2019-12-19 PAG FinalPARTNERSHIP ADVISORY GROUP
DECEMBER 19, 2019 MEETING PAGE 1
ASSEMBLY
The Partnership Advisory Group met for a meeting on Thursday, December 19, 2019, at 5:30 p.m. in
the Andre' Mallette Training Rooms at the New Hanover County Government Center, 230 Government Center
Drive, Wilmington, North Carolina.
Members present: Co -Chair Barbara Biehner; Co -Chair Spence Broadhurst; Vice Co -Chair Bill Cameron;
Vice Co -Chair Dr. Joseph Pino; Members: Dr. Virginia Adams; Evelyn Bryant; Robert Campbell; Chris Coudriet;
Cedric Dickerson; Brian Eckel; Jack Fuller; Hannah Gage; John Gizdic; Dr. Sandra Hall; Meade Horton Van Pelt;
Dr. Chuck Kays; Tony McGhee; Dr. Michael Papagikos; Dr. Mary Rudyk; and David Williams.
Members absent: Jason Thompson.
Staff present: County Attorney Wanda Copley; Clerk to the Board Kymberleigh G. Crowell; Assistant
County Manager Tufanna Bradley -Thomas; Chief Financial Officer Lisa Wurtzbacher; Chief Communications
Officer Jessica Loeper; Budget Officer Sheryl Kelly; New Hanover Regional Medical Center (NHRMC) Chief
Communications Officer Carolyn Fisher; NHRMC Chief Legal Officer Lynn Gordon; NHRMC Chief Strategy Officer
Kristy Hubard; NHRMC Media Relations Coordinator Julian March; NHRMC Executive Vice -President and Chief
Financial Officer Ed 011ie; Joseph Kahn, Shareholder with Hall Render and outside counsel for NHRMC; Ryal W.
Tayloe, Attorney with Ward and Smith and outside counsel for NHRMC; and David Burik, Navigant Managing
Director.
Co -Chair Broadhurst called the meeting to order and thanked everyone for being present.
Co -Chair Biehner thanked everyone for attending and stated there are three key items on the agenda
to cover in the time allotted and provided a brief overview of each item.
APPROVAL OF MINUTES
PAG Member Eckel MOVED, SECONDED by PAG Member Pino to approve the December 5, 2019
minutes as presented. Upon vote, the MOTION CARRIED UNANIMOUSLY.
DEVELOPMENT OF GOALS AND OBJECTIVES: REVIEW OF UPDATES TO GOALS 6 THROUGH 10 AND APPROVAL
OF ALL GOALS AND OBJECTIVES
Co -Chair Biehner stated that Goals 1 through 5 were covered at the prior meeting. Goals 6 through 10
will be covered during this meeting, modifications are noted in red in the PowerPoint, and the review
proceeded with discussions noted below:
Goal 6: Driving Quality of Care Throughout the Continuum: Discussion was held about changing the
word "quartile" to "decile" as NHRMC is already in the top quartile. There was general consensus of the
members to make the change. In response to questions, Member Gizdic stated that the current measurement
lands in the area of the 75th percentile on achieving top quartile performance on quality indicators. The
expectation is top decile if not top ten in the country.
Discussion was held about the objective "Engage and empower nurses to be leaders in achieving
excellence in quality and patient care" and having a reference to physicians as well. In review of whether or
not it is included under another goal, it was determined it is not specifically stated and should be. There was
general consensus of the members to include specific language to address other types of providers.
Goal 7: Improving Level and Scope of Care: Discussion was held about the probability of there being
some academic institutions in addition to other respondents to the RFP and if that is the case, would it be
possible to have those respondents elaborate on the potential to have a medical school, medical school branch,
or Physician's Assistant (PA) program here. While it is in Goal 5 in the discussion about partnership, it may also
apply to Goal 9. It was noted that these offerings would serve as an economic driver for the region and not just
for the development of future healthcare providers, but also for healthcare providers to populate the region
as a consequence. Member Gizdic stated that the support team will figure out where to include the language.
Discussion was held about removing the word "burns" from the statement "Ensure improved and
coordinated patient access to quaternary services not offered by NHRMC..." Co -Chair Biehner noted that the
statement is addressing coordinated access to the services not offered by NHRMC. Member Gizdic provided
additional clarification that this is not about drawing the services here, it's the fast pass concept. After
additional discussion, members were in general consensus on the statement.
Goal 8: Investing to Ensure Long -Term Financial Security: Member Gizdic stated there is a need to be
sensitive to NHRMC staff which is why the words "...including revenue cycle and IT infrastructure" were
removed. They were meant as specific examples, but were taken literally during an internal review that he held
in the organization and thinks it is better to remove the specific examples. Members were in general consensus
with the change.
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DECEMBER 19, 2019 MEETING PAGE 2
In response to questions, Member Gizdic stated that the long-range strategic capital plan has been
confidential. Respondents will have to sign a non -disclosure agreement to have access to the confidential
documents in the virtual (online) data room. He confirmed that once the committee begins discussions about
being stand alone, the capital plan will be part of the discussion.
Goal 9: Strategic Positioning: Co -Chair Biehner reviewed the modifications. No discussion was held or
comments made on Goal 9 as presented.
Goal 10: Governance: Co -Chair Biehner stated there will be a presentation on this goal during the
second meeting in January. In response to questions, Member Gizdic stated the idea for the objective
"Maintain local control/decision making on hospital-based provider contracts, joint ventures and other
physician contracts and agreements" is to learn about a respondent's specific physician relationships. Those
are areas that are specific to the different types of relationships NHRMC has with different physicians/providers
and the desire to make sure the decision making remains local.
After a brief discussion was held about taking a vote on the approval of all the Goals and Objectives as
amended and presented, Co -Chair Biehner asked for direction from the PAG.
Motion: PAG Member Williams MOVED, SECONDED by PAG Vice Co -Chair Pino to approve the ten Goals and
associated Objectives as amended. Upon vote, the MOTION CARRIED UNANIMOUSLY.
DISCUSSION ON ALL DRAFT RFP QUESTIONS
Co -Chair Biehner stated that the draft RFP Proposal Request document contains all of the comments
in red that were provided prior to today's meeting. A brief discussion was held about how to work through the
document and the general consensus of the members was to work through each section and related
subsections to review the referenced questions and comments.
A brief discussion was held about how to handle grammatical items in an effort to not take up time
during the meetings. The general consensus of the members was to send in grammatical (non -substantive)
items to the appropriate support staff for review and correction. Review of the sections took place with
discussions noted below:
Section 1: Improving Access to Care and Wellness Programs: In review of subsections 1.1 — 1.5,
Member Gizdic stated for subsection 1.5 there may be a need to flesh out a few more specialties in addition to
what is included in the section. There will be a need to figure out how to best word them as they are not
mutually exclusive, nor is there a comprehensive list of everything that the PAG would want the responders to
answer. There are several other specialties that NHRMC is interested in hearing about from the respondents.
Discussion was held as to whether or not a general question could be included about other specialties a
respondent could bring that NHRMC does not currently have. Member Rudyk noted one specialty that is lacking
in the region is psychiatry and it would be good to know how a respondent would address continuous
psychiatric care across the region. Member Hall stated if there is a specialty that is known to be in an area
where help is needed, such as maternal fetal health, then it should be included in the RFP. Member Papagikos
agreed that there are other specialties, services, etc. that should be included and could be summarized into
the RFP by using the needs assessment document if it is available. Co -Chair Biehner felt that could be done.
Member Gizdic stated the section is centered around service lines, access, and growth and in looking at it from
that perspective, it is a provider, staff, facilities, and equipment. The subsection can be expanded further to
have specific general questions on specific service lines.
Further discussion was held about listing questions on very specific service lines and then do a catchall
for any other service lines that are not asked about in the RFP. It was noted what is being asked for is the
respondent's experience in the service lines and how they will help NHRMC address its needs. Member Gizdic
suggested including in this section the phrase "provide quantifiable evidence" as included in other sections of
the RFP to learn how respondents have done it in other relationships.
Subsection 1.7: As to the commentary about ".... continued transition to value -based care..." and if
there is a separate section about a respondent's experience on it, Member Gizdic stated he thought it was
addressed in Section 2 of the document. Co -Chair Biehner asked to be sure it is not forgotten about.
Subsection 1.9: As to the commentary about ".... their experience with Predictive Analytics ..." Vice
Co -Chair Pino stated he knows it was included in Goal 7 or 8 and as the members approved all the Goals and
Objectives earlier, his question has been addressed.
Subsection 1.10: As to the commentary about if the verbiage for this subsection belongs in subsection
1.1.1, Member Gizdic stated he would err on the side of specifically addressing rural health care. It is a known
crisis in North Carolina and it is known that southeastern North Carolina is extremely rural once outside the
Wilmington city limits. As such, all of NHRMC's regional facilities and partners are very rural so it is well worth
asking the question, even if it is duplicative.
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Section 2: Advancing the Value of Care: Discussion was held on the commentary "... establishing and
further developing partnerships with our community service groups..." and that community partners had been
identified in another section of the RFP. Member Gizdic stated he thought it was mentioned in Section 6, but
he would also like to include it in this section to receive answers from a value perspective. Members were in
general consensus to have it added into this section. Member Coudriet asked when referencing the
Department of Health and Aging if it was something within the hospital or the County. Member Rudyk stated
it was referencing the County. Member Coudriet stated they do not exist in that context, but rather as the
Department of Public Health and the Senior Resource Center. Member Rudyk requested that be corrected.
Vice Co -Chair Pino stated for the Medicaid verbiage in the commentary should read "Community Care of the
Lower Cape Fear."
Section 3: Achieving Health Equity: Co -Chair Biehner reviewed the modifications and there was no
additional discussion or commentary.
Section 4: Engaging Staff: Discussion was held about asking in subsection 4.1.1 for nursing retention
rates and other retention rates as a benchmark to see how other organizations have done. Vice -Co -Chair Pino
stated it is not just about recruitment, but the objective value that could be used through this process is the
retention rate. Member Gizdic suggested going even broader to work in the concept of quantifiable evidence
including things such as turnover rates, retention rates, employee engagement scores, etc. to have data that
would demonstrate the evidence of what has worked and what has changed. Member Fuller stated throughout
the RFP, quantifiable evidence needs to be stressed as he would like to see the actual information to compare
to industry standards, NHRMC standards, etc. Member Gizdic stated he also likes the duration comment as a
theme and suggested both be incorporated where it is appropriate. Further discussion was held about
subsection 4.1.6 potentially covering these items. Members agreed what they are looking for are the rates and
quantifiable results, and were in general consensus to include quantifiable results and duration throughout the
document where appropriate.
Subsections 4.2 and 4.3: Discussion was held about concerns some members had with the verbiage "...
how long each such commitment and/or program was or will be in effect..." While realizing things do change,
there is an expectation for some things to continue without a duration. The concern about the effect on
NHRMC employees, compensation and benefits, etc. are concerns that have been voiced by many in the
community, in public forums, and by NHRMC staff. Respondents should share examples of how it handled
recent acquisitions as there have been a lot of stories of these type of acquisitions taking place and having
significant issues with job turnover and job loss. Members were in general consensus on asking about the
duration of any relevant commitment and to use the verbiage as the standard comment.
Subsections 4.3.3 and 4.3.5: Discussion was held about the subsections being similar, redundant, or
independent. Members were in general consensus to keep the verbiage as is.
Subsections 4.4 and 4.5: Co -Chair Biehner noted the sections have the same relevant commitment
language as the prior two subsections.
Subsection 4.5.4: Co -Chair Biehner noted that in this section there is an ask to "... provide quantifiable
data on programs introduced by respondent that supports enhanced efforts." Member Gizdic noted it will
probably be seen in several other places.
Subsection 4.7: In response to questions about the commentary "Is this question answered by the
response of the respondent's tax status?" Vice Co -Chair Pino stated for example if he is a physician who has a
student loan and is looking for some forgiveness or payback, and is working at a 501(c)(3) not-for-profit, he can
apply for loan forgiveness with the government. If the tax status changes to a private, for-profit institution and
the loan forgiveness to the government goes away, then he would have to find a different employer. He does
understand the rationale of including it. Ms. Gordon stated there are some options that for -profits can have
collaboration or affiliation agreements with a federally qualified health center facility that transitions. There
should not be an assumption this is what will happen and she would suggest leaving the question open to hear
the responses. Member Gizdic noted that there may be other programs that NHRMC may not qualify for
currently or does not participate in that another medical center or some other type of organization might bring
to the table that may result in more NHRMC employees being eligible for a form of loan forgiveness. He
suggested the section not only be left in but expanded to include "...and what other kinds of programs can be
brought in by the respondent in addition to ..." Members were in general consensus to include this verbiage in
this section.
Section 5: Partnering with Providers: It was noted that subsection 5.2.5 was removed due to
repetitiveness.
Subsection 5.4.3: In response to questions, Member Gizdic stated the question does take into account
stipends, hospitalists, other physician contracts, and agreements.
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Subsection 5.4.4: In response to questions if there are other clauses that should be thought about in
addition to the use of non -compete and cost share provisions, Member Gizdic stated that cost sharing is
another form of non -compete. The question is about at an organization's philosophy and how they work with
providers.
Subsection 5.4.5: In response to questions about including the same timeline wording, Member Gizdic
responded this is important as one of the Goals and Objectives is about maintaining and strengthening
relationships with independent practices in the community and recognizing their importance. He thinks having
examples and quantifiable evidence of how a respondent works with independent physician practices in their
other relationships would be important. In response to questions about the verbiage "... non -hospital affiliated
physicians...", Member Gizdic stated that he believes the intent is for it to mean physicians not employed by
NHRMC. It may be better to use "independent physician practices" as this is more common language, which is
consistent with the verbiage in the Goals and Objectives. Members were in general consensus to change the
verbiage to "independent physician practices". In response to questions about the verbiage"... expect for their
patients and practices ...", Member Hall stated it is along the lines of if they still have same access to the
hospital, if a respondent is still working with those physicians in a relationship that has been built, or they say
they will bring in their own people not allow those physicians the same access. Member Eckel stated this would
be a good area to include the ask of quantifiable evidence and members were in general consensus with the
inclusion of the language.
Section 6: Driving Quality of Care and Patient Safety Throughout Continuum: In response to questions,
Member Gizdic stated there are countless ways to report on quality of care. Every specialty has a place it
reports to. He would not limit it to one type of reporting system, but rather leave the question open ended. As
to reporting credentialing information, Ms. Gordon stated that will be listed by the respondent in the
description of themselves. Member Gizdic stated it is also who is used, what the expectations would be for
NHRMC, and a request to provide the report from the last visit so it can be seen what the deficiencies are and
other comments. It may not be a public document but it can be requested. He is not sure where it goes in the
RFP, not necessarily under continuum, but it is an important set of questions around a respondent's accrediting
body.
Subsection 6.1.5: In response to questions about the amount of information that may be provided,
Member Gizdic stated it can be either left open ended to see what is provided generally related to quality and
patient safety or it would have to be very specific with each item being listed. A lot of the systems are larger
and have hospitals where each has its own independent report so there will be variability between facilities.
Regarding including questions about the most recent acquisitions, Member Gizdic agreed this is
important information. Discussion was held on the need to request information on facilities that are
comparable to NHRMC, what impact did they have on their most recent acquisition, and to look at it over a
five and ten-year perspective.
Further discussion was held on the questions asked in the community about quality decreasing when
there is a change in ownership. Vice Co -Chair Pino stated having the data from over a period of time would
help to address that concern. Member Gizdic stated it ties back into the earlier question about how quartile is
not good enough, it is decile that is the expectation of NHRMC and should be the expectation of the community.
The question becomes how is any partner going to help NHRMC get there and can they demonstrate they have
done that anywhere else. In response to questions, Member Gizdic stated with the refinements that were just
discussed, this subsection will be more detailed than what is currently shown.
As to whether there is any warranty structure or default remedy if a respondent presents this
information and a diminution of care is seen five or ten years later and having the ability to reevaluate at a
later time, Ms. Gordon stated there would be an entire section on reps and warranties on what they are doing.
The reps and warranties can also be tied to what is being asked for. It is all negotiable in terms of how far they
go and what the penalties would be or the unwinds, etc. It would not be included in the RFP but in later
documents and will depend on the model.
Section 7: Improving the Level and Scope of Care: As to the commentary if subsections 7.1.3 and 7.1.4
are in conflict with each other, Member Gizdic stated the questions cover two separate things. The intent of
subsection 7.1.3 is to not take anything out of this market and move it somewhere else as there will not be a
downsize of any services here. The intent of subsection 7.1.4 is referring to southeastern North Carolina and
what is a respondent's philosophy on centralization versus decentralization. For example, should all services
be on one campus or do they believe primary level services should be close to home within one to three miles
driving distance, and secondary services should be geographically distributed within a seven to ten -mile radius.
Members were in general consensus for the verbiage to be clarified in subsection 7.1.4 to reflect what has
been discussed.
Section 8: Ensuring Long -Term Financial Security: Discussion was held about subsection 8.1.1. Member
Coudriet stated there is a limitation under the current structure for borrowing outside the County. Even if that
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is fixed, he does not think it deals with the bigger problem which is access to capital as there is very limited
access. Discussion was held that subsection 8.1.9 may address it. Member Gizdic stated this subsection is about
a respondent's access to capital and how they would provide it to NHRMC. Member Coudriet stated it is
important for proposers to understand there are two problems: 1) borrowing outside and 2) on its own NHRMC
does not have access to the necessary levels of capital. Further discussion was held about revising the
subsections. Member Gizdic stated he thinks as currently written, subsection 8.1.1 gets at the first issue and
potentially subsections 8.1.6 and 8.1.9 get to the second issue about debt capacity, access to capital, and capital
markets.
Subsection 8.1.4: In response to questions about if the words "obligated group" can be explained
further, Member Gizdic stated the language can be cleaned up. It is a technical term related to the audit and
the entities that are obligated. Mr. Burik stated for example, if the successful partner is a system in Nebraska
and if NHRMC is part of the obligated group and there is a cash flow in Nebraska, it is NHRMC's cash flow, so it
is obligated.
Subsection 8.1.8: As to the commentary about the data room and access to the information, Member
Papagikos stated based on Member Gizdic's earlier explanation, he understands what is being discussed.
Member Gizdic stated that the data room will be the virtual place where respondents can look up information
on NHRMC. The PAG will also get a lot of important information such as the long term capital plan, financial
projections, etc. The PAG will be reviewing this information while the RFP is out.
Subsection 8.1.9: Co -Chair Biehner stated this wording was discussed earlier about the addition of the
verbiage regarding access to capital structures.
Subsection 8.2.1: Discussion was held on the commentary about judging the responses based on who
will and will not allow current cash reserves to be released to the County. As to what is trying to be
accomplished, Member Gizdic stated it is based on the respondent's proposed partnership structure and what
impact would that have on NHRMC's existing cash and investments. Currently, the investments and cash in
terms of use and what happens with them are directed by the NHRMC Board of Trustees. If it is not an
acquisition and something short of that, then there is a need to know the respondent's commitment that the
NHRMC Board of Trustees continues to direct the cash and investments locally, not out of the area.
Subsection 8.3: In response to questions, Member Gizdic confirmed this is the same concept as in
subsection 8.2. In response to additional questions, Co -Chair Biehner confirmed that this section is distinct and
separate from the governance section.
Section 9: Strategic Positioning: Discussion was held about the commentary for subsection 9.2.1 and
why Pender Memorial Hospital (PMH) is being suggested versus the seven county area. Member Gizdic stated
the question is specifically addressing the lease with PMH and asking if the respondent will commit to
maintaining and honoring the existing relationship with PMH. NHRMC does not want a respondent to cut the
relationship with Pender, which has been in existence for 21 years. The desire is that a proposer will say they
will do PMH plus five others.
Member Gizdic shared with the members for their consideration a question to be included in Section
9 about the system or potential partners' resources, capabilities, and commitment to NHRMC as it relates to
disaster preparedness, recovery, and support. During Hurricane Florence and when the County became an
island, the physicians, County, and his staff did a phenomenal job. However, if there had not been access to a
mobile hospital there would not have been healthcare services in Pender County. If there had not been
relationships with other healthcare facilities in place, there would not have been staff flown in to relieve
NHRMC staff. When talking about being independent which has its own pros and cons, this was a
situation/scenario where NHRMC could take all the help it could get. When looking to other relationships, the
question is what can the respondent do for NHRMC given the geography and given the fact this area faces
natural disasters disproportionally to most others. Discussion was held that it needs to be about preparation,
recovery, and support.
A brief discussion took place about the NHRMC Hurricane Florence after action report and what was
determined to be the needs for the future. Member Gizdic stated some of the determined needs were access
to alternative care facilities such as a mobile hospital, other assets and resources an organization could bring
into the community if a facility was damaged or unable to reopen, access to staff that could relieve the NHRMC
staff, and supplies. Member Gizdic confirmed that during that time, NHRMC staff returned by organizations
that volunteered their helicopters and private aircraft as well as their own staff to assist. Those organizations
also diverted their own resources to provide supplies to NHRMC. The relationship with reserve military units
was support with supplies and in getting staff via high water vehicles from here to Pender. However, they do
not fly staff in from Charlotte or Raleigh, which is where NHRMC had staff stuck who could not get back. It was
also noted that when NHRMC requested help for shelters that were opened, the state took almost a week to
supply that type of emergency support. From that perspective and as much as it would be ideal to have the
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National Guard come in on short notice to provide that support, it did not play out that way. Members were in
general consensus to add this question to the RFP.
Brief discussion was held about the earlier question of asking about the expansion of a medical school
program, PA program, etc. While it is in Section 5 under graduate medical education, Member Gizdic stated he
likes Member Gage's idea and would like the question to be more direct. There are a lot of needs with health
shortages and a desire to know what the respondent could do to help bring programs here. Members were in
general consensus to add it under either Section 5 or 9.
Section 10: Governance: Discussion was held about the addition of subsection 10.3. Member Gizdic
stated he would like for it to be expanded to the language used in the Goals and Objectives and well as under
Section 5 around not only hospital-based contracts, but other joint ventures and other contractual
relationships with physicians. As to whether the question is different from subsection 5.4.3, Vice Co -Chair Pino
stated he did not see it when putting it together, so he placed it under Governance. Member Hall stated it does
not address local control. Member Gizdic agreed stating he thinks subsection 5.4.3 is more of learning the
respondent's philosophy and what kind of impact there has been, whereas subsection 10.3 is a respondent's
commitment to keeping all the decisions local.
Discussion was held about cleaning up the document, if there are going to be questions about "if so,
for how long" on some things, and the need to thoroughly review everything again. For example, in subsection
9.1.2 for the question about PMH, there is a need to know the "if so, for how long." Discussion was also held
about the commitment and quantifiable evidence questions being included consistently throughout the RFP.
A suggestion was made to make these questions a blanket statement for the entire RFP as an expectation of
responders.
Discussion was held about the possibility of the RFP being tightened based upon NHRMC's financial
posture and scores. Members expressed concerns that while there is the ability to ask for anything, there may
be a refusal by the responder to answer because it is thought the asks are too much and no responses may be
received. Member Gizdic stated it is the role of the support team (legal, financial, strategic, etc.) to tell the PAG
what it is able to ask for, if it is too much, or not enough. Co -Chair Biehner stated she would expect the financial
advisor to give a lot of information around the strategy. There is also a need to prioritize what the PAG
expectations are before the responses are received and to make sure the priorities are known when reviewing
the documents. There are critical points that need to be addressed during the reviews. Ms. Gordon stated that
the support team is responsible for this, has gone through the questions in great detail, and is continually
reviewing everything as comments are received. It is being done live and so far the PAG has not overreached
in the RFP. If the support team sees an overreach that would have the effect of not getting a response, the PAG
will be made aware. In response to questions, Ms. Gordon does not believe the PAG has under reached.
Further discussion was held about the RFP questions and how there will and will not be good things
seen from some responders. There may come a point in the second or third rounds during the culling of the
responses where it may be the PAG is thought to be asking for too much. Member Dickerson noted that no
matter what is asked for, what the responder is willing to give and receive is when the rubber meets the road.
They may be willing to give a lot, but want a certain level of control and that may be a deal breaker. At some
point after receiving the responses, a happy medium will be found to accomplish the goals and part of it is the
governance piece. He has heard a lot in the community about not relinquishing local control and feels if a
proposer can give what is needed and NHRMC maintains the control, then there is an opportunity to negotiate
to find a solution. Member Gizdic stated that since the beginning of this process, the discussion has been the
positon of strength NHRMC is in as an organization by just about every measure and every score as well as the
attractiveness of this market and good demographics. Mr. Kahn stated he thinks the way the RFP is setup it is
saying this is what we are interested in and what can the responder give to us. It is more of a solicitation to
make an offer as it is a request list that we want for x, y, and z and then the questions become are we justified
in asking for it, are they offering enough, too much, etc.
Co -Chair Biehner stated the ten sections just discussed follow NHRMC's strategic goals. The next two
sections to be reviewed are the Proposed Strategic Partnership Structure and Deal Process and Transaction
Timing. Review of the sections took place with discussions noted below:
Section 11: Proposed Strategic Partnership Structure(s): Co -Chair Biehner reviewed Section 11 noting
the commentary on subsection 11.2.4 and the new subsection 11.2.5. As to the commentary on subsection
11.2.4, Co -Chair Biehner asked for report cards on each respondent as it would be important to have the record
of each respondent's performance, whether in the form of a report card, summary, or some other form of
document. There is also an opportunity for the PAG to perform its due diligence by going into a community to
see what a respondent has done.
In response to questions, Co -Chair Biehner and Member Gizdic confirmed that the financial advisor
would help the PAG assess a lot of this information and is one of their key jobs. Co -Chair Biehner stated she
would look to Navigant as well for assistance.
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Section 12: Deal Process and Transaction Timing: As to the commentary on subsection 12.1, Co -Chair
Biehner stated she agrees that the question needs to go beyond for-profit and be asked of all the respondents.
For the rest of the section, particularly subsection 12.3.3, the information is standard statutory information.
Other General Commentary Section: A review was held and no additional comments were made.
Comments to be addressed through Exhibit B Section: Discussion was held about asking respondents
to provide their top ten diagnostic related grouping (DRG) codes to be able to compare those costs to NHRMC's
costs and show examples. Members were in general consensus to include this question. In response to
questions, Member Gizdic stated that the question on the social determinants of health is primarily covered in
Section 3.
General discussion was held on the information reviewed. Co -Chair Biehner stated she thinks all agree
there is a need to include requests for metrics on quality, patient satisfaction, reducing clinical variations,
employee satisfaction, and all the other pieces discussed that will be included in the RFP. Member Gizdic stated
the document will be revised and cleaned up to add the quantifiable evidence, relooking at commitment,
duration, etc. and it will be brought back at the next meeting for another review, much like what was done
with the Goals and Objectives. Co -Chair Broadhurst would like for the revised document to be sent to the
members in advance of the January 91h meeting so the members can be ready to vote during that meeting. Co -
Chair Biehner stated she would ask that members say everything has been done, the points made tonight are
accepted, and the new comments that were made are what should be addressed. This way, members are not
trying to re -red line the document and go back over and question all the work that was just done. Member
Cameron suggested that the support team take the document with the accepted changes, clean it up to remove
the footnotes, etc. and then send to the PAG the revised draft with a redline that is comparable to the draft
reviewed tonight as it has been accepted. Co -Chair Broadhurst confirmed this is what will be done.
Member Gizdic stated the revised draft will be sent back out to the members as soon as possible and
noted that what was discussed tonight is the core of the RFP. There are other sections of the RFP that are more
boilerplate which can also be provided to the members. Co -Chair Broadhurst stated if progress is made through
the rest of the agenda and there is time, he is going to ask the support team to disburse the hard copies of the
boilerplate information so the group will be able to review it in advance of the next meeting. It will also be
emailed. Co -Chair Biehner stated at the next meeting the process will be to endorse what was done tonight
and look at the RFP as a template.
In response to questions on when the PAG will discuss stratifying and determine what are the most
important responses through this, Member Gizdic stated once the RFP is sent out discussion will be held about
the priorities in a gap analysis format in setting the priorities. It will be one of the very next steps. Co -Chair
Biehner stated based on how future meetings proceed she would expect this topic and governance to be
discussed in January.
In response to questions, Co -Chair Biehner confirmed at the next meeting there will be a vote on the
final RFP. Member Papagikos asked if that will be the first time the perfected document will become available
to the public at the same time as respondents or is there an opportunity for additional crowdsourcing (making
it public) of the document one more time before it gets finalized. Co -Chair Broadhurst stated everything that
has been done is public and everything from tonight will be put on the website for the public. Member
Papagikos asked if there was going to be a solicitation for public comments before the final draft is sent out
and if members think there would be any value in having a request for comment period. Member Coudriet
stated that is not called for in the PAG charter and other members stated the PAG is the one representing the
public and voting on the document. Member Eckel said the website is setup, the emails are coming in, and
everything is being posted publically so he thinks it is being done as the PAG moves forward. Co -Chairs Biehner
and Broadhurst agreed. In response to questions, Member Papagikos stated he supposes it is a little late for a
great idea to come in that says the PAG missed a really important question. For example, could the PAG have
almost missed the question about disaster preparedness. Member Gizdic stated what will be seen in the
boilerplate language and what has been discussed, the PAG reserves the right to ask any and all questions at
any time throughout the entire process.
Co -Chair Biehner asked Member Eckel to report on the review by the NHRMC Board of Trustees (BOT)
of the Goals and Objectives. Member Eckel reported that the BOT has been trying to find its place in this process
and not step on the toes of the PAG. The BOT has been following the progress of the PAG and voted during its
December 18th meeting to take a position to support the Goals and Objectives, one through ten, and also the
RFP knowing there would be more changes based on the available information. Co -Chair Biehner stated the
BOT is now meeting monthly and Member Williams noted that the extra meetings are solely about the PAG
and its work. Member Eckel stated the BOT has been discussing what if the PAG does not make a
recommendation or the County Commissioners kill it, as the hospital still has to operate, there are goals and
objectives, and the BOT has to move forward.
PARTNERSHIP ADVISORY GROUP
DECEMBER 19, 2019 MEETING PAGE 8
In response to questions, Member Coudriet stated that the County Commissioners are being kept
informed through County staff and also the Board Chair sits on the BOT and has maintained regular
communication. However, none of this is going before the Board of Commissioners for approval, the RFP or
the Goals and Objectives. A status update to the Board of Commissioners will be provided during an upcoming
January meeting.
In response to questions about what happens if the BOT does not approve something done by the PAG
and how will it impact the PAG or negate its work, Member Eckel stated the Goals and Objectives were easy
because they are aligned with the strategic plan and the RFP followed those Goals and Objectives. There was
not a lot of opportunity for disagreement. The BOT is trying to be very careful and not overstep. It is understood
the PAG is doing the work, not the BOT. The BOT is closely following what the PAG is doing, is in full support,
and thinks it is important for the citizens to know that it is engaged and following the work of the PAG. As to
the earlier question of the worst case scenario of the BOT not being in support, Member Eckel stated he thinks
the worst case scenario for all of it is when the PAG makes a recommendation but the ultimate decision is with
the County Commissioners.
Further discussion was held about crowdsourcing. Member Campbell stated he thinks the PAG has
done a phenomenal job of being transparent. He also thinks it would be worth whatever delay it would be after
the RFP is written, even if it is put on the regular post, and state that the PAG is soliciting any comments. Then
when those comments come in, the RFP does not have to be rewritten, they can glean through them to see
what is worth considering between now and the January Stn meeting. He thinks it is another step in being
transparent in soliciting input and shows that the PAG has been very intentional about being transparent. He
would ask the soliciting of public input be reconsidered. Member Eckel stated everything is being posted, the
PAG is already saying it is being transparent and asking for comments, and there is a whole PR team pushing
that forward. He would be concerned if the PAG says on January Stn that now it will take comments, then the
question is how long does the PAG want comments for because if it is for two weeks, that would not be enough
time. Co -Chair Biehner stated what she heard Member Campbell say is the PAG can move forward in the
process because the RFP does not have to be rewritten, if it has comments those will be brought together, and
while moving through the RFP process some comments may be added because something else was thought
of. Member Campbell agreed with Co -Chair Biehner's comments. Co -Chair Broadhurst stated the work done
up to this meeting is already public and the information from this meeting will be available to the public on the
website very soon. All members should encourage the community, through the website and conversations, to
give the PAG feedback and questions. The PAG members have access, if it goes through the email system, to
all the comments that come in and the PAG members can make their comments through the system between
now and January Stn, so the support team will have a chance to incorporate all of that for review on January
Stn It was noted that some of the citizen emails are good comments and most are dealing with what will be
discussed in January and February.
Additional discussion was held about how asking for a specific public comment period would not
necessarily slow the process down and looking into what mechanism could be used to advertise it. Member
Coudriet stated he is not certain the charter allows for that, which is why the PAG does not open and invite
public comments at the meetings. There has been a system setup for people to read, hopefully it is influencing
the members as they have their debate, but he does not believe the charter allows for the PAG to put the final
document out there for that and is going to be looked at in the opinion of is this good or not. The PAG is not
asking for permission from anyone to release an RFP. This group has been charged with it, there have been
meetings, and everyone has been bringing their ideas forward. To put it out for public comment in the
traditional sense that is being framed is not in keeping with what the members signed onto. Member Gage
stated she thinks what is being discussed is not a public hearing, but rather making sure people realize the PAG
is interested in their thoughts. The communications team is working on promoting the PAG members and it
seems there is a way a message can be sent out to local tv and radio, etc. to say if people have comments send
them in through the email process. Member Coudriet stated that is very different from what is being described.
Co -Chair Broadhurst stated he thinks everyone is saying the same thing because what the PAG wants is all the
input it can get from anywhere it can be received from, that is productive towards getting the RFP right. The
PAG is charged with the final vote and decision to do that, so any mechanism within the charter that can be
utilized for this needs to be done. He also thinks the support team has done a remarkable job of promoting this
as well as the media.
In response to questions concerning the message not getting out for people to provide comments
through the website, Member Papagikos responded that he was not concerned until he received requests for
marketing material, being asked to sit for videos, and make rounds at the hospital. It appears there is a desire
to accurately portray the transparent and high quality work of the PAG. If the idea is to market that the PAG is
doing a good job and the process is going well, this seems to be very much in keeping with what the marketing
team is trying to get members to do. Co -Chair Biehner stated she thinks the description he used was a much
more formal process, but thinks everyone is on the same page. It is going to be promoted, it is going to be on
the website, and comments are welcomed and will get integrated throughout the process. Member Coudriet
stated this is what has been happening along the way, but for bureaucrats like him when someone says open
it up for public comment, that is an altogether different process than what was agreed on for this work.
PARTNERSHIP ADVISORY GROUP
DECEMBER 19, 2019 MEETING PAGE 9
UPDATE ON RFP FOR FINANCIAL ADVISOR
Ms. Wurtzbacher reported that the recommendation is for Ponder & Company to be the financial
advisor. Three responses to the RFP were received and all respondents were qualified. Ponder & Company is a
niche firm in that it focuses on not-for-profit healthcare systems and hospitals and their proposal was more
geared specifically to what was asked for in the RFP. They have been doing mergers and acquisitions practice
for twenty years, but have been in business since 1974 providing advice and are based in Tennessee. They do
have experience with North Carolina healthcare systems and are absolutely qualified. The hourly rate provided
was a competitive rate, references for all the firms were checked, and all came back good. The references
received for Ponder & Company echoed their response in that they are as experienced as the bigger firms, but
provide a more personalized approach to their services. Member Gizdic stated that NHRMC has not worked
with any of the three respondents.
Hearing no further discussion, Co -Chair Broadhurst asked for direction from the members on the
recommendation.
Motion: PAG Member Eckel MOVED, SECONDED by PAG Member Pino to accept the recommendation of
Ponder & Company as the Financial Advisor. Upon vote the MOTION CARRIED UNANIMOUSLY.
CLOSING REMARKS
Co -Chair Biehner stated the RFP template is being handed out for members to review prior to January
Stn and it will be emailed as well. It is a standard RFP template. Member Gizdic stated this is a very standard
approach which has been tailored to this specific situation so the respondents know upfront the expectations,
how the PAG is going to move forward, and are being encouraged to provide multiple options.
Ms. Gordon stated that document is still marked as confidential as the support staff was not sure the
PAG would have time to get to the document tonight. As with every PAG document to date, that will be
removed and it will be posted tomorrow for the public.
Discussion was held about the email members received about outreach efforts for the community and
asking members to do videos, rounding at the hospital, etc. Member Hall stated she feels this should be more
about the process, not the PAG members. She would prefer time and energy be put into public forums and
answering the public's questions. Co -Chair Broadhurst stated his understanding was that the community wants
to know who the members are in addition to the bios that have been sent out. Member Gizdic stated he holds
meetings/CEO forums throughout the organization and one of those was done by video. The video received
about ten times more activity than any CEO forum he has ever done. What has been found internally is that it
is much easier for people to access a video anywhere, anytime, on any device, and they seem to like to getting
information that way. It is also about being able to get the message out to more people, reaching a larger
audience, and again, it has been seen to work better internally. As such, the thought was it might translate to
getting the word out much more across the community. Ms. Fisher stated each member brings a unique
experience, background, and perspective that it is helpful for people to hear directly from members to provide
a better understanding of what is being brought to the discussion and the perspective that will influence what
is being recommended. She and the team want members to be comfortable and making a video is optional.
The team is working on putting out information on the process, putting out articles after every meeting, and
finding ways to create graphics and shorter presentations on each of the Goals and Objectives so people can
really understand them.
As to rounding at the hospital and some of the other pieces, Member Gizdic stated the goal is the same
as with the video. This matter is being discussed a lot amongst staff internally as is the PAG and its work.
Hearing about it from him is one thing, but the thought was that it would be helpful and beneficial for staff to
be able to meet some of the PAG members and get their perspectives. From the staff's perspective, this is the
group that holds their futures and they want to meet the members and understand where the members are
coming from. He also thinks it would help reduce anxiety and provide additional information. Member Eckel
said it is probably more important to go to the forums to reach more staff than rounding. Member Papagikos
stated he knows that a public forum is not part of the PAG charter, but there are public forums mandated in
the resolution and asked when the next public forum would be held. Member Gizdic stated the next public
hearing will be after all of the RFP responses are back and that the County Commissioners have to post the
responses ten days prior to a public hearing being held on all of the responses.
Further discussion was held about members attending the employee public forums. Member Eckel
stated it might be good to have five or six members attend the forums together. Some members stated they
are unable to make the forums held during the day. Members were in general consensus to respond to staff
with their availability. Ms. Fisher will be relied upon to allocate the correct number for each forum.
Member Gage stated she thinks staff is doing a remarkable job and commended their efforts to get
information out to the public. She believes it does help the process.
PARTNERSHIP ADVISORY GROUP
DECEMBER 19, 2019 MEETING
ADJOURNMENT
PAGE 10
There being no further business, Co -Chair Biehner adjourned the meeting at 7:33 p.m.
Respectfully submitted,
/final -approved
Kymberleigh G. Crowell
Clerk to the Board
Please note that the above minutes are not a verbatim record of the Partnership Advisory Group meeting.
The handouts and PowerPoint materials associated with the December 19th meeting are included as
attachments to these minutes for reference.
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DRAFT REQUEST FOR PROPOSAL (RFP) PROPOSAL REQUEST QUESTIONS
FOR CONSIDERATION BY THE PARTNERSIIIP ADVISORY GROUP (PAG)
DECEMBER 19, 2019
PLEASE NOTE: The Partnership Advisory Group Support Team leveraged the revised goals and
objectives 1-10 to draft the following Proposal Request section of the RFP for the PAG's
consideration. In addition to the questions derived from the goals and objectives', the
Partnership Advisory Group Support Team included a request for the Respondent to detail the
Proposed Strategic Partnership Structure(s) and the Deal Process2 and Transaction Timeline'
(as applicable to the Respondent's proposal).
The following draft Proposal Request section is not intended to represent a complete RFP.
The remaining RFP sections will be shared with the PAG in advance of subsequent PAG
meetings. We anticipate the final RFP would contain the following contents (in addition to the
questions detailed below):
A. Introduction to RFP Process
B. Submittal Deadline and Instructions to Respondents
C. Basic Information on NHRMC/Accessing the Data Room
D. Potential Next Steps and Asks in the PAG Evaluation Process
E. Goals and Objectives Overview
F. Proposal Requests
Exhibit A: Detailed Goals and Objectives
Exhibit B: Outline for Background Information on Respondent
Exhibit C: North Carolina General Statute §131E -13(d)
F. Proposal Requests
First, the Respondent will provide an overview of its organization following the outline
listed on Exhibit B with as much detail as possible.
Second, Respondent will provide responses to all of the topics set forth below in the
numbering regime provided in this RFP. Answers from Respondent should be succinct and to
the point, providing meaningful information and verifiable content so that PAG can discern the
Respondent's qualifications, plans, intentions and commitments relative to NHRMC. Again,
we emphasize that we are not asking for general summaries or explanations; rather, the PAG
is looking for specific, customized responses. To the extent that Respondent believes that a
prior or subsequent response also addresses other questions, it is acceptable to cross reference
another response rather than create duplicative responses. Additionally, if the Proposed
Strategic Partnership described in Question 11.1 would alter an answer to any other aspect of
Respondent's proposal, please make note of that in responses to those specific RFP questions.
1 F. Proposal Request sections 1-10 beginning on page 2 of this document
z F. Proposal Request section 11 beginning on page 14 of this document
s F. Proposal Request section 12 beginning on page 14 of this document
REQUEST FOR PROPOSAL
Page 2 of 35
Finally, given that NHRMC is a public hospital and must follow the statutory process
outlined in Exhibit C, Respondent must clearly mark — and include as a referenced addendum
that will be redacted — any confidential proprietary or competitive information that is legally
protected from disclosure. All proposals, in final form, will be publicly posted simultaneously
prior to a public hearing excluding appropriate redacted language.
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 3 of 35
1. Improving Access to Care and Wellness Programs DRAFT
1.1. Describe what impact, if any,itnpftet 4 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to furthers develop ambulatory and other outpatient
and wellness program access points in the communities it serves. Also speak to how
and whether Respondent's Proposed Strategic Partnership will facilitate
capitalization and growth of care and wellness sites across the Service Area, including
beyond New Hanover County, understanding the current debt limitations for
NHRMC that preclude this regional health care system from borrowing to build
outside of the County.'
1.1.1. If applicable, discuss Respondent's position on NHRMC's current plans to
expand ambulatory and other outpatient and wellness program access points
in the Service Area.
1.1.2. If applicable, describe the scope and timing of Respondent's commitment to
adding ambulatory and other outpatient access points in the Service Area.
1.1.3. If applicable, describe how Respondent and/or any of Respondent's strategic
partners used the same or similar proposed strategic partnership to improve
ambulatory and other access points in the communities served by Respondent
and its affiliate or partner hospitals.
4 Bill Cameron
'Bill Cameron
' "(add question 1.1.4.) articulate the regulatory or legal issue involved with expanding outside the NH County
area?" Jack Fuller
'Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 4 of 35
1.2. Describe what impact, if any,impaet' Respondent's Proposed Strategic Partnership
would have on improving access to primary care services in NHRMC's Service Area.
1.2.1. If applicable, discuss your organization's approach to staffing primary care
clinics, including leveraging providers with team -based care.
1.2.2. If applicable, describe how Respondent would identify and resolve any gaps
in primary care coverage in the Service Area.
1.2.3. If applicable, provide examples of how Respondent improved both primary
care access and operational efficacy (improved quality, improved patient
safety, improved patient satisfaction, lower cost) in communities served by
Respondent and its affiliate or partner hospitals.
1.2.4. [If applicable,] provide quantifiable evidence of the improvements in the
communities served by respondent and its affiliates.'
1.3. Describe what impact, if any,impaet ") Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to further develop and enhance NHRMC's home
care services within the Service Area.
s Bill Cameron
Jack Fuller
10 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 5 of 35
1.4. Describe what impact, if any,impaet 11 Respondent's Proposed Strategic Partnership
would have on NHRMC providing care for the elderly in both urban and rural settings
in the Service Area. Describe any programs that could be introduced at NHRMC (e.g.,
PACE , adult day care, geriatric urgent care services) and provide
quantifiable evidence to support respondent's approach.13
1.5. Describe what impact, if any,ifnpaet 14 Respondent's Proposed Strategic Partnership
would have on further developing access in women's, neonatal, basic pediatric care,
pediatric oncology, pediatric cardiology and other pediatric subspecialty caress
options in the Service Area.
1.5.1. If applicable, discuss how the Proposed Strategic Partnership would prioritize
and advance maternal and fetal health in the Service Area? 16
1.5.2. Describe what impact, if any, the Proposed Strategic Partnership would have
on NHRMC's ability to support maternal and fetal health programs in and out
of the hospital, including education and outreach to improve health prior to
pregnancy? 17
1.5.3. If applicable, discuss how the Proposed Strategic Partnership would support
the deployment of laborist programs at NHRMC?"
11 Bill Cameron
12 "We already have a PACE program in Wilmington. Is the intent of including it as an example to suggest
developing another one?" Joseph Pino
13 Jack Fuller
14 Bill Cameron
15 Michael Papagikos and "How have the respondents addressed the needs of pediatric population -expanding
access to basic care as well as subspecialty care- our need for expanded subspecialty care (examples pediatric
oncology/cardiology)" Sandra Hall
16 "How have they prioritized maternal and fetal health?" Sandra Hall
1' "How have they addressed the rising maternal mortality rate in the US (only industrialized country with rising
maternal mortality rate). Given the relatively small numbers — surrogate for this would be maternal morbidity?
(e.g., programs in and out of hospitals? education and outreach to improve health prior to pregnancy?)" Sandra
Hall
is "Have they had any experience with laborist programs?" Sandra Hall
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 6 of 35
1.6. Describe what impact, if any, irnpaet 19 Respondent's Proposed Strategic Partnership
would have on NHRMC aligning with employers in the Service Area to provide
wellness and healthcare services to local employees (e.g., occupational health
programs; walk-in occ-health services at urgent care center; health clinics located on-
site at employers).
1.6.1. If applicable, discuss Respondent's position on developing NHRMC's
programs to align with local employers.
1.6.2. If applicable, describe the scope and timing of Respondent's commitment to
expanding and improving upon NHRMC's programs with local employers.
1.6.3. If applicable, provide examples of the successful implementation of
occupational health or other employer -based programs with employers in
communities served by Respondent and its affiliate or partner hospitals.
1.7. Describe what impact, if any, ifnpaet 20 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to add patient -friendly, consumer -facing programs
that provide added convenience (e.g., call centers, online scheduling, other digital
offerings) and that anticipate a continued transition to value -based care and
population health management along with increased patient engagement in
understanding the financial costs of healthcare (e.g., pricing transparency).
1.7. Commentary
1. "... and that anticipate a continued transition to value -based care and
population health management", I suggest this have its own set of
questions. Totally different than patient friendly. (Bill Cameron)
PAG Support Team Comment in Response: Consider Question 2.1
1.7.1. If applicable, discuss how Respondent supports and engages patients to make
informed healthcare decisions (e.g. using cost transparency tools, providing
patient education, etc.).
1.7.2. If applicable, describe the scope and timing of implementing any of
Respondent's initiatives at NHRMC and/or within the Service Area.
1.7.3. If applicable, provide examples of the successful implementation of such
initiatives in communities served by Respondent.
" Bill Cameron
zo Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 7 of 35
1.8. Describe what impact, if any,inipaet 21 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to further 22 enhance telehealth programs (e -
visits and consults; remote specialty monitoring such as eICU) and similar digital
health platforms and capabilities.
1.8.1. If applicable, discuss Respondent's strategy to receive a reasonable
reimbursement for these services.
1.8.2. If applicable, describe the scope and timing of implementing any of
Respondent's initiatives (for both urban and rural populations) at NHRMC
and/or within the Service Area.
1.9. Describe what impact, if any,impaet 23 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to establish eammand eentefs a Command Center24
to monitor data from the health system and use it to improve efficiency, quality and
safety and to manage inpatient referrals for advanced care.
1.9.1. If applicable, briefly discuss Respondent's experience fostering collaborative
relationships that establish regional and national systems.
1.9.2. If applicable, describe the scope and timing of implementing a Command
Center25 at NHRMC.
1.9. Commentary
1. Is there value to add a question about their experience with Predictive
Analytics and what have been their successes with it and how could it be
implemented at NHRMC? (Joseph Pino)
PAG Support Team Comment in Response: Consider Question 6.5
1.10. If applicable, describe what impact, if any,impaet Respondent's Proposed Strategic
Partnership would have on NHRMC's ability to facilitate care delivery and wellness
services in rural areas.
1.10. Commentary
1. Does this belong in 1.1.1.? (Joseph Pino)
21 Bill Cameron
"Bill Cameron
z3 Bill Cameron
24 Bill Cameron
25 Note for Internal Review Purposes: A Command Center is a centralized repository of real-time data that allows an
organization to continuously monitor the operations of the hospital or health system to improve efficiency and patient safety
and deliver optimal patient care.
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 8 of 35
2. Advancing the Value of Care DRAFT
2. Commentary
Do not see anything regarding establishing and further developing partnerships
with our community service groups such as the Department of Health and Aging,
Lower Cape Fear Community Medicaid, our nursing home partners. I would like
to see how the respondents would or have developed community links and giving
our community back the responsibility for their health. This may be under 2.
Advancing the Value of Care (2.3) but I feel that it needs further development.
(Mary Rudyk)
PAG Support Team Comment in Response: Consider Question 3.2
2.1. Describe what impact, if any,impaet 26 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to maintain and improve high-quality care while
controlling the cost of healthcare delivery.
2.1.1. If applicable, describe Respondent's innovative strategies to help control out-
of-pocket costs, including those for patients with high -deductibles and copays
as well as self -pay patients.
2.1.2. If applicable, describe any health plan owned or joint ventured by Respondent.
Discuss the rationale for this "vertical" strategy and how it furthers the goals
and objectives of Respondent's organization.
2.1.2.1. If applicable, comment on Respondent's position on continuing
NHRMC's efforts to establish, own and operate a Medicare
Advantage health plan.
2.1.2.2. If applicable, describe how any health plan affiliated or partnered
with Respondent could enhance NHRMC's efforts to lower cost and
improve access in the Service Area.
2.1.3. Describe what impact, if any,ifnpaet 27 Respondent's Proposed Strategic
Partnership would have on NHRMC's ability to establish and further
participation in value -based provider networks (e.g., ACO and CIN) and/or
value -based care initiatives.
26 Bill Cameron
27 Bill Cameron
2.1.3.1. If applicable, discuss Respondent's approach to NHRMC's existing
value -based networks, including any opportunities to expand or
improve upon these networks.
2.1.3.2. If applicable, describe any operational or strategic synergies that
may be captured by combining Respondent's value -based networks
with NHRMC affiliated or partnered networks.
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 9 of 35
2.1.4. Describe what impact, if any,impaet 28 Respondent's Proposed Strategic
Partnership would have on NHRMC's capabilities in value -based care
contracting models (e.g., bundles, shared savings, capitation, etc.) with
commercial insurers, employers and governmental health programs.
2.1.4.1. If applicable, discuss Respondent's outlook on the timing and
materiality of future value -based arrangements.
2.1.4.2. If applicable, how could Respondent enhance NHRMC's value -
based care contracting efforts?
2.1.5. If applicable, provide detail on how cost and quality and patient safety29 were
impacted at hospitals and health systems that have recently affiliated or
partnered with the Respondent. Please rely on the examples provided in
response to section 6. Driving_ Quality of Care Throughout the Continuum and
8. Ensuring Long -Term Financial Security."
2.2. Describe what impact, if any,ifnpaet 31 Respondent's Proposed Strategic Partnership
would have in developing and/or enhancing NHRMC's patient satisfaction programs,
including monitoring and the appy -e e *^ 32 using feedback to make improvements in
the patient experience.
2.2.1. If applicable, discuss how Respondent could help NHRMC enhance patient
satisfaction. Describe specific programs and plans that Respondent would
implement at NHRMC.
2.2.2. If applicable, provide detail on patient satisfaction for hospitals and health
systems that have recently affiliated or partnered with the Respondent. Include
the record of patient satisfaction scores prior to any affiliation with
Respondent and the record of patient satisfaction following the affiliation with
Respondent.
2.3. Describe what impact, if any,ifnpaet 33 Respondent's Proposed Strategic Partnership
would have in developing and/or enhancing how NHRMC coordinates patients within
the continuum of care, both within the system (e.g., using patient care coordinators)
and outside the system (e.g., sub -specialty providers, post -acute care providers).
2.3.1. If applicable, describe any current initiatives or future plans by the
Respondent that would improve patient care coordination in the communities
it serves.
28 Bill Cameron
Z9 Joseph Pino
30 "Is this too similar to 2.1.5. and/or should it be merged?" PAG — Joseph Pino
3i Bill Cameron
3z Bill Cameron
33 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 10 of 35
2.3.2. If applicable, describe any enhancements to patient care coordination that
Respondent can introduce to NHRMC.
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 11 of 35
3. Achieving Health Equity DRAFT
3.1. Describe what impact, if any,ifnpaet 34 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to maintain and enhance charity care and financial
assistance in the communities it serves and to expand coverage for uninsured and
underinsured individuals. Also, for each subpart below, address the duration of any
relevant commitment (providing examples and how long such policy, practice or
program was or will be in effect).35
3.1.1. If applicable, describe the Respondent's philosophy and approach to charity
care, financial assistance, debt collection and debt forgiveness policies.
Provide examples of approach used in various communities.36
3.1.2. If applicable, explain the process of how Respondent would maintain or
modify NHRMC's charity care, financial assistance, debt collection practices
and/or debt forgiveness policies.
3.1.3. If applicable, provide detail on how charity care, financial assistance, debt
collection practices and/or debt forgiveness policies were impacted at
hospitals and health systems that recently affiliated or partnered with the
Respondent. Describe any changes to policies as well as any changes to the
dollar amounts of care/assistance provided.
34 Bill Cameron
3s "Achieving Health Equity — can we ask for examples of how long it lasted after they acquired other facilities
— (does the charity care go away)?" Barb Biehner
36 Jack Fuller
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 12 of 35
3.2. Describe what impact, if any,iflipaet 37 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to maintain and enhance community outreach
programs, including health education, free health screenings, wellness programs and
other community health programs, as well as general engagement in a community as
a contributing "corporate citizen" in the Service Area. Also, for each subpart below,
address the duration of any relevant commitment (providing examples and how long
such policy, practice or program was or will be in effect).38
3.2.1. If applicable, specifically, also discuss how Respondent works with local
departments of health, public schools, indigent care clinics, federally qualified
health care centers and other agencies and providers in addressing the health
needs of communities. Detail any current or future population health
initiatives done in conjunction with municipalities, counties or any other units
of local government, or with other agencies or providers aimed at addressing
health issues and improving access to necessary health services, including:
3.2.1.1. Any approach to and previous success with impacting social
determinants of health;
3.2.1.2. Treatment and prevention strategies in addressing drug and
alcohol addiction or abuse, including tackling the opioid epidemic;
and
3.2.1.3. Inpatient and outpatient behavioral health services.
3.2.2. If applicable, is the Respondent committed to expanding NHRMC's programs
and financial outlays for community outreach and engagement?
3.2.3. If applicable, discuss any enhancements to NHRMC's levels of community
outreach and engagement in the Service Area (e.g., new programs; leveraging
programs proven successful in other markets) that the Respondent could
introduce.
3.2.4. If applicable, discuss the process for how the Respondent would make
changes to NHRMC community outreach and engagement programs. How
would such decisions be made?
3.3. Describe what impact, if any,ifflpaet 39 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to equip employees with the knowledge and training
needed to support health equity (e.g., diversity training).
3' Bill Cameron
38 "Achieving Health Equity — can we ask for examples of how long it lasted after they acquired other facilities
— (does the charity care go away)?" Barb Biehner
39 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 13 of 35
4. Engaging Staff DRAFT
4.1. Describe what impact, if any,impaet " Respondent's Proposed Strategic Partnership
would have on NHRMC's capabilities in building and maintaining a high -performing
employee team, specifically those programs related to (i) employee recruitment
(including addressing critical shortage areas such as nursing), (ii) retention (e.g.,
engagement programs; structuring incentive compensation and employee benefits),
(iii) career development (management and clinician training), (iv) health and wellness
programs and (v) leadership training.
4.1.1. If applicable, discuss how Respondent would enhance NHRMC's efforts
relative to employee recruitment, retention, career development and
leadership training.
4.1.2. If applicable, discuss any community and educational institution engagement
or training programs supported or maintained by the Respondent, including
partnerships or other collaborations with others that could assist NHRMC's
recruiting for healthcare related jobs.
4.1.3. If applicable, how would Respondent plan to minimize the potential for
employee disruption and turnover in any transition of NHRMC into
Respondent's organization?
4.1.4. If applicable, discuss how Respondent would support or improve current
staffing models at NHRMC.
4.1.5. If applicable, discuss how Respondent would support or improve current
health and wellness programs for NHRMC staff.
4.1.6. If applicable, provide detail on how employee recruitment, retention,
leadership training and career development was impacted at hospitals and
health systems that have recently affiliated or partnered with the Respondent.
4' Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 14 of 35
4.2. Describe what impact, if any,ifnpaet 41 Respondent's Proposed Strategic Partnership
would have on the retention of existing NHRMC employees. Also, for each subpart
below, address the duration of any relevant commitment, program or practice and
provide information on actual impact, if any. In other words, also provide examples
and how long each such commitment and/or program was or will be in effect, with
data or other information that will indicate the relative success or lack thereo£42
4.2.1. If applicable, will the Respondent make a commitment not to make any
material changes to NHRMC's employee base and staffing commitments
without the approval of the NHRMC Board? If so, for how long?
41 Bill Cameron
41 "Look 2, 5, 10 years out .......... how many were retained -where did they make significant changes and why?"
Barb Biehner
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 15 of 35
4.3. Describe what impact, if any,impaet Respondent's Proposed Strategic Partnership
would have on the compensation and benefits, including current pension plan,
currently provided t043 NHRMC employees. Also, for each subpart below, address the
duration of any relevant commitment, program or practice and provide information on
actual impact, if any. In other words, also provide examples and how long each such
commitment and/or program was or will be in effect, with data or other information
that will indicate the relative success or lack thereo£44
4.3.1. If applicable, discuss how Respondent would support or improve current
health and wellness programs for NHRMC staff, including NHRMC's fitness
center.
4.3.2. If applicable, discuss how Respondent's employee compensation is set and
how it would impact compensation for NHRMC staff.
4.3.3. If applicable, discuss how Respondent's benefits, including pension plan and
other retirement benefits, compare to those offered by NHRMC, particularly
with regard to contribution rates and how those might be impacted under the 45
Proposed Strategic Partnership.
4.3.4. If applicable, please describe the Respondent's plans related to maintaining or
enhancing46 current salaries, addressing accrued benefits for length of service
and pension plan matters for the employees of NHRMC.
4.3.5. If applicable, discuss what type of retirement (pension or 403b/40lk) package
Respondent offers and how th$tt--the41 Proposed Strategic Partnership would
impact retirement plans for NHRMC staff and retirees.
4.3.5. Commentary
1. Would this be considered redundant with 4.3.3.? (PAG — Joseph
Pino)
43 Bill Cameron
44 "Look 2, 5, 10 years out .......... how many were retained -where did they make significant changes and why?"
Barb Biehner
45 Bill Cameron
46 Jack Fuller
47 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 16 of 35
4.4. Describe what impact, if any,ifflpaet 48 Respondent's Proposed Strategic Partnership
would have on employment (adding or detracting) in the communities in which
NHRMC operates. Also, for each subpart below, address the duration of any relevant
commitment, program or practice and provide information on actual impact, if any.
In other words, also provide examples and how long each such commitment and/or
program was or will be in effect, with data or other information that will indicate the
relative success or lack thereo£49
4.4.1. If applicable, would the Respondent make a commitment to base certain
corporate services for its entire system in the Service Area?
4.4.2. If applicable, provide detail on how local employment was impacted at
hospitals and health systems that have affiliated or partnered with the
Respondent.
4.5. Describe what impact, if any,ifnpaet 50 Respondent's Proposed Strategic Partnership
would have on furthering and preserving the mission, vision, values and culture of
NHRMC. Also, for each subpart below, address the duration of any relevant
commitment, program or practice and provide information on actual impact, if any. In
other words, also provide examples and how long each such commitment and/or
program was or will be in effect, with data or other information that will indicate the
relative success or lack thereo£51
4.5.1. If applicable, discuss similarities that the Respondent sees between the
Respondent's organization and NHRMC's mission, vision, values and
culture.
4.5.2. If applicable, provide detail on how organizational mission, vision, values and
culture were preserved at hospitals and health systems that have recently
affiliated or partnered with the Respondent.
4.5.3. If applicable, discuss impact, if any, impaet 52 Respondent's Proposed
Strategic Partnership and Respondent's tax status (exempt or taxable) would
have on furthering and preserving NHRMC's charitable mission and the
County's commitment to public interest.
4.5.4. [If applicable,] provide quantifiable data on programs introduced by
respondent that supports enhanced efforts.ss
48 Bill Cameron
49 "Look 2, 5, 10 years out .......... how many were retained -where did they make significant changes and why?"
Barb Biehner
"Bill Cameron
" "Look 2, 5, 10 years out .......... how many were retained -where did they make significant changes and why?"
Barb Biehner
" Bill Cameron
13 Jack Fuller
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 17 of 35
4.6. Describe what impact, if any,ifilpaet 5' Respondent's Proposed Strategic Partnership
would have on NHRMC's commitment to being an inclusive organization, supporting
anti -discrimination efforts and building and maintaining a diverse workforce.
4.6.1. If applicable, is the Respondent committed to continuing NHRMC's
inclusion, anti -discrimination and diversity programs?
4.6.2. If applicable, describe any enhancements to NHRMC's inclusion, anti-
discrimination and diversity programs that could be introduced by the
Respondent based on its experience in running similar programs for its
affiliated or partnered hospitals and health systems.
4.7. If applicable, describe any impact Respondent's Proposed Strategic Partnership could
or would have on the ability of certain NHRMC employees to achieve student loan
forgiveness by virture of their work for NHRMC as a nonprofit organization.
4.7. Commentary
1. Is this question answered by the response of the respondent's tax status?
(Joseph Pino)
;4 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 18 of 35
5. Partnering with Providers DRAFT
5.1. Describe what impact, if any,ifflpaet 55 Respondent's Proposed Strategic Partnership
would have on NHRMC's capabilities in recruiting providers into the Service Area.
5.1.1. If applicable, specifically, discuss how the Respondent would work with
NHRMC's existing provider recruitment staff.
5.1.2. If applicable, what enhancements and improvements to physician recruiting
would Respondent commit to making for NHRMC?
5.1.3. If applicable, what enhancements and improvements to advanced practice
provider recruiting would Respondent commit to making for NHRMC?
5.1.4. If applicable, provide detail on how provider recruitment was improved at
hospitals and health systems that have affiliated or partnered with the
Respondent.
5.1.5. If applicable, discuss how an affiliation or partnership with the Respondent
would enhance recruitment and retention of or access to specialists and sub-
specialists not currently, or adequately, available in the region.
5.1.6. [If applicable,] describe additional new service offerings respondent might
suggest being introduced to NHRMC.56
15 Bill Cameron
" Jack Fuller
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 19 of 35
5.2. Describe what impact, if any,ifflpaet 57 Respondent's Proposed Strategic Partnership
would have on ^**^; ,;,, . ind/0 58 developing and/or enhancing NHRMC's medical
education, residency and fellowship programs as well as nursing education and other
provider training programs.
5.2.1. Tappl-ieable,dDiscuss how an affiliation or partnership with the Respondent
would impact existing medical education programs at NHRMC, including the
affiliation with UNC. Does the Respondent commit to maintaining and
enhancing all of these programs unless otherwise decided by the NHRMC
Board? 7P s IjE) 1.,,,,t? 59
5.2.2. if applieable, -wWill the Respondent commit to eentintting developing and
enhancing60 NHRMC's existing medical residency programs in Internal
Medicine, General Surgery, Family Medicine and Obstetrics and
Gynecology?
5.2.3. How would Respondent expand or develop current and future residency and
fellowship training programs? 61
5.2.4. If applicable, does the Respondent e ffef additional ,,,edie^i o,a,,eati ,.,
of thef pfevidef edti ati r s that „l.d be implemented atN uv> Gr
if so, wha�'r, these pfegfams and ho „l,a Respondent eva _'_'ate their
feasibility? discuss how an affiliation or partnership with the Respondent
would support new programs or the implementation of Respondent's current
programs in the following education and training programs at NHRMC,
5.2.4.1. Graduate Medical Education;
5.2.4.2. Nursing Education; and
5.2.4.3. Allied Health Education.62
'''I I, I
1Z 1 11 1
1M I 1� i
57 Bill Cameron
5'Joseph Pino
59 Joseph Pino
6o Joseph Pino and PAG — Jack Fuller
61 Joseph Pino
62 " I think questions about education and training should split out Graduate Medical Education from Nursing
Education from Allied Health Education. Those are distinctly different areas and the people writing the
responses are likely to be different. I suspect it will be easier to track responses if we break out with a little more
granularity." (Michael Papagikos)
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 20 of 35
5.3. Describe what impact, if any,ifflpaet 63 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to effectively deploy advanced practice providers
in healthcare delivery teams?
5.3.1. If applicable, discuss the Respondent's approach and experience in the use of
advanced practice providers to address sh-. .ffnafy eafeph s64
5.4. Describe what impact, if any,ifilpaet 65 Respondent's Proposed Strategic Partnership
would have on NHRMC's approach to working with community physicians.
5.4.1. If applicable, describe any programs offered by the Respondent that could be
rolled -out at NHRMC in order to more closely align with and support
independent physicians and medical groups (e.g., management services
organization and providing EMR access to small practices and other clinical
points of care 66).
5.4.2. If applicable, what is the Respondent's approach to partnering with
independent physicians and medical groups in joint ventures and clinically -
integrated programs?
5.4.3. If applicable, discuss how an affiliation or partnership with the Respondent
would impact existing (and developing) hospital-based provider contracts,
joint ventures and other physician contracts and agreements. Does the
Respondent commit to maintaining all of these relationships unless otherwise
decided by the NHRMC Board? If so, for how long?67
5.4.4. If applicable, describe the Respondent's approach to the use of non -compete
and cost share provision clauses in physician contracting.68
5.4.5. If applicable, what can non -hospital affiliated physicians, who have built
practices in the community, expect for their patients and practices? Provide
examples of this.69
63 Bill Cameron
64 Joseph Pino
65 Bill Cameron
66 Michael Papagikos
6' "This is in response to the last item in Goal 10 not making its way into the RFP" (Michael Papagikos)
68 Michael Papagikos
69 Sandra Hall
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 21 of 35
5.5. Describe what impact, if any,impaet 70 Respondent's Proposed Strategic Partnership
would have on NHRMC's approach towards medical group practice operations for
its employed physician base.
5.5.1. If applicable, what does the Respondent suggest felative—to NHRN4C's
tnedieal gfetip felatiensh ip with Atfitim Health?—how does the respondent
view the NHRMC medical group relationship with Atrium and would that be
continued? If not, what is the alternative and how does it compare to the
current state?71
5.5.2. If applicable, what enhancements to medical group operations could
Respondent offer to NHRMC?
5.6. Describe what impact, if any,ifilpaet 71 Respondent's Proposed Strategic Partnership
would have on local medical staff governance at NHRMC. Address any material
shifts or changes in policy and procedure regarding privileging, credentialing, quality
and safety that the medical staff may anticipate as a result of such partnership.73
5.7. Describe what impact, if any,itnpaet 74 Respondent's Proposed Strategic Partnership
would have on physician retention at NHRMC by discussing:
5.7.1. If applicable, medical education and training programs for physicians offered
by the Respondent's system.
5.7.2. If applicable, programs to enhance physician satisfaction and to prevent
physician burnout.
5.7.3. If applicable, programs to train physician executives and further physician
leadership.
5.7.4. If applicable, finally, discuss Respondent's experience with physician
retention at hospitals and health systems that have affiliated or partnered with
the Respondent.
70 Bill Cameron
71 " I understand the purpose of the question, but can it be stated better?" (Joseph Pino)
72 Bill Cameron
73 "Should it also include credentialing and privileges?" (Barb Biehner)
7' Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 22 of 35
6. Driving Quality of Care and Patient Safety Throughout Continuum DRAFT
6.1. Describe what impact, if any,ifflpaet 15 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to improve and measure the quality of care and
patient safety.
6.1.1. If applicable, are there programs offered by Respondent that could enhance
NHRMC's outcomes?
6.1.2. If applicable, describe how the Respondent's quality and patient safety
assurance efforts would be integrated with NHRMC's existing quality and
patient safety assurance infrastructure.
6.1.3. If applicable, describe how the Respondent's care management and
coordination efforts would be integrated with NHRMC's existing programs.
6.1.4. If applicable, provide detail on how quality of care and patient safety was
impacted at hospitals and health systems that have recently affiliated or
partnered with the Respondent. Describe any changes to quality performance
and patient safety from prior to the affiliation or partnership to the most recent
year of reporting.
6.1.5. [If applicable,] provide comparable data relative to quality of care and patient
safety for Respondent's relative organizations against national standards and
NHRMC experience.76
75 Bill Cameron
76 Jack Fuller
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 23 of 35
6.2. Describe what impact, if any,ifflpaet 77 Respondent's Proposed Strategic Partnership
would have on adherence to preventive care guidelines, evidenced -based protocols,
quality or—of" care and patient safety initiatives within the organization and in
partnership with community providers?
6.3. Describe what impact, if any,ifnpaet 79 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to engage and empower nurses to be leaders in
achieving excellence in quality and patient safety (e.g., Magnet Recognition
Program)?
6.4. Describe what impact, if any,impaet " Respondent's Proposed Strategic Partnership
would have on enhancing or developing performance excellence programs at
NHRMC (e.g., Baldridge, Lean, Six Sigma, High -Reliability, Just Culture, etc.).
6.5. Describe what impact, if any, impaet " Respondent's Proposed Strategic Partnership
would have on NHRMC's access to emerging technologies that have been successful
in addressing patient safety and enhancing the provision of high-quality care (e.g.,
analytics to identify quality and safety gaps, artificial intelligence/machine learning
to support medical decision-making, patient engagement platforms, etc.).
77 Bill Cameron
78 Bill Cameron
79 Bill Cameron
80 Bill Cameron
" Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 24 of 35
7. Improving the Level and Scope of Care DRAFT
7.1. Describe what impact, if any,ifflpaet 12 Respondent's Proposed Strategic Partnership
would have on growing NHRMC clinical service lines based upon Respondent's
experience at other affiliated or partnered hospitals.
7.1.1. If applicable, how would Respondent approach service -line planning for
NHRMC?
7.1.2. If applicable, what commitments would Respondent make to enhancing
NHRMC's service lines?
7.1.3. If applicable, will the Respondent make a commitment not to downsize or
discontinue any existing NHRMC service line unless otherwise decided by
the NHRMC Board? If so, for how long?
7.1.4. If applicable, describe Respondent's philosophy around what services should
be available in local markets vs. what should be centralized in more distant
locations.
7.1.3. and 7.1.4. Commentary
1. Questions 7.1.3. and 7.1.4. seem to be in conflict with each other.
(PAG — Jack Fuller)
7.2. Describe what impact, if any,ifilpaet 13 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to improve the timing in securing patient transfers
for quaternary services not offered by NHRMC.
7.2.1. If applicable, provide detail on how referrals and transfers for quaternary
services are coordinated with hospitals and health systems that have recently
affiliated or partnered with the Respondent.
7.3. Describe what impact, if any,impaet 84 the Respondent's Proposed Strategic
Partnership would have on NHRMC EMS and critical care transport services.
82 Bill Cameron
83 Bill Cameron
" Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 25 of 35
7.4. Describe what impact, if any,ifflpaet 15 Respondent's Proposed Strategic Partnership
would have on developing innovative care solutions and technology that further
supports service line growth at NHRMC.
7.4.1. If applicable, discuss any new medical technologies that could be rolled -out
at NHRMC.
7.4.2. If applicable, discuss any genomic medicine programs offered by the
Respondent and how such programs could be introduced at NHRMC to
advance NHRMC's current efforts to expand this service area.
7.4.3. If applicable, discuss what impact, if any,impaet86 Respondent's Proposed
Strategic Partnership would have on NHRMC's Innovation Center and Lean
Strategies.
7.5. Describe what impact, if any,iflipaet 17 Respondent's Proposed Strategic Partnership
would have on NHRMC's ability to further clinical research or participate in grant
funding.
7.5.1. If applicable, discuss any clinical trials or other research programs that could
be introduced at NHRMC.
7.5.2. If applicable, provide detail on how clinical research and/or access to grants
was impacted and the type, scope and depth of current research
programs/grant participation at hospitals and health systems that have recently
affiliated or partnered with the Respondent.
" Bill Cameron
86 Bill Cameron
87 Bill Cameron
DRAFT IN REVIEW
REQUEST FOR PROPOSAL
Page 26 of 35
8. Ensuring Long -Term Financial Security DRAFT
8.1. Describe what impact, if any,impaet'8 Respondent's Proposed Strategic Partnership
would have on ensuring future access to capital for growth at NHRMC. Also speak
to how and whether Respondent's Proposed Strategic Partnership will facilitate
capitalization and growth of facilities and other sites of service across the Service
Area, including beyond New Hanover County, understanding the current debt
limitations for NHRMC that preclude this regional health care system from borrowing
to build outside of the County.89
8.1.1. If applicable, describe Respondent's current capital capacity and its ability to
access to capital.
8.1.2. If applicable, describe the Respondent's budgeting, capital budgeting and
capital allocation processes.
8.1.3. If applicable, discuss how capital is advanced to Respondent -affiliated or
partnered hospitals and health systems.
8.1.4. If applicable, describe Respondent's obligated group. Would NHRMC be
made a part of the obligated group of Respondent?
8.1.4. Commentary
1. What does "obligated group" mean? Will we have a chance to
discuss? (PAG — Michael Papagikos)
8.1.5. If applicable, discuss how Respondent's existing financial policies and
practices would impact NHRMC in the short-term (1-5 years post -affiliation
or partnership) and the long-term.
8.1.6. If applicable, does the Respondent anticipate any issues with obtaining capital
necessary to fulfill any financial obligations connected to the Proposed
Strategic Partnership?
8.1.7. If applicable, will the Respondent guarantee or otherwise backstop all of the
existing long-term debt of NHRMC?
8.1.8. NHRMC's capital budgets and other estimates of long-term strategic capital
have been provided to Respondent in the Data Room. If applicable, will the
Respondent commit to fulfilling these capital investments by ensuring
NHRMC's future access to capital?
8.1.8. Commentary
1. What is the "Data Room"? Will PAG receive NHRMC's capital
budgets and other estimates of long-term strategic capital being
supplied to the Respondents? (PAG — Michael Papagikos)
88 Bill Cameron
89 "(add question 1.1.4.) articulate the regulatory or legal issue involved with expanding outside the NH County
area?" (Jack Fuller)
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8.1.9. [If applicable,] describe various avenues of access to financial and capital
structures that are currently being used at respondent's entities, and how they
might apply and help structure NHRMC capital needs.90
90 Jack Fuller
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8.2. Describe what impact, if any,impaet 91 Respondent's Proposed Strategic Partnership
would have on any existing cash and investments held by NHRMC at the time of
affiliation or partnership.
8.2.1. If applicable, does the Respondent commit to allowing existing cash and
investments to be utilized by NHRMC as directed by the NHRMC Board for
capital and strategic investment in the Service Area and/or allowing the
distribution of existing cash to New Hanover County given its ownership of
the healthcare system operated by NHRMC?
8.2.1. Commentary
1. Are we judging the responses based on who will, or will not,
allow current cash reserves to be released to NHC or not?
(Michael Papagikos)
8.3. Describe what impact, if any,ifnpaet 92 Respondent's Proposed Strategic Partnership
would have on continuing and enhancing the NHRMC Foundation (the
"Foundation").
8.3.1. If applicable, does the Respondent offer corporate development and other
services that could enhance the Foundation's operations and fund-raising
efforts?
8.3.2. If applicable, describe the Respondent's commitment for the Foundation to
remain a sole supporting organization of NHRMC and for any existing
Foundation funds, whether donor restricted or not, remain allocated for the
benefit of NHRMC.
" Bill Cameron
92 Bill Cameron
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8.4. If applicable, will the Respondent make a commitment to maintain NHRMC's
material payer contracts and agreements without disruption?
8.5. Describe what synergies, if any, NHRMC may have in accessing Respondent's
corporate services and programs based upon the Proposed Strategic Partnership.
8.5.1. If applicable, discuss Respondent's approach for integrating administrative,
corporate or other shared services and programs at NHRMC.
8.5.2. If applicable, how does Respondent allocate corporate overhead to its
affiliated or partnered hospitals and health systems?
8.5.3. If applicable, discuss how Respondent proposes to introduce corporate
overhead charges to NHRMC.
8.6. Describe what impact, if any,ifnpaet 93 Respondent's Proposed Strategic Partnership
would have on existing grant -funded programs and services and other funding sources
tied to NHRMC's tax-exempt status that rely on NHRMC remaining a non-profit
organization.
93 Bill Cameron
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9. Strategic Positioning DRAFT
9.1. Describe what strategic priorities, if any, for southeastern North Carolina the
Respondent maintains and how a strategic relationship with NHRMC fits into the
Respondent's overarching strategy based upon the Proposed Strategic Partnership.
9.2. (i) Describe what impact, if any,ifilpaet 94 Respondent's Proposed Strategic
Partnership would have on maintaining or revising NHRMC's strategic plans and (ii)
describe how consistent (or inconsistent) NHRMC's strategic planning documents
are with the Respondent's overarching strategy?
9.2.1. If applicable, will the Respondent make a commitment to maintain the
existing Management Services Agreement and Clinical Affiliation with
Pender Memorial Hospital?
9.2.1. Commentary
1. Don't understand the specific Pender Memorial Hospital question in
context with expanding the service area? (Jack Fuller)
9.2.2. If applicable, discuss the Respondent's position on continuing any other
contractual relationships NHRMC has with hospitals in the Service Area.
9.3. Describe which of Respondent's system -wide strategic initiatives, if any, would be
introduced at NHRMC as part of Respondent's Proposed Strategic Partnership.
94 Bill Cameron
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10. Governance DRAFT
10.1. Describe what impact, if any,ifnpaet95 Respondent's Proposed Strategic Partnership
would have on NHRMC current governing structures, including:
10.1.1. If applicable, the authority of the NHRMC Board post -affiliation or
partnership (and the authority of Respondent's board vis-a-vis NHRMC).
10.1.2. If applicable, the composition of the NHRMC Board post -affiliation or
partnership including any new directors appointed by the Respondent on that
board.
10.1.3.If applicable, the process by which NHRMC Board members will be
nominated and appointed.
10.1.4. If applicable, the extent and duration of any reserve powers held by legacy
NHRMC Board and/or any decisions of the NHRMC Board that would be
subject to further approval by the County.
10.2. If applicable to the Respondent's Proposed Strategic Partnership, discuss any
proposed representation from NHRMC (or residents of the Service Area) on
Respondent's parent or system board of directors or any of such board's committees.
10.3. If applicable, will the Respondent allow local control and decision making on
hospital-based provider contracts? If so, for how long?96
95 Bill Cameron
96 Joseph Pino and "Concern related to maintaining local hospital-based provider contracts" (Sandra Hall)
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11. Proposed Strategic Partnership Structure(s) DRAFT
In this section, provide an overview of Respondent's Proposed Strategic Partnership
transaction structure(s). Respondents may provide more than one proposed transaction
structure but should clearly indicate its preferred transaction structure. For each transaction
structure provide -a" sufficient detail addressing:
11.1. Transaction structure and type of legal arrangement.
11.2. The key business and legal terms of that transaction structure, including:
11.2.1. Financial terms, as applicable, including any (a) purchase price based upon of
fair market value of operating assets, (b) financial contributions to the County
or an independent, local foundation whose general charter would be to benefit
the local community, (c) lease payments, (d) funds to support ongoing or
planned capital projects (i.e., capital commitments), (e) funds committed to
strategic growth and expansion, (0 any other financial commitments.
11.2.2. If applicable, discuss with specificity any assets or liabilities that would be
excluded from the proposed transaction.
11.2.3. Note and estimate the value of any other specific financial commitment to the
County such as payment of property taxes, sales taxes or commitment to
directly fund a community health need.
11.2.4. Post -closing commitments of the parties as outlined by the Respondent in its
proposal.
11.2.4. Commentary
1. Is it possible to ask for a "report card" on the Respondent's prior
post -closing commitments? Have they been found in breach?
Had their hands slapped? How do we get a sense of how good
their word is after the deal is inked? (Michael Papagikos)
11.2.5. A summary of both quantifiable and qualitative benefits that NHRMC and
NH County would receive from said arrangement.98
97 Barb Biehner
9s Jack Fuller
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12. Deal Process and Transaction Timing DRAFT
12.1. For any Respondent that is a for-profit corporation (or other taxable legal entity),
provide information on charges, services, debt collection protocols and indigent care
at facilities owned or operated by the Respondent.
12.1. Commentary
1. Can we ask this of all Respondents and not just the for-profit ones?
(Michael Papagikos)
12.2. If Respondent's Proposed Strategic Partnership is ultimately selected by the PAG and
the Boards, describe the scope and timing for the following:
12.2.1. Confirmatory due diligence review of NHRMC
12.2.2. Obtaining financing for any financial commitments related to the Proposed
Strategic Partnership.
12.2.3. Obtaining Respondent's corporate approvals (e.g., approval by its board of
directors).
12.2.4. Describe the scope and timing of any other contingencies or approvals
identified by Respondent.
12.3. In any definitive agreement entered into by Respondent to orchestrate the Proposed
Strategic Partnership, discuss Respondent's position to the following terms:
12.3.1. All NHRMC and County representation and warranties will expire at the
closing, and there will be no claw -back or recovery provisions for any
financial consideration provided by Respondent to NHRMC and the County.
12.3.2. Remedy for any material breach of Respondent's post -closing commitments
will include a repatriation of NHRMC to the eemmunity (ef the reunty)
and/or transfer of certain or all assets to NHRMC and/or the County, as
applicable per model."
" "Do we need to say if it is the community or county? Pretty vague." (Barb Biehner)
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12.3.3. For any Respondent, including any for-profit corporation (or other taxable
legal entity) the Respondent will agree to all of the following North Carolina
statutory requirements:
12.3.3.1. The Respondent shall continue to provide the same or similar
clinical hospital services to its patients in medical -surgery,
obstetrics, pediatrics, outpatient and emergency treatment,
including emergency services for the indigent, that the hospital
facility provided prior to the lease, sale or conveyance. These
services may be terminated only as prescribed by Certificate of
Need Law prescribed in Article 9 of Chapter 131E of the General
Statutes, or, if Certificate of Need Law is inapplicable, by review
procedure designed to guarantee public participation pursuant to
rules adopted by the Secretary of the Department of Health and
Human Services.
12.3.3.2. The Respondent shall ensure that indigent care is available to the
population of the Service Area served by NHRMC at levels related
to need, as previously demonstrated and determined mutually by
NHRMC and the Respondent.
12.3.3.3. The Respondent shall not enact financial admission policies, or
engage in debt collection practices, that have the effect of denying
essential medical services or treatment solely because of a patient's
immediate inability to pay for the services or treatment.
12.3.3.4. The Respondent shall ensure that admission to and services of the
facility are available to beneficiaries of governmental
reimbursement programs (Medicaid/Medicare) without
discrimination or preference because they are beneficiaries of
those programs.
12.3.3.5. The Respondent shall prepare an annual report that shows
compliance with the requirements of the lease, sale or conveyance
related to the Proposed Strategic Partnership.
12.3.3.6. The Respondent shall further agree that if it fails to substantially
comply with these conditions, or if it fails to operate the facility on
17th Street in Wilmington, North Carolina as a hospital open to the
general public and free of discrimination based on race, creed,
color, sex or national origin unless relieved of this responsibility
by operation of law, or if the Respondent dissolves without a
successor corporation to carry out the terms and conditions of the
lease, agreement of sale or agreement of conveyance, all
ownership or other rights in the hospital facility, including the
building, land and equipment associated with the hospital, shall
revert to the County; provided that any building, land or equipment
associated with the hospital facility that the Respondent has
constructed or acquired since the sale may revert only upon
payment to the Respondent of a sum equal to the cost less
depreciation of the building, land or equipment.
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Other General Commentary:
1. Data Analytics (DA) is a very important and recurring theme. Some references to DA
are sprinkled throughout the RFP but I'd suggest a dedicated section asking for a
description of the Respondents DA capability and its success at scaling and deploying
that to other systems. Time, expense, disruption, etc. (Michael Papagikos)
2. In reference to first five areas for the RFP, I would like to see quantifiable data to
support the respondents' claims to improved services or offerings. (Jack Fuller)
3. It looks fine but I can't help but think that "if applicable" is a little unnecessary and
the directives are stronger without it but I assume this is part of the regular language
of an RFP. It seems superfluous. (Hannah Gage)
Comments to be addressed through Exhibit B:
1. Need to see quantifiable metrics on quality of care, patient satisfaction and reducing
clinical variation. Compared to industry norms. (Jack Fuller)
2. Track Record: What are patient safety scores? Quality scores? Patient satisfaction
scores? Analysis of costs and compare — provide top 10 DRG codes and costs?
(Sandra Hall)
3. How have they addressed the rising maternal mortality rate in the US (only
industrialized country with rising maternal mortality rate). Given the relatively small
numbers — surrogate for this would be maternal morbidity? (Sandra Hall)
4. Can we ask for examples [on cost and quality and patient safety]? (Joseph Pino)
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