive Product Predictive Commercial RegulatoryRegulal ttory Technology Clinical Prescriptive Decision Payor Support CMS P4P Registries Care Solutions Organization EDW State Management MIPS and APM Self Insured Telehealth Employers Compliance Quality Reporting Patient Portal Contract Medicare/MediCal Management Governance Our Own Employees Culture eVisits Rural Outreach Leadership 35 Mission, Vision & Values Our Mission To heal, comfort and promote health in the communities we serve. Our Vision EXECUTIVE Palomar Health will be the health system of choice for patients, physicians and employees, recognized nationally for the highest quality of clinical care and access to comprehensive services.

Values Compassion Providing comfort and care SUMMARY Integrity Doing the right thing for the right reason Teamwork Working together toward shared goals 5 YEAR STRATEGIC PLAN Excellence Aspiring to be the best

Service Serving others and our community

Trust Delivering on promises

78 San Marcos Escondido San Elijo Hills 78 5 Ramona 56

Poway

We’re driven by our passion for health and wellness, our commitment to our people and the community, and our purpose to provide exceptional care.

36 Table of Contents Navigating the Future Letter from the Board of Directors Chair and President & CEO Letter From The President And Board Chair ...... 3

Table of Contents ...... 4 To our Palomar Health Family and Community: Strategic Plan Executive Summary ...... 5 With the uncertain landscape of healthcare today, it is vital for Palomar Health to have a clear Strategic Planning Process ...... 6 vision and strategic direction so we can be prepared for the future. To this end, we have developed Phase I: Creating Value That Leads To Market Dominance ...... 7 our strategic plan through a comprehensive process listening to our Board of Directors, leaders, Phase II: Long-Range Priorities That Sustain Market Dominance ...... 10 physicians, employees and community members. Executive Summary Conclusion...... 13 Our strategic plan describes how Palomar Health is navigating toward the future with purpose Next Steps ...... 14 to create sustained value for the communities we serve. We will keep our strategic plan vibrant Summary And Final Remarks ...... 14 with frequent evaluation and adaption to the changing external factors. We remain committed to our mission – Heal, Comfort and Promote Health in the communities we serve. We recognize Appendix ...... 15 that high quality, safety and excellent patient care will allow us to serve our community for generations to come.

Our culture of caring is focused on Patient First. This means that we put the needs of every patient ﬁrst, every time. The key to our success has been the collaboration of our experienced team of physicians, nurses and staff who care for others, as they would expect their family members or themselves to be cared for.

We are now in position to navigate with the goal to deliver high quality, standardized care with 100% reliability. At the end of the day, it is about how our hearts touch the lives of our patients and their families through our guiding values of compassion, excellence, integrity, services, teamwork and trust.

Thank you for your support and commitment, and for entrusting your care to Palomar Health.

Dara Czerwonka Bob Hemker Chair of the Board of Directors President & CEO

44 5 YEYEARAR SSTRATEGICTRATEGIC PLANPLAN 3

37 Strategic Planning Process Strategic Plan Executive Summary Over an eighteen-month period that began in early 2015, Palomar Health engaged in a comprehensive strategic planning process. “True North is the California, like the rest of the country, has experienced years of healthcare turbulence. Industry Throughout our planning process, our fiduciary responsibility internal compass disruption across the country has led to mergers, acquisitions and closures of hospitals and the and commitment to the Triple Aim remained our True North – that guides you growth in publically traded, for-profit mega healthcare systems whose decisions are made by successfully through improving our patients’ experience of care, including quality and governing boards on behalf of shareholders far removed from their main streets. Fortunately for life. It represents satisfaction, improving the health of our population and reducing the citizens served by the Palomar Health District and represented by their citizen boards who who you are as a know their names and care about their friends and neighbors, our communities can feel reassured the cost of health care. human being at your that their voices are heard in matters of their communities’ healthcare needs – indeed, serving the Throughout the process, Palomar Health engaged a broad, deepest level. It is your orienting point needs of our communities is the very reason for our existence. representative constituency in comprehensive dialogue about the – your fixed point in a future of health and healthcare in our community. Using Scenario Healthcare district hospitals are not immune to the winds that buffet healthcare today. Like all spinning world – that healthcare systems, we must develop new models of care delivery that more efficiently and Planning methodology, we took both a short-and long-term view helps you stay on effectively meet our communities’ healthcare needs in a manner that is sustainable for the long of the healthcare industry and considered Palomar Health’s role track as a leader. Your in that future. Maintaining relevance and reliability as a healthcare True North is based term. We understand that the most effective ways to ensure the sustainability of our district well provider framed our thinking. While we planned for a number of on what is most into the future will include: important to you, possible future scenarios, we were cognizant of the need to build Success in our Mission to heal, comfort and promote health in the communities we serve agile and resilient systems that could respond to unpredictable your most cherished values, your passions market forces. We considered the current and future role of other Proactive leadership, collaboration and cooperation in population health that includes and motivations, the providers as partners, collaborators and competitors and the understanding the health outcomes in our communities, the health determinants sources of satisfaction impact that each could have on the future of Palomar Health and that influence those outcomes, and the policies and interventions that affect those in your life.” 1 our community – severally or collectively. determinants – Bill George, We considered how Palomar Health would create sustained “True North” Leadership in building awareness and strategies to address our communities’ population value for the communities that we serve and how that we health needs could differentiate our value from other providers. We were Integrated, interdisciplinary healthcare teams with shared knowledge supported by appreciative that value is defined through the eyes, minds and interoperable cross-continuum information technology and systems hearts of our customers and that our customers include patients A strong network of aligned and engaged physicians as the foundation of a high-value and their families, physicians, payers and the community. We network that will meet population health needs of our community understood that although each of these customers may define value differently, it is, nonetheless, our responsibility to align “In the long term Efficient and effective operations and cost management our organizational capabilities, actions and behaviors to create the most important Viable reimbursement through the influence of network size and value value for each. Building and retaining a highly skilled, dedicated question for a and compassionate workforce will be essential in creating and company is not what Local access to high-quality healthcare services for the patient in the communities we serve you are but what you sustaining customer value. are becoming.” Palomar Health completed two phases of strategic planning − Gary Hamel which will be described in the following sections of the Executive Summary.

1 David B. Nash, Raymond J. Fabius, Alexis Skoufalos, Janice L. Clark, Melissa R. Horowitz, “Population Health, Creating a Culture of Wellness”, Second Edition, Jones & Bartlett Learning, 2016, p.2,

66 5 YEAR STRATEGIC PLAN 5

38 Operational Excellence describes the critical few Phase I: Creating Value that Leads to Market Dominance processes that have the greatest impact execution of our “More than cost or Palomar Health’s Strategy Map describes how we create value. It communicates where everyone strategy. These internal processes create customer values quality, experience in our organization fits into our strategy and how their jobs affect our strategic objectives. It tells us of quality, cost and experience and lead to brand engagement and drives whether a not only where we are going, but also how we will get there and what organizational capabilities patient will come back loyalty. Palomar Health will focus on clinical integration, effectiveness and infrastructure we need to complete our journey. It guides the daily work of the organization. to a health system – and efficiency, hassle-free experiences and consumerism. and then return over The Strategy Map is enduring; while tactics will change to reflect changes in the organization or What matters most to our customers is how we give care. That is and over again as a our healthcare environment, the importance of how we do our daily work to create value for our true regardless of the skill and training of our providers and staff, repeat customer.” customers will not. The Strategy Map guides our daily work. the lifesaving procedures we perform, the advanced technology we – The Advisory Board Palomar Health Strategy Map use or the modern, sleek aesthetics of our buildings. According to (Strategic Management System) The Advisory Board, “a range of studies and surveys have found that experience drives loyalty, and loyalty drives business. For healthcare providers to realize their potential they must convert patients from being satisfied to loyal.

Satisfaction measures only a patient’s perception at a speciﬁc moment in time, whereas experience encompasses the complete set of interactions a patient has with the health system over time. Satisﬁed patients leave every day, but loyal patients stay for life. More than cost or quality, experience drives whether a patient will come back to a health system – and then return over and over again as a repeat customer.”2

We have identified four areas that are critical to operational Strategy Palomar Health will be recognized as the dominant provider of integrated excellence that creates customer value: health services. We measure successful execution of the strategy by our market share and value-based metrics of care 1. An efficient and effective system of care that reduces waste and eliminates defects, both of which are critical to Mission Sustaining Financial Performance describes the outcomes of the strategy creating quality as defined by our customers execution in financial terms. We use a number of contributing financial indicators to measure our successful execution. 2. Clinical integration that allows providers to work together to create and enhance access, improve quality and reduce Customer Value defines our market differentiating value proposition for our targeted cost and risk customers. Palomar Health will create value that matters to our customers through: 3. Elimination of customer hassles and barriers that create a Excellent and consistent quality suboptimal experience for our customers and lead to loss Access to health care and information when, where and how our customers want it of their trust, loyalty and engagement and result in loss of Convenient, hassle-free experiences for those seeking, receiving or providing care, market share Integration of clinical information that increases quality and experience and reduces cost and risk 4. Provider collaborations that create a consumer-focused Products and services that meet or exceed our population’s health needs and our network. Our customers’ health and wellness network customers’ expectations includes physician offices, hospital- and privately-owned Exceptional service, both before and after every interaction outpatient testing and treatment facilities, skilled nursing Enduring relationships of trust and confidence with those that we serve facilities, inpatient acute care settings, their homes,

88 5 YEAR STRATEGIC PLAN 7

39 Phase II: Long-range Priorities that Sustain Market Dominance virtual care technologies and other emerging techniques. With the Strategy Map in place to guide our daily work, we began long-range strategic planning Customers judge the value of each provider relative to their “Focus on Patient that considered the healthcare industry, as it exists today and possible scenarios of how it will look own needs and the providers’ quality, cost and convenience. First and highly reliable outcomes will in the next decade. Our planning included an extensive analysis of our current market position The providers our consumers choose, and the health systems allow Palomar Health and opportunities to strengthen our market performance. with which those providers align, will influence a consumer’s to navigate with future choice of a healthcare system. Palomar Health’s This work in this phase included: purpose.” consumer strategy should include strategic pricing that leads A gap analysis of culture, workforce, information technology, facilities, operations, quality, to patient preference and more market share capture. Both – Bob Hemker, President and CEO, cost, experience and brand, financial performance, and market share, and Palomar Health and community physicians should include Palomar Health strategies for on-demand, convenient access models tailored Identification of strategic priorities considered critical for Palomar Health’s success in to include options that match interactions with the care the future. needs of our multi-generational, multi-cultural population, Gap Analysis from on-site face-to-face visits to virtual care. Leaders completed a gap analysis in each area critical to successful execution of our strategy (see Organizational Capabilities and Patient First Culture are areas outlined in the Strategy Map). Leaders considered: most important to our strategy. The objectives here identify Current state of the area under review, what jobs (human capital), which systems (information capital), and what kind of climate (organization culture) are What capabilities the future state of health care would require, required to support value-creating internal processes. Gaps between our current state and the future state requirements, Ultimately, the creation of all customer value starts here. Individuals Risks of acting or not acting to fill those gaps, and finally, and teams that are passionate about their work create operational excellence. Every interaction, by every person, at every level across Key takeaways that should receive planning focus. the entire healthcare system, including our community network Long-Term Strategic Priorities of providers, creates operational excellence. Some of the most Based on an extensive analysis of internal and external data and stakeholder interviews, we critical work over the life of our organization will be our ongoing identified five strategic priorities that are critical to the future of Palomar Health and the population commitment to developing our workforce; creating and sustaining we serve. Our Board of Directors approved the following long-term priorities: organizational knowledge, supporting systems and human capital; and building a culture that reflects the values and behaviors of the Population Health Management Patient First organization that we aspire to be. Strong Physician Alignment and Networks To prepare for the next ten years, we considered our current state Effective and Efficient Care against these future needs and asked some important questions: Creation of Value that Matters to Customers What skills, capabilities and tools are needed to execute our strategy successfully? How will we sustain our passion for service Regional Collaborations, Partnerships and Alignments and our ability to embrace change and improvement to achieve The strategic priorities are interdependent. They will serve as a guide to the organization in our vision? How will we fulfill our purpose – individually and aligning and prioritizing our work, developing tactics, goals and targets, as well as in capital collectively? How will we live our values? planning. While no supremacy of order was identified, successful population health management We understand that employee and physician engagement is critical will require success in each of the other four priorities. to maximizing operation excellence and creating superior patient experiences. We are committed to building a culture that engages our employees and physicians and creates a world-class workforce through our investment in talent and leadership development. 1010 5 YEAR STRATEGIC PLAN 9

40 STRATEGIC PRIORITIES STRATEGIC PRIORITIES EFFECTIVE AND EFFICIENT CARE POPULATION HEALTH MANAGEMENT Develop effective and efﬁcient systems that support achievement of the Quadruple Aim to We will serve as providers, coordinators, collaborators and aggregators in population health enhance patient experience, improve population health, reduce costs and improve the life of and population health management for our employees and the communities we serve – our health care providers, including clinicians and staff. population. This will include understanding the health outcomes in our population, the health determinants that inﬂuence those outcomes and the policies and interventions that affect those determinants. Our understanding will inform development of strategies to address our population’s health needs and build the physician and provider network, technology, systems WHY and community alignment and partnerships necessary to support meaningful Population Health Operational excellence creates an environment that makes superior customer experience and Management for the communities we serve.

employee engagement possible. Efﬁcient and effective systems of care reduce waste and eliminate defects, which leads to lower costs and higher quality. Eliminating hassles and barriers to giving or receiving care improves customer experience and employee engagement, which leads to higher trust, loyalty and engagement and results in higher quality, lower costs and increased WHY market share. Healthy people, comprising healthy populations create productive workforces and thriving communities. Furthermore, the status of health in our communities has a tremendous impact on the cost, quality and experience of care at Palomar Health. Alignment of resources across STRATEGIC PRIORITIES the continuum improves clinical quality, total cost of care for both Palomar Health in the acute CREATE VALUE THAT MATTERS TO CUSTOMERS care setting and for our communities at a population level, and elevates overall community Attract, create and retain loyal customers – where customers are deﬁned as our patients and health and wellness. Palomar Health can serve as coordinators, collaborators, aggregators and their families, physicians, payers and our community – by achieving the Triple Aim initiatives of providers in the development of a robust wellness and care management infrastructure with an enhancing customer experience, improving population health and reducing costs. integrated primary care and post-acute care network connected with an integrated IT platform.

STRATEGIC PRIORITIES

WHY STRONG PHYSICIAN ALIGNMENT AND NETWORKS Value is deﬁned through the eyes, minds and hearts of our customers who include patients Build physician-hospital alignment and physician engagement as the foundation of a high-value and their families, physicians, payers and the community. Although each of these customers, network that will meet the Population Heath Management needs of our community and ensure actual or potential, may deﬁne value differently, it is our responsibility to align our organizational that Palomar Health is the preferred provider of care in North County.

capabilities, actions and behaviors to create value for each so that we remain the health system of choice for the communities we serve. This is the core of who we are, what we do and how we do it. Our success will be measured by our quality, cost, experience, brand and market share. WHY As both providers of care and customers of our health system, physicians are critical for our success. Strong physician relations and engagement is a key factor in physician satisfaction and retention. An engaged physician workforce is linked to enhanced patient care and experience, greater efﬁciency and lower costs, and improved quality and patient safety.

1212 5 YEAR STRATEGIC PLAN 11

41 Next Steps STRATEGIC PRIORITIES REGIONAL COLLABORATIONS, PARTNERSHIPS AND ALIGNMENTS Our strategic plan is a living document that exists to support of Palomar Health’s achievement Through collaborations, partnerships and affiliations in the region, Palomar Health will build of a sustainable, competitive advantage and increased market share by creating customer value aligned networks that ensure community access to comprehensive, clinically integrated, value- differently or better than our competitors create. While our plan is comprehensive, long-range based care that will meet the needs of the population we serve for generations to come. strategic planning is inherently imperfect in this disruptive healthcare environment and adjustments to our strategic plan will be required as the industry evolves. We will evaluate the sequence and timing of accretion for each of the five strategic priorities over the next five years.

The full strategic plan includes a comprehensive assessment of our current capabilities and identifies WHY those capabilities needed to support population health management in the future, new or changing The new value proposition requires new strategies and capabilities, and in some cases, new delivery models, evolving value-based reimbursement and transformational consumer demands. partners. The industry has new and emerging models of care where patients choose health care Gaps between our current capabilities and those needed in the future were identified, and the risks companies that organize care for them. There will be a continued decline in inpatient utilization of acting or not acting to remove those gaps has been considered, and key takeaways noted. as population health management models of care evolve and outpatient care delivered in The strategic plan does not include tactics for addressing gaps or key takeaways. Each year leaders ambulatory settings increases. Larger networks and tighter collaborations will be necessary to in the organization will develop specific tactics that support value-creating outcomes in customer aggregate lives, assemble intellectual and financial capital required to absorb and manage risk, values of quality, experience, finance and brand. The Palomar Health Balanced Score Card will report and make investments in information technology to support population health management. the system’s performance in relation to goals in finance, quality, experience and brand (market share EXECUTIVE SUMMARY CONCLUSION and volume). Delivering customers value better or differently from our competitors leads to market Our strategic plan is a living document that exists to support of Palomar Health’s achievement differentiation and successful execution of our strategy. of a sustainable, competitive advantage and increased market share by creating customer value To ensure that this plan remains relevant and useful as a guide in sustaining competitive advantage, differently or better than our competitors create. the organization will review strategic execution outcomes on a quarterly basis, assess any necessary While our plan is comprehensive, long-range strategic planning is inherently imperfect in this changes and update the strategic plan annually. disruptive healthcare environment, and adjustments to our strategic plan will be required as the industry evolves. We will evaluate the sequence and timing of accretion for strategic priorities over Summary and Final Remarks the next five years. To ensure that this plan remains relevant and useful as a guide in sustaining competitive advantage, Strategic planning is a visionary process that results in major, long-term strategic goals to help the organization will review outcomes quarterly using our Balanced Score Card, make necessary organizations reach their desired future state while developing and growing with the changing changes and update the strategic plan annually. environment that surrounds them. For Palomar Health, this plan provides a foundation for understanding where we are now, what will be required to succeed in the industry’s future state, and gaps that we must eliminate to achieve our strategic goals.

With this report, we begin to shape our future. We stand together, ready to serve our mission to heal, comfort and promote health in the communities we serve. While we cannot fully know what the future holds, we are conﬁdent that we will succeed as a united team of providers with our patients as the single foci of why we are here, persistently imagining what we can do to serve their needs, and innovating new ways to do it.

1414 5 YEAR STRATEGIC PLAN 13

42 Palomar Health Board of Directors Dara Czerwonka Jerry Kaufman Joy Gorzeman Appendix Board of Directors, Chair Board of Directors, Treasurer Board Member Jeff Griffith Hans Cristian Sison Douglas Moir, MD Board of Directors, Vice-Chair Board Member Board Member Ray McCune Board of Directors, Secretary Palomar Health Executive Management Team Robert Hemker, Dan Farrow, AVP Tim Nguyen, VP President & CEO Hospitality & Facilities, Revenue Cycle, Palomar Health Palomar Health Palomar Health Jeannette Skinner, VP Prudence August, VP John Zubiena, VP, Interim Palomar Medical Center Poway Information Systems, Human Resources, Della Shaw, EVP Palomar Health Palomar Health Strategy, Palomar Health Frank Beirne, EVP Jerry Kolins, MD, VP Leslie Solomon, VP Operations, Experience, Palomar Health Culture & Talent Planning, Palomar Health Larry LaBossiere, CNO Palomar Health Sheila Brown, VP Palomar Medical Center Poway Maria Sudak, VP Continuum of Care, Jean Larsen, President & Palomar Medical Center Palomar Health Chief Philanthropy Officer Escondido Karen Buckley, Chief Palomar Health Foundation Nursing Officer Maureen Malone, AVP Palomar Medical Center Clinical & Diagnostic Services Escondido Palomar Health Alan Conrad, MD, EVP Mark Neu, VP Physician Alignment, Compliance, Audit & Legal Palomar Health Palomar Health Strategic Plan Document Authors and Editors Della Shaw, Executive Vice Alan Conrad, MD, David Lee, MD President Executive Vice President Medical Quality Officer, Palomar Strategy, Palomar Health Physician Alignment, Health Palomar Health Leila Shams, Past Manager Tina Pope, Manager Strategic Planning Nicole Delange, Fellow Service Excellence, Palomar Palomar Health Health Prudence August, Vice President Dan Farrow, Assistant Vice Leslie Solomon, Vice Information Systems, Palomar President President Health Hospitality & Facilities, Palomar Culture & Talent Planning, Health Palomar Health Serrina Bergstraesser, Director Diane Hansen, Executive Brenda Turner, former Business Development & Vice President Executive Vice President Physician Integration Finance, Palomar Health Human Resources, Palomar Health Deborah Clark, Director Jerry Kolins, MD, Vice Marketing President Experience, Palomar Health 16 5 YEAR STRATEGIC PLAN 15

43 Strategic Planning Participants (continued) Organization Profile Authors and Editors Della Shaw, Executive Irma Cota, Chief Tracy Ream, Chief Vice President Executive Officer Executive Officer Cyndi Heimerich Danielle McCarthy, RN Jeffrey Rosenburg, MD Strategy, Palomar Health North County Health Services Neighborhood Health Executive Assistant Executive Director Surgery & Procedure Past Chief of Staff PMC Vice Presidents of Strategy & Services, Palomar Medical Escondido Luanne Arangio-Law, Jean Larsen, President & Russell Riehl, Director Physician Alignment Center Escondido Employee & Corporate Health Patty Sargent Supervisor Chief Philanthropy Officer Community Health Palomar Health Foundation Robert Hemker Ray McCune, RN Director Performance President & CEO Palomar Health Board of Excellence Mark Boll, Director Todd Mills, Manager John Van Cleef, Manager Directors, Secretary Kim Jackson Jacqueline Saucier Healthcare Marketing and Marketing & Communication, Community Development & Strategy, Arch Health Partners SCMG Spiritual Care District Director Medical Paul Neustein, MD Director Adult Inpatient & Records, PBX Communications Past Chief of Staff Palomar Emergency Services PMC Poway Sheila Brown, Joseph Parker, Director Fran Waller, Director & Privacy Officer Medical Center Poway Chris Saunders Vice President Home Health Community Engagement & Volunteer Development Omar Khawaja, MD Andrew Nguyen, MD Manager Public Relations Continuum Care, Palomar Health Medical Director Operating Medical Director Spine Surgery Room Palomar Medical Center Leila Shams Past Strategy Manager Escondido Tim Nguyen, FHFMA Vice President Revenue Cycle Strategic Planning Participants Jessica Kim Della Shaw Executive Vice President Past Administrative Fellow Cheryl Olson Past Interim Vice President PMC Strategy Jerry Kolins, MD Poway & Downtown Escondido Roger Acheatel, MD Sheila Brown, RN Steve Ellis, CMRP Vice President Patient Rupa Sidhu Past Chief of Staff PMC Poway Vice President Continuum Care Director Corporate Supply Director Wound Care Centers Experience Joseph Parker, RN Chain Services Director Home Care Services & Marcy Adelman, RN, CCM Cynthia Burns, CRCR Brad Krietzberg Home Caregivers Teja Singh, MD Director Clinical Resource Director Patient Access Richard Engel, MD Medical Director Continuum Director Organizational Management Past Chief of Staff PMC of Care Charles Callery, MD Learning Sabiha Pasha, MD Escondido Chief of Staff Elect & Quality Joel Alberto, RN Chief of Staff Palomar Medical Jean Larsen Management Committee Chair Leslie Solomon Director Sub Acute Unit Center Poway Keyvan Esmaeili, MD Vice President Culture & Talent President & Chief PMC Escondido Medical Director Rehabilitation Planning Prudence August Deborah Clark Philanthropy Officer Donita Phillips Vice President Information Director Marketing Eva Fadul, MD Jeremy Lee, PharmD, BCPS District Director Risk Tim Stevens Systems Medical Director Operating Director Biomedical David Cloyd, MD District Director Pharmacy Management Room PMC Escondido Engineering Deborah Barnes RN Associate Medical Director Services Michelle Pius District Director Regulatory Trauma Dan Farrow Maria Sudak, RN Assistant Vice President Stephanie Love Director Major Giving Palomar Virginia A Barragan, PT Brian Cohen Vice President PMC Escondido Hospitality & Facilities Director Finance Health Foundation Director Rehabilitation, Director Orthopedic & Spine Lachlan Macleay, MD Beth Remsburg-Bell Cedric Terrell Developmental Services & Services Elly Garner Past Assistant Vice President Pathology Chair PMC Poway & Director Perioperative & North County First 5 & First Director Government Affairs Clinical & Diagnostic Services Steps Alan Conrad, MD PMC Escondido Women’s Services Executive Vice President Jay Grove, MD PMC Poway Pia Mangini Robert Trifunovic, MD Frank Beirne Physician Alignment Past Surgery Chair PMC Past Medical Staff Development Manager Digital Marketing Russell Riehl Executive Vice President Escondido Officer Operations Heidi Cramer Director Employee, Corporate, Director Major Giving Palomar Michelle Gunnett, RN Franklin Martin, MD Retail & Infusion Health Chief of Staff Palomar Medical Brenda Turner Serrina Bergstraesser Health Foundation Director Emergency Services Past Executive Vice President Center Escondido Jaime Rivas, MD Director Business Development PMC Escondido Human Resources Dara Czerwonka Emergency Medicine Chair PMC Michael Blundell Palomar Health Board of Diane Hansen, CPA Valerie Martinez RN Poway & Escondido District Director Quality/Patient Melissa Wallace Director Information Directors, Chair Executive Vice President Director Financial Planning & Safety/Infection Prevention, Mel Russell, RN Technologies Finance Decision Support Liz Dawodu, MSN Stroke & Diabetes Programs Director Critical Care Services James Bried, MD Director Women’s Services PMC Monica Heath PMC Escondido Susan May RaeAnne Watson, RN Medical Director Orthopedics Escondido Director Advancement Services Director Progressive & Acute Director Patient Financial Sherri Romo Palomar Health Foundation Care PMC Escondido Bobette Brown Margie Drobatschewsky Services Director Compensation, Communications Manager Past Director Managed Care Benefits & HRIS

18 5 YEAR STRATEGIC PLAN 17

44 Notes:

______

5 YEAR STRATEGIC PLAN 19

45 Passion. People. Purpose.TM

Facilities Projects Status Update Dan Farrow, VP Hospitality & Facilities Hugh King, CFO Strategic and Facilities Planning Committee Monday, March 19, 2018

46 Facilities Title • • PMC PMC – – – – – – – – – – –

Text Outpatient New Buildout New New Imaging Centralized Crisis CT New Hospital New

Poway Escondido Projects Replacement

Ambulatory Rehabilitation CT Parking Medical

Stabilization

adjacent

Center general of

Campus Pavilion Floors Behavioral

Structure Office

Campus on

improvements to Surgery

9, Unit Floor

Hospital Emergency

Building 10 Health and 1

Title Center –Pomerado Text 11

Service

Department and

on Floor upgrades

Line

Outpatient 2 –Pomerado

Pavilion

2 47 Facilities Title • • PMC Other – – – – – – – –

Text Relocation Relocation Relocation Relocation Relocation Marcos Relocation Relocation Relocation

Downtown Projects

Palomar

Campus of of of of of of of of

(Cont’d) Microbiology Health Infusion Financial Microbiology Radiation Rehabilitation Behavioral Health Escondido Information

Therapy

Facilities Services

Therapy

Health Title

Text Lab Lab

Unit Campus

to to Unit and

Management Enterprise San Radiosurgery Marcos

Building

Campus to

San 3 48 New Title Medical

Text Office Building

Title Text 4 49 New Title • • Lease Three‐ the to – – – – – Medical

be Text Remaining In In Relocating Palomar base • • • • • •

negotiations negotiations .75 cost story Downtown Enables Operating Linear New Planned Planned Plan

cost to

to Office Linear has .90

building

$2.75 accelerator Radiation

see space only

relocation occupancy occupancy

leased

per Lease

first Escondido accelerator

with with

base Building

978 ft

patient with

terms 2 the 1

, North Rady

Oncology leased

of with

date date plus 2 radiation

approximately Campus

include

Children’s to in

and November November County

a via

Title an November be

2.75% Text

operating operating installed 2 Program

to nd 60 therapy floors Health PMC payments

annual

for 2018 2018

2018

‐Escondido in 5845

lease program 9240

24,000

180

September

Services expense

escalation

agreement; months

ft ft $56,469 2 2

from ft

Campus

for 2

estimated per

term PMC 6587

each

cost Monthly floor ‐

for 2

5 50 New Title Occupants – – – – – – – – Medical

Text subspecialties Negotiating 1 pain 3 neurosurgeons Relocation Palomar Enable currently Downtown Evaluating accommodate Negotiating management

relocation

Office Health being

of options

Escondido lease lease

Infusion

(ft 4

seen Urgent

physicians 2 Building

agreement agreement of to

bedetermined)

physician infusion in expand

Therapy Campus

Palomar Care (

Title (Cont’d) 7,030 therapy Clinic

with with oncology Text

to (ft Health PMC‐ 2 ft

Rady UCSD for to to 2 accommodate )

be program

Escondido services Children’sfor Emergency determined)

physician

from

Campus

Department PMC‐

patients

offices pediatric

6 51 Developer’s Title

Text

Rendering: Proposed

Title Text Parking Structure 7 52 Proposed Title • • Included Details

Text

Parking

will

be this Structure addressed

presentation

Title under Text

for

Agenda site plan

Item purposes #8 8 53 New Title Rehabilitation

Text

Hospital

Title Text 9 54 New Title • • • • Construction Joint Enables Estimated Downtown rehabilitation – – Rehabilitation

Text 49% Palomar

Venture with

Palomar

relocation

Health completion Escondido

scheduled

hospital

Health/51%

Hospital Rehabilitation

of Kindred

rehabilitation

Campus date

to Title

Kindred

Text begin Healthcare is

Institute, October

to in

the

April unit

LLC new

2019

from 2018

PMC‐ 10 55     Build Title ADA Patient Rms. (3) Private Patient Rms. (24) Rms. (1) Multi-Purpose/Consultation Patient IsolationRms. (2)

Out

Text of

Floor

Title Text 11 56         Build Distributed nurse stations Play Rm. (1) Double Occupancy Rms. (8) PEDs Title Line of Sight Monitoring Sight Line of Negative Pressure Rm. (1) (23) Private &Semi-PrivateRms. NICU

Out

Text of

Floor

Title Text 12 57      Build Title eoeyBays (4) Recovery Operating Rooms(2) Stations Distributed Nurses ADA &IsolationRooms LDR/LDRP Rooms(15)

Out

Text of

Floor

Title Text 13 58 CT Title • • • • • •

Replacement Existing Installed Phillips at Replacement Will Replacement Department

no Text

impact

charge

has Phillips’ in

2012 agreed patient

scheduled to

Palomar

be CT

to completed is flow

malfunctioning replace

to Title through Health Text

begin

the

the July in CT April

with Emergency 2018

2018

newer

unit

14 59 Third Title • • Proposal Drivers Finish – – – –

Text Heavy Eliminates Extend 2018 Pod patient in

In being

3 D

Emergency rd

on usage

life throughput CT replaced the

the span room of Emergency need current of

(currently Department new

to lease two and

Department Title Text units existing

trailered shell with Area

units only)

is CT negative

opening

unit

while

impact

April/May 2012

15 60 Crisis Title

Stabilization

Text

Unit (CSU)

Title Text 16 61 Title

Text

Title Text 17 62 Crisis Title • Information – – – – – – – – –

Stabilization

Text 1 Adjacent Dedicated Secure Washer/dryer Patient 2 Identical 16 st Story, patient chairs, outdoor showers 6,000

patient to

security to quiet ED

be Unit

2 and courtyard

seen (2) care

rooms presence (CSU) Ambulance in lay February

out Title Text

on bay 1 st 2019 and 2 nd floors 18 63 Centralized Title • • • There behavioral Palomar located Escondido Stabilization a There – –

centralized

Text To To

reduce meet

is are

Behavioral at a Health

clearly other

community the

Campuses health costs

Unit location PMC‐Poway

currently opportunities

of defined at services

services Health

PMC

needs

(BHU) with Title

Escondido – community has

Service

Text

the (GSU)

and

behavioral

for following is

and

expanded

Line initiating

need PMC

objectives: health Downtown – for

the services services Crisis in

64 PMC Title Escondido –

Text

Campus

Overview Title Text 20 65 PMC Title • • • • Rooms Nursing Entry Lobby – – – – – – –Poway

Text Headwalls, Flooring, Inviting Greeter Seating Chapel Drive

tower

area entry

area Campus

walls,

lighting

hallways

hand

Improvements

and furniture

rails,

Title

ceilings Text

and lighting

21 66 PMC Title • • Payments Schedule – – – –Poway

Text Hallways Entry Lobby • • • • • Begin Schematic Preliminary Completion Estimated – – Drive

Provide Define

Campus from

Spring proceeds scope costs

design clarity

design end

Improvements 2018

are of and May to Title

spring 2018 of

$1,000,000 Text options provide

December

2018

2018 and cost

2017 cost

range

bonds

22 67 PMC Title –Poway:

Text

Imaging

Center

Title Text 23 68 PMC Title • • Imaging Information –Poway: • • • • • • •

Text Fluoroscopy Ultrasound Computerized Magnetic building A Enables Ample

convenient

Modalities

parking

Imaging coordination

Resonance

location

Axial for

will

Center patients

Tomography include:

Imaging with

with Title Text physician easy (MRI) access (CT) offices

in the POP

24 69 PMC Title –Poway:

Text

New CT

Scanner

Title Text CT

Big

Bore 25 70 PMC Title • • Trailer Existing in – – – –Poway:

June Text Cost power Replacement Often covered • • Renovation Expected ‐mounted

of 2018

CT inoperable

conditioning equipment

using

New Scanner

completion

will

proceeds to CT CT begin

and require

Scanner and

was

system Scanner needs

renovations date

from

installed June Title renovation Text and

in replacement

December 2018

November and OSHPD

in Pad ($3.5 of 2007 approval existing

2017 will 2018

million)

(10‐year be

Bond

space, installed

will

Issue

life)

26 71 Other Title • • Relocation Relocating Downtown Building to Department – – – – – –

Palomar Text the Relocation Renovation once Estimated Provides Cost Planned San

is the

in relatively

relocation

space Marcos schematic the Escondido of Health Escondido cost to from to

the be Health begin

including for

low completed Microbiology

the

Facilities

campus Microbiology to

design in

occur

Enterprise Information Campus the

renovation Title

is summer Text

in by

competed the the

Lab

to Lab

summer Building spring

of the

will Management from 2018

be Enterprise of

of determined the 2019

in 2018 Escondido PMC ‐

27 72 Other Title • Relocating leased Campus – – – – –

Palomar Text Timing: Reduces Reduces Centralizes Cost

building is

relatively

annual intra the Health be

all ‐ determined

Financial

financial departmental in

lease low Escondido

Facilities

expenses

services

Services Title Text travel

by within

the

$120,000 time Department San

one

Marcos building from

28 73 PMC Title • • • • • • Current Behavioral recalculated Microbiology Escondido Radiation Building Medical Infusion Medical Rehabilitation Rehabilitation Downtown –

Text

cost Office Office in Therapy

Therapy

Campus Escondido Health

Lab Escondido

unit Hospital

Building Building operations program to Unit

program

to is

relocate

1million $1 relocate by

–relocation by Title by by

Campus s Text pring

the to s s at

pring pring to

to relocate the

4 to relocate

th of the per

the PMC‐Downtown of of Quarter

2019

date Enterprise month 2019 2019 new

the is

of the

being

2019 new new

29 74 Questions Title

Text

? Title Text 30 75 Passion. People. Purpose.TM

Behavioral Health Services Update Sheila Brown, RN, MBA, FACHE, Chief Operations Officer Hubert King, Chief Financial Officer March 19, 2018

1 1

76 FACTS • One in four Americans experiences a mental illness or substance abuse disorder each year; half will experience a Behavioral Health (BH) disorder in their lifetime* • BH conditions (mental illness and substance abuse) are the leading cause of disability and death for women and the second highest cause for men • Based on Palomar Health’s 2016 Community Health Needs Assessment, mental health is one of the top four health issues identified as a need in the community** *Source: NIMH –National Institute of Mental Health Disorders, part of the National Institute of Health‐2014 **Source: San Diego 2016 Community Health Needs Assessment/HASD&IC/Institute for Public Health

77 Impact on Emergency Departments • Delayed treatment of urgent psychiatric conditions • Wait times/Emergency Department (ED) throughput • Wrong setting despite ED Providers and Staff doing all they can • Wasted resources due to the costs associated with staffing RNs, sitters and/or security and usage of space • Insufficient resources post‐discharge • Increased safety risk for staff and patients • High recidivism

78 Behavioral Health Services Climate • San Diego County’s hospitals are overtaxed for inpatient BH beds – 4‐6 BH patients boarding in ED’s for days awaiting BH beds • Over 4,500 ED BH assessments are performed in Palomar Health’s ED’s annually – Increasing 10% annually – 35‐40% are admitted for inpatient mental health treatment • At times, patients needing treatment wait for extended periods of time in Palomar Health ED’s due to limited beds and placement/referral options

79 Current San Diego County BH Bed Status

• San Diego County Public and Private Hospitals contain a total of 691 licensed BH beds • Scripps has plans to temporarily close BH beds during construction/renovation (36 beds) • UCSD has plans to temporarily close BH beds during construction/renovation (32 beds) • San Diego County Hospital has one closed 22‐BH‐bed unit

80 Behavioral Health Services Needs • Palomar Health currently has 37 licensed beds • Current estimated need is 118 beds within Palomar Health’s defined area, with projected growth of a need for 135 beds over the next 5 years • Current shortfall between licensed bed and projected bed need = 81 beds

81 Palomar Health Behavioral Health Services • Inpatient Behavioral Health Services – Palomar Medical Center Downtown Escondido . 14 acute adult beds . 11 older adult beds – Palomar Medical Center Poway . 12 acute Gero‐Psychiatric beds

82 Palomar Health Behavioral Health Services • Outpatient Behavioral Health Services – Intensive Outpatient Program . For adults and older adults, located in San Marcos in leased space . Each patient attends this therapeutic day program two to three days a week – Crisis Stabilization Unit (CSU) . Sixteen recliner‐chair unit (currently 8 recliners at the Downtown Escondido campus) . The CSU is open 24 hours a day, seven days a week . It will be relocated to a new modular building adjacent to the ED at Palomar Medical Center Escondido in February 2019 . Title 9, California Code of Regulations’ requirement is for less than 23 hours and 59 minutes . The length of stay is reimbursed up to 20 hours

83 Palomar Health Behavioral Health Services • Consultation/Liaison Services – Psychiatrists and BH Liaisons evaluate patients with BH issues in: • ED’s – The patients are medically cleared for Inpatient BH admission, transfer to the CSU or another facility, or discharge to a home or for placement in the community • Acute Care Units at Palomar Medical Center Escondido and Palomar Medical Center Poway • Villa Pomerado Skilled Nursing Facility

84 Behavioral Health Services Opportunities • New Behavioral Health Pavilion at PMC‐Escondido in the 2nd Medical Office Building • Exploring Feasibility of Joint Venture with Diamond Healthcare – Add 33 additional beds (total of 70 licensed adult behavioral health beds) – Add 18 Adolescent behavioral health licensed beds via agreement with Rady – Include Crisis Stabilization Unit in Pavilion – Relocate intensive outpatient program to Pavilion

85 Behavioral Health Services Opportunities • New Behavioral Health Pavilion at PMC‐Escondido in 2nd Medical Office Building • Exploring Feasibility of Joint Venture with Diamond Healthcare – Add 33 additional beds (total of 70 licensed adult BH beds) – Add 18 Adolescent BH‐licensed beds via agreement with Rady Children’s – Include CSU in Pavilion • Relocate intensive outpatient program to Pavilion

86 Thank You

87 Passion. People. Purpose.TM

Proposed Parking Structure Dan Farrow, VP Hospitality & Facilities Hugh King, CFO Board Strategic & Facilities Planning Committee Monday, March 19, 2018

88 Strategic Title • • • o o o o Parking Parking Critical Crisis Floors New

New Text

rehabilitation

MOB

to Initiative Stabilization issues at 9,

expansion 10 PMC is and

opened will

Escondido – 11

Unit

be hospital are

of escalated

completed building services

opened

Title is

currently

opened Text

when: at

PMC ‐

inadequate Escondido

Campus 2 89 Developer’s Title

Text

Rendering: Proposed

Title Text Parking Structure 3 90 Issues • • Title o o o o o o o Timing Capital which Floors Crisis Rehabilitation Medical Parking Palomar Parking .

Text to If

Requirements Stabilization

Be construction is 9,

structure structure

Office already Health 10

Addressed and

Hospital Building

has 11 committed

will with begins

Unit are

approximately

take

1,900+

expected is is #1

expected expected

Q2 about is to

expected

2018, – spaces other

Title to 15

$60 to to Text open months

will strategic will open open

million

open cost in

available

Q3 Q3 Q3 to

over projects

Q3 2019 – complete 2019 – 2021 –

available

2018 –

$27 for

use

million

in capital,

2019 – build

most

of 4 91 Proposed • • Title o o o o o o o o o o o FINANCING TIMING monthly NHREFCO Contract If Estimated Remaining Will Contract Monthly Operating Ground Tax‐ building Collective with completion

the Text

exempt provide

necessary

plan

lease Plan

rental

rent rent with with

is Bargaining

revenues lease is 1,257

bonds a

approximately approved

of from 501(c)(3) NHREFCO ACE

Q3 and projects

from approximately

slots

2019 – Parking

Palomar operating

Agreement) NHREFCO

would

$5.00 in

corporation

which to

March,

Services

develop

750 Health

per

need costs

they

$117,000

slots to

slot construction

Palomar

to to

cannot a whose Title

(reserved per

5‐ generate operate NHREFCO

story Text

day

finance tax Health

parking would

‐ could fee

exempt an free

‐ average based

using

parking

be begin

structure

mission needed

their parking

in of

for

Q2 $3.10

own

with employees is to

2018, –

program to

cover

credit

per

1,907 assist

slot monthly with

spaces hospitals per to

project

cover 5 92 Benefits • • Title o o o o o o o RISKS BENEFITS Potential If Provides Provides Assuming No Enables “This no Health’s would

parking Text

impact impact

parking and

Palomar Balance

for for

negative

a structure

parking

on on

negative

Risks timely construction

facility cash income

Health Sheet

structure

public positon

completion revenues

impact is

from

owned

relations of

meet

operations

fees on parking

were

of cash

cover

its NHREFCO

parking

impact to parking

structure flows Title

costs Text

less

structure (can

and needs of than

with

be operations

operated

mitigated the for

before

the cost debt

by foreseeable

and of

peak added

by ACE

operations,

lease signage,

demand

Parking

payments,

Palomar

future

i.e.,

Services”) there

6 93 Recommendation • Title o o o Board To To To with

Text negotiate negotiate negotiate

NHREFCO Authorization

and and and

execute execute execute

for

a an an

ground

Management operating operating

lease Title

Text agreement lease

with

for

NHREFCO

the

with

proposed

ACE

Parking

parking

Services

structure 7 94