Planning for Tomorrow Thank you for your interest in JPS and the continuing efforts of your public healthcare system to Improve performance meet demands of our growing community and provide stewardship of the taxpayer’s money. Today I want to provide a brief overview of : JPS history and unique role in our community, Public health system’s value beyond the quality of care provided through more than 1 million patient encounters every year, and Challenges we face daily in keeping up with community growth, technology advancements, and regulatory and industry changes.

Meeting Community Needs 1913 1939 1951 JPS’s roots date back more than 100 years, when Fort Worth and the county agreed to jointly operate a 25-bed emergency hospital, located at Fourth and Jones. In 1937, Fort Worth and county officials voted to approve $137,500 in bonds to match a Public Works Administration grant for construction of a new hospital on land that businessman and visionary John Peter Smith deeded back in 1877 as the site of a place where the community’s indigent could have the best of medical care. New hospital was occupied in 1939. Through the 1950s, numerous additions were made. By 1959, it was clear a reliable source of funding was crucial. A public election allowed for the creation of the Tarrant County Hospital District, authorizing the assessment of taxes to support the hospital. By 1971, the 11-story patient tower was completed as phase III of a construction plan that included new ER and radiology facilities, power plant, cafeteria, laundry, pharmacy, a blood bank and labs. In 1985, county voters approved a $49.5 million bond for major renovations and additions, including construction of Trinity Springs Pavilion, our psychiatric hospital. Thirty years ago was the last time the hospital district went to voters with a bond election. In 2008, Patient Care Pavilion opened, built through a capital campaign and operational efficiencies. 1971 1985 2008

Centered in Care 1.7 million+ patient encounters in 2015 330+ Emergency Department patient visits/day – 120,000 emergency visits/year 60,000 Urgent Care visits/year 20,000 Behavioral Health patients/year 5,000 babies delivered annually JPS is YOUR PUBLIC HEALTHCARE SYSTEM. JPS offers the full CONTINUUM OF CARE, from a 537-bed acute hospital to outpatient/preventative services at our more than 40 primary care community clinics to behavioral health services. The demand on JPS services has increased significantly in the past 10 years, much less the last 30 years, when last we had a bond election. When the new ED opened in the patient care pavilion in 2008, we were seeing about 160 patients a day. Today we average 330. And with flu season coming, we know the number will bump above 400 on many days.

Our Unique Role Level 1 Trauma Center Leaders in Behavioral Health The only one in Tarrant County Leaders in Behavioral Health Psychiatric Emergency Center – only one in Tarrant County Correctional Health – more than 60,000 patient encounters per year Teaching Hospital Residency programs – 11 residency and fellowship programs; 202 JPS residents Undergraduate programs – 50 affiliation agreements; 1,000 students Care for Underserved – More than 40,000 charity-eligible JPS Connection members JPS is uniquely equipped to satisfy its unique role in Tarrant County Only Level 1 trauma center. Not every hospital can attain Level 1 status – facility requirements – OR on standby at all times – spectrum of subspecialty physicians available at all times, research component. Only Psychiatric Emergency Center in county – unique facilities and infrastructure as well as an experienced and compassionate pool of caregivers. Correctional Health – clinic at county jail AND inpatient services. Teaching hospital – largest hospital based family medicine residency in the nation. Care of the underserved – population largely more diverse, more sick and with more issues than our peer hospitals see. JPS also helps lessen the impact on other public and private service agencies, such as EMS, police, the jail as well as other hospitals. You may never imagine a scenario in which you would need to seek help at JPS. But Trauma and BH are society’s great equalizers. The dollars in your bank account, degrees behind your name, street address of your house or the importance of your job can’t insulate you against potential traumatic injury or behavioral health issues. JPS IS where you want to be in those cases.

Community Footprint Our Starbucks map – JPS’s footprint extends throughout Tarrant County. Our primary care and 20 school-based health clinics are largely located in areas of high poverty penetration. We can never forget our over-arching mission as our community’s safety net healthcare system. And that is true to John Peter Smith’s vision of providing the best of medical for all Tarrant County residents, regardless of their ability to pay.

Estimated growth based on population growth trend from 2000-2010. Population Trends 3.5 million 1.8 million 860,000 Growth is good – it’s a sign of an attractive community offering opportunities for employment, good schools and great quality of life for families. North Texas is a great place to live – and that explains why Tarrant County’s population has more than doubled in the past 30 years, since the last bond election. And you as chamber members know very well what the population is projected to be. But growth brings its own set of challenges as well, be they transportation, air quality, water availability, educational demands or strain on the public healthcare system. Turn it over to my colleague Scott Rule, vice president and administrative chief of staff, to talk about what those growth challenges are doing at JPS. Estimated growth based on population growth trend from 2000-2010. Source: University of Houston Hobby Center for Public Policy. (2014). Projections of the Population of Texas and Counties in Texas by Age, Sex, and Race/Ethnicity from 2010 to 2050. Retrieved from http://www.uh.edu/class/hcpp/_docs/research/population/2014%20PPRLE-SV2.pdf

Environment of Care/Patient Experience JPS Patient Tower Patient Care Pavilion Does not support: Infection control standards State and federal privacy laws (HIPAA and CMS) Reimbursements tied to patient satisfaction Improved quality outcomes Operational and cost efficiencies

Campus Split by Main St. Lack of appropriate adjacencies of departments and services

Emergency/Urgent Care Urgent Care is separated from Emergency Department Approximately 750 monthly transfers Approximate total transfer time: 250 hours/month Urgent Care Main ED

Behavioral Health Psychiatric Emergency located on 10th floor of main hospital tower Access challenges Potential risks to others Potentially unsafe transfers 10th Floor Trinity Springs Pavilion Main ED

Care Delivery Challenges JPS Current State Best Practice Outpatient Clinics Patients waiting in corridors Waiting areas remote from clinic entrance Lack of capacity - landlocked Multiple registration areas confusing for patients Outdated design limits productivity and performance improvement

Past Projects JPS Medical Home Southeast Tarrant $7,812,343 Partial Hospitalization (four sites) $915,896 Bardin Road Specialty Clinic renovations $1,045,589 JPS Health Center – Stop Six Pharmacy Expansion $231,285 Center for Pain Management Clinic $365,066 Gertrude Tarpley JPS Health Center at Watauga $3,477,722 JPOC 1400 and 1350 renovations $17,355,983 Medical Home Northeast Tarrant Land Purchase $1,100,000 Outpatient Pharmacy $1,318,167 Emergency Department split flow $994,263 East Pavilion Expansion $23,533,442 St. Joseph Hospital Abatement and Demolition $5,325,237

JPS Medical Home Northeast Tarrant 30,000 square feet Primary Care Medical Home RFQ issued September 2015 Design Process: Underway Construction RFPs out: Late September/early October 2016 Services will include: Primary Medical Care Dental Geriatrics Pharmacy Lab Behavioral Health Radiology Patient Education Case Management Financial Screening Snapshot of JPS presence in Precinct 3 – two adult primary care facilities – Health Center Northeast on Brown Trail in Bedford; Gertrude Tarpley Health Center in Watauga – and four school-based clinics. Our Grapevine/Colleyville school based clinic is located on Timberline Drive. JPS recently completed a land purchase to build a new 30,000-square-foot primary care medical home for Northeast Tarrant County. Design is scheduled to begin late 2015, with construction getting underway in spring of 2016. Operations are scheduled to being in late spring, early summer of 2017. Located at 3200 W. Euless Blvd., the medical home will feature primary care, dental, pharmacy, lab, behavioral health, radiology, patient education, case management and financial screening.

3 1 2 Proposed Future Projects Renovate Existing Facilities subject to change 3 1 Renovate Existing Facilities 164,619 sf Renovation New Inpatient Tower 739,011 sf New Construction 2 Psychiatric Hospital 220,000 sf New Construction

1 3 2 Proposed Campus subject to change RENOVATIONS TO EXISTING FACILITY 164,619 sf Hospital Renovation and Backfill 739,011 sf 10 floors Parking Garage (2,300 spaces) Central Utility Plant SOUTH MAIN ST. 2 PSYCHIATRIC HOSPITAL 220,000 sf 5 floors including psychiatric emergency

in the Tarrant County Hospital District tax rate. County Support The bond improvements as outlined in this proposal will result in NO INCREASE in the Tarrant County Hospital District tax rate.

County Support STEP 1 – Analyze and review healthcare and JPS’ role STEP 2 – Establish a citizens committee STEP 3 – Evaluate JPS’ current facilities STEP 4 – Combine findings from Steps 1-3

Diversity and Inclusion Our Mission Transforming healthcare delivery for the communities we serve Our Vision To be a regional and national leader in: Improving the patient and family experience Improving the quality and outcomes of population health Improving access to care Our Values Trust Mutual Respect Excellence Integrity Accountability Teamwork Our Diversity and Inclusion Commitment JPS seeks to promote and provide equity of access, care and opportunity to patients, individuals or business owners seeking health care, employment or business opportunities within JPS Health Network.

To ask questions via email, go to www.jpshealthnet.org/bonds To ask questions via email, go to jpsbondquestions@jpshealth.org Schedule a tour of JPS www.jpshealthnet.org/tours

Growth is good – it’s a sign of an attractive community offering opportunities for employment, good schools and great quality of life for families. North Texas is a great place to live – and that explains why Tarrant County’s population has more than doubled in the past 30 years, since the last bond election. And you as chamber members know very well what the population is projected to be. But growth brings its own set of challenges as well, be they transportation, air quality, water availability, educational demands or strain on the public healthcare system. Turn it over to my colleague Scott Rule, vice president and administrative chief of staff, to talk about what those growth challenges are doing at JPS.