1. Big Plans for Big Boxes Pros and Cons of Retail-To-Healthcare Conversions

2. Session Description In the progressively challenging financial environment facing the delivery of healthcare, institutions are increasingly considering repurposing existing “big box” facilities for healthcare functions. Opportunities exist in this approach, but challenges also lurk.

3. Session Objectives Identify potential benefits of repurposing an existing facility and assess likelihood of fruition Assess appropriateness of potential investment Assemble a list of potential pitfalls Explain examples of pros and cons that might not be readily evident

4. Introduction  Drive for more with less cost, yet higher quality  Disruptive innovation & digital transformation  Ambulatory settings to reduce costs / provide access  Industry trends in facility conversion 1 2 3 4

5. Presentation Format  Original Drivers / Strategy  Guiding Principles 1  Selection of Neighborhood / Search For Facility  Experience of Conversion Process - Suitability for purpose - Economics: planned cost vs. actual - Challenges / restrictions / surprises 2 3  Lessons Learned

6. 1 ORIGINAL DRIVERS / STRATEGY GUIDING PRINCIPLES

7. Patient Care Pavilion and John Peter Smith Hospital Fort Worth Campus JPS Health Network nation’s largest hospital-based family medicine residency 30 primary care and specialty clinics 20 school- based health centers 1.1 million patient encounters annually 2 INPATIENT LOCATIONS System Facilities $1.7B ECONOMIC IMPACT – CREATING MORE THAN 12.5K JOBS IN TARRANT COUNTY ACADEMIC PARTNERS: UNIVERSITY OF TEXAS SOUTHWESTERN MEDICAL SCHOOL BAYLOR MEDICAL CENTER UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER TEXAS A&M HEALTH SCIENCE CENTER 49 UNIQUE LOCATIONS

8. JPS Project Strategy  Moving from fee-for-service to medical home model  Improve the patient experience  Increased access with design  Community education  Locate services near our patients  Provide services at one location  Proximity to other services  Reduce operational costs  Design and build a prototype for the patient-centered medical home

9. 9 Source: Data Bank CHC Revised January 2010.pdf + JPS Contacts. 6 JPS Sites located within a 3.5-mile Radius JPS Clinical Access 3.5 Mile Radius

10. JPS Project Guiding Principles Promote Patient and Family-Centered Principles - Welcoming, Patient Friendly, Easy To Access And Navigate - Child Friendly, Respite Spaces, Reduced Stress Encourage Partnerships Between Providers, Staff & Patients Promote Active Patient Engagement With Dignity And Respect, Including Use Of Remote Health Management - Access To Internet, Family Resource Area Protect Patient Privacy, Both Visual And Auditory Practice At The “Top Of License” Integrate Ancillary Services To Support The Medical Home Meet The Diverse Needs Of Our Population Promote Provider Fulfillment, Effectiveness and Satisfaction Leverage Technology To Optimize Work Of Our People Exam Room Layout To Facilitate Interaction & Documentation Computer Access Outside Exam Rooms To Facilitate Work Flow Establish The New JPS Health Network Brand Pursue LEED Certification If Practical and Affordable Support Education Needs For Patients and Community Provide “Alternative Hour” Access To Designated Areas 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15

11. Promote Flexibility Standardize Room Sizes For Future Alternative Uses Optimize Efficiency Limit Travel Distances To Frequently Used Spaces Seek To Share Spaces, Staff and Functions Provide Family “Self-Testing” Room For Unscheduled Use Include Quiet/Meditative Space Option For Patients Be Mother Friendly Support “On-stage” and “Off-stage” Circulation and Functions JPS Secondary Guiding Principles 1 2 3 4 5 6 7

12. Greater Houston Area TCH Background 2 INPATIENT CAMPUSES (3 RD UNDER CONST.) System Facilities 10 MAJOR BUILDINGS 8 MILLION SF 7 CORPORATIONS OVER 10,000 EMPLOYEES ACADEMIC PARTNER: BAYLOR COLLEGE OF MEDICINE Texas Medical Center West Campus The Woodlands Texas Children’s Pediatrics And Community Cares Health Centers TCHP – The Center for Children & Women Urgent Care MFM/Therapy Center/ Imaging

13. TCH Project Guiding Principles Change “sick engine model” to “well engine model” delivered by a health care team Leverage medical home concept within existing expenditures by downstream savings – ED & NICU 8 year implementation trajectory for a positive ROI Multiple Center locations anticipated (2 created to date) Target population: children and pregnant women Ultimate size: 359,000 members Center 1, Year 1: 16, 408 members; Year 2: grow by 40%; and Year 3: grow by 26% (ultimately serving 28,884 members at this location) Patient and Family-Centered Medical Home New model of delivery : personal physician leads team of individual who collectively take responsibility for the ongoing care of patients Enhanced afterhours and weekend access to care Equip healthcare team with timely data to identify how to best serve patients and families Physically dispersed into community that is served Lower cost physical setting 1 2 3 4 5 6 7 8 9 10

14. 2 JPS HEALTH NETWORK

15. JPS Patient Demographic Study 15 Note: Driving times are averages used in Microsoft MapPoint, and may not adequately reflect rush times and other non-controllable traffic factors. The zip codes with the largest populations < 250% FPL and uninsured are within 20 minutes of JPS’ main campus, with the exception of North Arlington’s 76010, which is inside of 30 minutes. Areas of Poverty include Central Tarrant County, Northern part of Arlington, South Central Tarrant County *Because this is a service area analysis, there are pockets of wealth, but overall the average HH income is below $35,000 for these areas

16. Current State – Patient Origin Connection membership 2/28/11 = 12,400 JPS Patient Origin Study

17. Operational Parameters: Workload Volumes Future Scenario Projections

18. JPS Site Selection JPS Campus Arlington Medical Home

19. JPS Conversion $7.2M Original Construction Budget $6.1M Final Construction Cost 2 Bidders After 16 Pre-Bidders (Complexity, Building Access, Unknowns From Limited Investigation, Aggressive Schedule) Different Footprint From When Project Started Approvals Required By Neighboring Tenants – Couldn’t Add Coffee Shop

21. Arlington, TX Cooper Commons

22. Medical Home – Space Program Summary Total Area50,400 sfQuantity of Rooms Admin / Public Area11,045 sf Diagnostics7,770 sf2 Gen Rad, 2 US, 2 Mammo, 1 Bone Exam Modules16,560 sf40 Exam Rooms, 8 Consult Room Women’s Clinic5,785 sf12 Exams, 2 Consult, 2 Centering Dental Clinic1,730 sf5 Operatories Behavioral Health1,170 sf5 Exam Rooms Support Services4,170 sf Education2,170 sf