Governance Board and Full Board of Directors Meetings Thursday, February 8, :00 p.m.

Governance Board and Full Board of Directors Meetings Thursday, February 8, 2018 1:00 p.m. Lee Memorial Health System Board of Directors

BOARD OF DIRECTORS OFFICE 239-343-1500 FAX: 239-343-1599 13685 DOCTORS WAY #190 FT MYERS, FLORIDA 33912 CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER LEE MEMORIAL HOSPITAL GOLISANO CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL LEE PHYSICIAN GROUP LEE CONVENIENT CARE BOARD OF DIRECTORS DISTRICT ONE Stephen R. Brown, M.D. Therese Everly, BS, RRT DISTRICT TWO Donna Clarke Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Peer Stephanie Meyer, BSN, RN AGENDA GOVERNANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS February 8, 2018 at 1:00 p.m. Gulf Coast Medical Center Boardroom (Medical Office Building) 13685 Doctors Way, Ft. Myers, FL 33912 1. CALL TO ORDER (Sanford Cohen, M.D., Board Chairman) Lee Memorial Health System Board of Directors, sitting as the Board of Directors for Lee Health, Gulf Coast Medical Center & Lee Memorial Hospital/HealthPark Medical Center and the Board of Directors of its subsidiary corporations, including but not limited to Cape Memorial Hospital, Inc. doing business as Cape Coral Hospital; Lee Memorial Home Health, Inc.; and HealthPark Care Center, Inc. 2. INVOCATION & PLEDGE OF ALLEGIANCE (Rev. Mike Warthen, MDiv, BCC) 3. PUBLIC INPUT Agenda Items: Any Public Input is limited to three minutes and a Request to Address the Board of Directors card must be completed and submitted to the Board Staff prior to meeting. Individuals wishing to address the Board on a Non Agenda item must notify the Board Staff of the subject matter at least three (3) days prior to the meeting. 4. RECOGNITION: HRSA NATIONAL WORKPLACE PARTNERSHIP FOR LIFE HOSPITAL CAMPAIGN RECOGNITION (Lisa Sgarlata, Chief Patient Care Officer) (Liz Lehr, RN, MHA, Senior VP/Executive Director LifeLink of Florida) 5. PHYSICIAN LEADERSHIP COUNCIL (PLC) REPORT (Accept) (William Hearn, D.O., PLC Chairman) 6. PRESIDENT S REPORT (Larry Antonucci, MD, President & CEO) RECESS to CALL TO ORDER Lee County Trauma Services District Board of Directors Meeting (Sanford Cohen, M.D., Board Chairman) RECONVENE LEE MEMORIAL HEALTH SYSTEM BOARD MEETING (Sanford Cohen, M.D., Board Chairman) 7. CONSENT AGENDA (APPROVE) 1. Finance and Full Board Meeting Minutes of 1/25/18 2. Board Policy 10.26C Arrangement with Large Commercial User of System Services (No revisions) 3. Board Policy 30.05 Direct Consultation with Medical Staff Leader (No Revisions) 8. INFORMATION TECHNOLOGY BUDGET IMPLICATIONS EPIC AND OTHER SYSTEMS UPDATE (Mike Smith, Chief Information Officer) 9. WORKFORCE PLANNING (Kristy Rigot, System Director of Recruitment & Retention) (Michelle Zech, Business Partner) 10. MENTAL & BEHAVIORAL HEALTH STRATEGY (Lisa Sgarlata, Chief Patient Care Officer) Lee Memorial Health System Board of Directors

AGENDA (Page 2 of 2) GOVERNANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS February 8, 2018 at 1:00 p.m. BOARD OF DIRECTORS OFFICE 239-343-1500 FAX: 239-343-1599 13685 DOCTORS WAY #190 FT MYERS, FLORIDA 33912 CAPE CORAL HOSPITAL GULF COAST MEDICAL CENTER HEALTHPARK MEDICAL CENTER LEE MEMORIAL HOSPITAL 11. OLD BUSINESS 12. NEW BUSINESS 13. Governance Portion: Nancy McGovern, Governance Liaison 14. BOARD OFFICER ELECTIONS (Jim Humphrey, Board Counsel) LEE HEALTH BUSINESS BOARD CHAIRMAN 15. BOARD MEETING CRITIQUE 16. BOARD OF DIRECTORS REPORTS GOLISANO CHILDRENS HOSPITAL OF SOUTHWEST FLORIDA THE REHABILITATION HOSPITAL LEE PHYSICIAN GROUP LEE CONVENIENT CARE Date of the next Meeting: ADJOURN (Board Chairman) February 22, 2018 at 1:00 p.m. Quality, Safety & Education and Full Board Gulf Coast Medical Center Boardroom 13685 Doctors Way, Ft. Myers, FL 33912 BOARD OF DIRECTORS DISTRICT ONE Stephen R. Brown, M.D. Therese Everly, BS, RRT DISTRICT TWO Donna Clarke Nancy M. McGovern, RN, MSM DISTRICT THREE Sanford N. Cohen, M.D. David Collins DISTRICT FOUR Diane Champion Chris Hansen DISTRICT FIVE Jessica Carter Peer Stephanie Meyer, BSN, RN Lee Memorial Health System Board of Directors

BOARD OF DIRECTORS Invocation & Pledge of Allegiance Lee Memorial Health System Board of Directors

BOARD OF DIRECTORS PUBLIC INPUT AGENDA ITEMS: Any public input pertaining to items on the Agenda is limited to three minutes and a Request to Address the Board of Directors card should be completed and submitted to the Board Staff prior to meeting. Refer to Board Policy: 10:15H: Public Addressing the Board Non-Agenda Item: Individuals wishing to address the Board on an item NOT on the Agenda, the Board office must be notified of subject matter at least three (3) days prior to the meeting to allow staff time to prepare and to insure the matter is within the jurisdiction of the Board. Lee Memorial Health System Board of Directors

BOARD OF DIRECTORS RECOGNITION: HRSA NATIONAL WORKPLACE PARTNERSHIP FOR LIFE HOSPITAL CAMPAIGN RECOGNITION (Lisa Sgarlata, Chief Patient Care Officer) (Liz Lehr, RN, MHA, Senior VP/Executive Director LifeLink of Florida)

BOARD OF DIRECTORS PHYSICIAN LEADERSHIP COUNCIL REPORT William Hearn, D.O, PLC Chairman Lee Memorial Health System Board of Directors

INFLUENZA UPDATE: Physician Leadership Council Report 2/08/18 The pneumonia and influenza mortality has exceeded the epidemic threshold from previous years. Positive test results reflect a very high increase in positive test results when comparing 2016/2017 flu season with the 2017/2018 flu season. The CDC recommends the use of antiviral treatment as soon as possible for all hospitalized, severely ill, and people who are at higher risk for complications with suspect influenza. Medical Staff is participating in regular Flu update meetings and planning sessions. REVISED CALL PAY PROGRAM: The Administration plans to update both the structure and process of current call programs and develop, implement and administer the system s call pay programs for both ED and Trauma. Current call pay rates are result of multiple agreements at various dates, ranging 1-12 years ago. Program changes will ensure consistency across all specialties by using national benchmarks, standard agreements and an indexed MGMA pay rate for current and future call arrangements. New Call Program agreements will be executed not later than July 1, 2018. These actions are meant to ensure specialty coverage across the entire system. PATIENT EXPERIENCE UPDATE: Physician/Nurse Rounding is essential for Improving Patient Experience. Proven improvement of scores. An education plan will be presented at the next PLC meeting in order to move forward and engage physician/nurse rounding of non-contracted medical staff. Part of the Quality metrics of contracted groups. Communication with Doctors is crucial for improving scores. Efforts to have patients rate always are being made. A comparison of hospitals throughout Florida with HCHAPS 4 star rating was reviewed in comparison with local Lee and Collier hospitals. CLINICAL COLLABORATION COUNCIL UPDATE: Telemetry Update: utilization is down approximately 35% system wide with Zero SSE related to the Telemetry project in 3 months after go-live. Cardiac Bundle Update The implementation of CMS bundle payments has been postponed. The health system is not obligated to participate. Lee Health Administration and MS recognize the scope of the bundle to be critical to our population to improve quality, patient experience and cost of care. Plan is to finish the work and develop an integrated model of care for future CMS innovations and success in other advanced payment models.

Top action items for areas of improvement for Stemi / Non-Stemi and CABG was presented. Sepsis Workgroup update The new Sepsis Order sets were implemented October 24, 2017. The utilization of ED provider sepsis order set since Sepsis 2.0 go-live is approximately 50% system-wide. Barriers are being evaluated and resolved locally and system-wide. Sepsis outcomes dashboard in Epic is a tool that is available to monitor performance on CMS bundle compliance, mortality, readmission rate, and LOS. SSI/ERAS Update: The top 20 surgeons by number of procedures through November, 2017 for Colorectal SSI have been evaluated. Documentation and specific language is crucial to reduce apparent infection rates. A new action plan implemented January 1 st. PHYSICIAN COMMUNICATION PLAN: The implementation of a Steering Committee formed. It was noted, pediatric representative will be added to the Steering Committee. Monthly president s report to physicians that will include topics i.e. strategy, mission, vision, major news will be emailed and placed in the physicians lounges. New CCC monthly newsletter to the medical staff and CCG members with CCG status will be emailed and available in SharePoint. Electronic solutions utilizing Sharepoint and integration with existing EPIC platform MEDICAL STAFF REORGANIZATION: Need of medical staff legal representation. Physicians need to know where to go to get complex information with the continuing changes with Medicare COP s, bundle payments, etc. Recommendation was made to present a prepared brief summary to all FMEC s in March for further direction from the medical staff. Bylaws Committee convened 1/24/18. Medical Staff has agreed upon a selection of external Legal Council to help guide the process.

BOARD OF DIRECTORS PRESIDENT S REPORT Larry Antonucci, MD, President & CEO Lee Memorial Health System Board of Directors

Lee Health Board of Directors Meeting February 8, 2018 President s Report Health Grades Baby Friendly Site Visit Medicaid Work Requirement impact ECCL meeting follow up State Budget Update HealthCare Disruptors Organizational Structure Update

Users don t pay Supply drives demand Very limited pricing power Provide service without payment Our primary supplier is our customer It s hard to comparison shop 1

Mortality Cohorts HealthGrades 5 Star Diagnosis/Procedure In-house Mortality Mortality 30 Day Bowel Obstruction X COPD X X Coloector Surgery X CABG X X Coronary Interventional Procedures X Cranial Neurosurgery X Diabetic Emergencies X Esophageal/Stomach Surgeries X GI Bleed X AMI X X CHF X X Pancreatitis X Pneumonia X X Pulmonary Embolism X Respiratory Failure X Sepsis X Small Intenstine Surgeries X Valve Surgery X HealthGrades In-house Mortality Compared to 5 Star 30 Day Any Cause Mortality 2

In-Hospital Complication Cohorts HealthGrades 5 Star Diagnosis/Procedure Complication Complication Abdominal Aortic Aneurysm Repair X Appendectomy X Back and Neck Surgery (no Fusion) X Carotid Surgery X Defibrillator Procedures X Gallbladder Removal Surgery X Hip Fracture Treatment X Hip Replacement X X Pacemaker Procedures X Peripheral Vascular Bypass X Prostate Vascular Surgery X Spinal Fusion X Total Knee Replacement X X Transurethral Prostate Resection Surgery X HealthGrades In-house Complications Compared to 5 Star In-house Complications 3

020818 REV. 2 Senior Leader Org chart VP s and above Board Legal Counsel Jim Humphrey Board of Directors President Larry Antonucci Chief Medical & Clinical Integration Officer Scott Nygaard, M.D. Chief Foundation Officer Lee Health Foundation Skip Leonard Chief Acute Care Officer Scott Kashman Chief Population Health Officer John Chomeau Chief Patient Care & Nursing Officer Lisa Sgarlata CAO Golisano Children s Services Armando Llechu Chief Legal Officer Legal Services Mary McGillicuddy Chief Human Resources Officer Jon Cecil Interim Chief Compliance Officer Ben Spence Chief Financial & Business Services Officer Ben Spence Chief Admin. Officer LPG, Home Health & Physician Services Kristine Fay Vice President LPG Operations LaTrice Davis Vice President Oncology and Palliative Care Dennis Bruens Medical Director Palliative Care Colleen Tallen, M.D. CAO System Ancillary Services Josh DeTillio GCMC Acute Care Medical Officer Jonathan Velez, M.D. System Medical Director Care Management Jon Hart.M.D. GCMC VP Pt. Care Svs. Holly Muller GCHSWFL VP Pt. Care Svs. Susan Ryckman GCHSWFL Acute Care Medical Officer VACANT System Medical Director Wellness & Emp. Health Sal Lacagnina D.O. Chief Information Officer Mike Smith Vice President & CMIO Bill Carracino. M.D. Vice President LPG Nursing Ambulatory Diane Smith Chief Admin. Officer Outpatient Services David Cato Vice President Rehab Hospital Jeffrey Brown Vice President Coconut Point Alex Greenwood Vice President Quality & Safety Alex Daneshmand, D.O. VP Medical Affairs Medical Staff Services Mark Greenberg, M.D. Medical Director Oncology James W. Orr Jr., M.D. System Medical Director Physician Services & Cultural Transformation Phyllis Neef M.D. Chief Medical Officer Lee Physician Services Venkat Prasad, M.D. Regional Medical Officer & System Medical Director Pediatrics Emad Salman, M.D. System Medical Director LPG Hospitalist Medicine Andres Laufer, M.D. Medical Director Informatics Leah Lynch, M.D. Medical Director Academics & Medical Ed. Eric Goldsmith, D.O. HPMC Acute Care Medical Officer Eric Appelgren, M.D. CCH Acute Care Medical Officer Harry Alberti, M.D. LMH Acute Care Medical Officer Scott Wolf, D. O. HPMC VP Pt. Care Svs. Cindy Brown CCH VP Pt. Care Svs. Wendy Piascik LMH VP Pt. Care Svs. Jennifer Higgins System Medical and nursing practice oversight through Chief Medical Officer and Chief Nursing Officer Clinical Service Line Dyads: Oncology James Orr M.D., Dennis Bruens Heart & Vascular Institute Rick Chazal M.D., Michael Montgomery Neuroscience Institute Bill Carracino M.D. interim, Cindy Drapal Orthopedic Co-Management John Mehalik M.D., Alex Greenwood Infectious Disease Mary Beth Saunders D.O., Stephen Streed Vice President Facilities & Support Services Dave Kistel Vice President Finance Patty Duquette Vice President Revenue Cycle PHO Anne Rose Medical Director Clin. Integration PHO Joby Kolsun, D.O. President LeeSar & CSF Bob Boswell Vice President Clin.Transformation Marilyn Kole M.D.

RECESS To Call to Order the: Lee County Trauma Services District Board of Directors Meeting Board Chairman: Sanford Cohen, M.D.

TRAUMA DISTRICT MEETING TO CHAIRMAN: RECONVENE Lee Memorial Health System FULL BOARD OF DIRECTORS MEETING Thursday, February 8, 2018 BOARD CHAIRMAN: Sanford Cohen, M.D.

BOARD OF DIRECTORS CONSENT AGENDA (APPROVE) 1. Finance and Full Board Meeting Minutes of 1/25/18 2. Board Policy 10.26C: Arrangement with Large Commercial User of System Services (No revisions) 3. Board Policy 30.05: Direct Consultation with Medical Staff Leader (No Revisions)

FINANCE BOARD AND FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, January 25, 2018 LOCATION: Gulf Coast Medical Center, Medical Office Building, Board of Directors Boardroom, 13685 Doctors Way, Fort Myers, FL 33912 MEMBERS PRESENT: Sanford N. Cohen, M.D., Board Chairman; Donna Clarke, Board Vice Chairman; David Collins, Board Treasurer; Therese Everly, Board Secretary; Stephanie Meyer, BSN, RN, Board Member; Nancy McGovern, RN, MSM, Board Member; Stephen Brown, M.D., Board Member; Jessica Carter Peer, Board Member MEMBERS ABSENT: Chris Hansen, Board Member; Diane Champion, Board Member NOTE: Documents referred to in these minutes are on file by reference to this meeting date in the Office of the Board of Directors and on the Board of Directors website at www.leehealth.org/boardofdirectors, for public inspection. SUBJECT DISCUSSION ACTION FOLLOW- UP MEETING The LEE HEALTH FINANCE BOARD CALLED TO ORDER & FULL BOARD OF DIRECTORS MEETINGS were CALLED TO ORDER at 1:00 p.m. by Sanford Cohen, M.D., Board Chairman. INVOCATION AND PLEDGE OF ALLEGIANCE PUBLIC INPUT RECOGNITION: KATHLEEN HERRICK 29 YEARS PRESIDENT S REPORT Rev. Denise Sawyer, MDiv, BCC, gave the Invocation, followed by the Pledge of Allegiance. None at this time. Susan DiMatteo recognized Kathleen Herrick for 29 years of service. Larry Antonucci, M.D., President & CEO presented the President s Report. Discussion ensued about the opioid crisis. CHAIRMAN TO FINANCE LIAISON The gavel was turned over to FINANCE Liaison, David Collins, to CONVENE the FINANCE portion of the meeting at 1:27 p.m. CONSENT AGENDA David Collins asked for approval of the Consent Agenda. A motion was made by Donna Clarke to approve the Consent Agenda consisting of: 1. Financial and Statistical Reports as of October 31, 2017 2. Financial and Statistical Reports as of November 30, 2017 The motion was seconded by Nancy McGovern and carried with no opposition. PRICE WATERHOUSE COOPERS FY 2017 AUDIT REPORT John Sittig presented the Price Waterhouse Coopers FY 2017 Audit Report. Discussion ensued. A motion was made by Therese Everly to accept the Price Waterhouse Coopers FY 2017 Audit Report. The motion was seconded by Jessica Carter Peer and carried with no opposition. FINANCIAL AND STATISTICAL BUSINESS Ben Spence presented the Financial and Statistical Business. A motion was made by Nancy McGovern to accept the Financial and Statistical Reports as of December 31, 2017. The motion was seconded by Jessica Carter Peer and carried with no opposition. Lee Memorial Health System Board of Directors

LEE HEALTH FINANCE & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, January 25, 2018 Page 2 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP Stephen Brown requested an update on the number of Flu cases at the next Scott Nygaard/ Quality, Safety & Education Meeting. Flu Update/ 2/22/18 Discussion ensued around bad debt, Medicare and supplemental insurance plans. John Chomeau to report back to the Board. John Chomeau/ Beneficiary/ TBD Therese Everly discussed readmission rates and requested an update on the Chronic Care Clinics and Expansion Model. Lisa Sgarlata/ Dr. Prasad/ Chronic Care Clinics/ Expansion Model/TBD MED PLAZA ONE ACQUISITION Ben Spence asked for approval of the Med Plaza One Acquisition. A motion was made by Stephen Brown to (1) approve the contract to purchase of property located at 9800 South Health Park Drive, Fort. Myers, FL 33908, from Lee Memorial Hospital, Inc., d/b/a Lee Healthcare Resources, for the purchase price of $12,350,000 subject to terms and conditions set forth in the contract and seller financing terms listed in Exhibit A ; (2) authorize the President of Lee Health to execute the purchase agreement and other documents necessary to effectuate the purchase of the property subject to review and approval by legal counsel; and (3) authorize the Board Chairman to execute the attached Resolution of the Lee Memorial Health System Board of Directors. The motion was seconded by Nancy McGovern. Discussion ensued. The Board requested additional information on the survey, appraisal and value of the land lease. A motion was made by Dr. Cohen to table the Med Plaza One Acquisition until further information is available. The motion was seconded by Nancy McGovern and carried with no opposition. Ben Spence/TBD FINANCE LIAISON TO CHAIRMAN The next LEE HEALTH Finance Board Meeting is: Thursday March 22, 2018, at 1:00 p.m. Gulf Coast Medical Center, Medical Office, Boardroom 13685 Doctors Way, Fort Myers, FL 33912 The gavel was turned over to the Board Chairman, Sanford Cohen, to RECONVENE the FULL BOARD portion of the meeting at 3:10 p.m. RECESS was called at 3:11 p.m., meeting RECONVENED at 3:20 p.m. CONSENT AGENDA Dr. Cohen asked for approval of the Consent Agenda. A motion was made by Therese Everly to approve Consent Agenda items: 1. Planning and Full Board Meeting Minutes of 1/11/18 The motion was seconded by David Collins and carried with no opposition. Donna Clarke and Stephanie Meyer were not present for the vote. Lee Memorial Health System Board of Directors

Discussion ensued. LEE HEALTH FINANCE & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, January 25, 2018 Page 3 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP CORPORATE Tracy Stott Pyles presented the Corporate Compliance Report. A motion was made by Donna Clarke to accept the Corporate COMPLIANCE REPORT Compliance Report for the period October - December 2017. The motion was seconded by Jessica Carter Peer and carried with no opposition. MEDICAL STAFF RECOMMENDATIONS OLD BUSINESS Dr. Cohen asked for approval of the Medical Staff Recommendations. Stephanie Meyer recused herself from voting. Dr. Cohen asked for approval of the Board of Directors Commitment to Excellence Award. A motion was made by Donna Clarke to approve the Medical Staff Recommendations for all five listed institutions. The motion was seconded by Nancy McGovern and carried with no opposition. A motion was made by Donna Clarke to approve option 4 and all the details listed in the documentation. The motion was seconded by Jessica Carter Peer. Therese Everly suggested the audit process as a future workshop topic. Donna Clarke suggested placing this topic in the Strategic Planning Workshop. Therese Everly moved to amend the main motion to include the Board be extended an invitation to attend the departments celebration. The motion to amend was seconded by Donna Clarke and carried with no opposition. The amended motion passed without opposition. Audit Workshop/TBD NEW BUSINESS Nancy McGovern requested Board Members to send the Board Office Coordinator any information they would like on the Governance agenda for the next meeting. BOARD MEETING CRITIQUE BOARD OF DIRECTORS REPORTS Dr. Cohen stated that he would like a Dashboard Summary of the last two meetings at the next Board Meeting. Therese Everly stated that the Med Plaza One green sheet lacked key components of the contract. Donna Clarke would like to know what would happen if we did not purchase the Medical Plaza lease. Stephen Brown thanked David Collins and Ben Spence for their work. Stephen Brown thanked the staff at HealthPark for their wonderful care while admitted. Therese Everly will liaison for the Liability Insurance Bid Committee and will report back. Therese updated the Board on the closing of the Cath Lab at Cape Coral Hospital. She congratulated the team for moving the Phase 3 Cardiac Rehab Program into the Wellness Center, attended the FHA Annual Membership Meeting and the Make a Wish Ball. Nancy McGovern informed the Board that Mary Andrews will be presenting at the League of Women Voters on Saturday, February 3 rd at the Heritage Palms Golf and Country Club in Fort Myers. Jessica Carter Peer attended the FHA Annual Membership Meeting and informed the Board of the SWFL VegFest this Sunday, January 28 th at the Riverside Park in Bonita Springs. Lee Memorial Health System Board of Directors Board Staff/ Summary/ 2/8/18

LEE HEALTH FINANCE & FULL BOARD OF DIRECTORS MEETING MINUTES Thursday, January 25, 2018 Page 4 of 4 SUBJECT DISCUSSION ACTION FOLLOW- UP Minnie Jackson, Community Member attended the JimFest at Lee Memorial Hospital and informed the Board that she will be taping with Lee Pitts Live on the subject of Lee Health from the closure of Jones Walker to now. NEXT REGULAR MEETING The next LEE HEALTH BOARD OF DIRECTORS GOVERNANCE BOARD AND FULL BOARD MEETING will be held on February 8, 2018, at 1:00 p.m. in the Gulf Coast Medical Center, Medical Office Building, Boardroom 13685 Doctors Way, Fort Myers, FL 33912 ADJOURNMENT Minutes were recorded by Jennifer Zager, Assistant to the Board of Directors The LEE HEALTH SYSTEM FINANCE BOARD & FULL BOARD OF DIRECTORS MEETINGS ADJOURNED at 4:10 p.m. by Sanford Cohen, M.D., Board Chairman. Therese Everly Date approved Board Secretary Lee Memorial Health System Board of Directors

Once this policy is printed, it is not considered a controlled document. Please review electronic version of this policy for the most current document. LEE MEMORIAL HEALTH SYSTEM BOARD OF DIRECTORS POLICY MANUAL no. 30.05 supersedes no. --------------------------------------------------------------------------------------------------------------------------------------- category: Medical Staff Relations title: Direct Consultation with Medical Staff Leader --------------------------------------------------------------------------------------------------------------------------------------- Date Originated: 02/05/2015 Reviewed/No Revision: 2/8/18 Dates Revised: Next Review Date: 02/05/182/8/21 --------------------------------------------------------------------------------------------------------------------------------------- PURPOSE: To establish a policy and procedure for the Lee Memorial Health System Board of Directors to consult directly with the individual assigned the responsibility for the organization and conduct of each of the hospital s Medical Staff, or his or her designee, as required by federal regulations. --------------------------------------------------------------------------------------------------------------------------------------- POLICY: 1. Pursuant to the Medical Staff Bylaws, the Medical Staff serves as the primary means for accountability to the Lee Memorial Health System Board of Directors for the quality of the medical care provided to patients of each hospital. 2. The President of the Medical Staff is assigned responsibility for the organization and conduct of the Medical Staff. The Centers for Medicare and Medicaid refers to the individual assigned this responsibility as the leader of the Medical Staff. 3. The Board of Directors will consult directly with the President of the Medical Staff, or his or her designee. An individual may be the designated consultant for multiple hospitals as long as the designee is knowledgeable about the quality of medical care provided to patients of each hospital. 4. Direct consultation will occur periodically throughout the calendar year, in accordance with this policy, and include discussion of matters related to the quality of medical care provided to patients of each hospital. 5. "Direct consultation" means that the governing body, or a committee or subcommittee of the governing body, meets with the leader of the Medical Staff, or his or her designee, either faceto-face or via a telecommunications system permitting immediate, synchronous communication. 6. As a governing body of a multi-hospital system that has one single governing body, the Lee Memorial Health System Board of Directors will consult with each separately certified hospital's Medical Staff leader, or his or her designee. The consultations do not have to be separate and may include the leader of the Medical Staff, or his or her designee, from each 30.05 Direct Consultation with Medical Staff Leader Page 1 of 2

Once this policy is printed, it is not considered a controlled document. Please review electronic version of this policy for the most current document. hospital within the health system, so long as there is discussion of matters related to the quality of medical care provided to the patients of each hospital. Procedure: 1. The President of the Medical Staff will advise the Board of Directors when assigning another individual as the designee for periodic consultation with the Board of Directors. Designations may be informal and made on an ad hoc basis. 2. Consultations will occur at least twice during the calendar year. The Board of Directors will be responsive to any periodic and/or urgent requests from the President of the Medical Staff, or his or her designee, for timely consultation on issues regarding the quality of medical care provided to patients. Further, the Board of Directors retains flexibility to schedule additional consultations during the calendar year with the President of the Medical Staff, or his or her designee. 3. Documentation will be created to demonstrate the required consultations have occurred. Such documentation may include, meeting agendas and lists of attendees; or minutes, including who was present and that matters related to the quality of medical care provided to patients of each hospital were discussed. 30.05 Direct Consultation with Medical Staff Leader Page 2 of 2

BOARD OF DIRECTORS INFORMATION TECHNOLOGY BUDGET IMPLICATIONS EPIC AND OTHER SYSTEMS UPDATE (Mike Smith, Chief Information Officer)

IT Expense Discussion Lee Health Board February 8, 2018 #3400.159 Rev. 10/16

Topics Major Components of the IT Operating Expense Budget Key Cost Components of an IT Project Optimizing IT Investment Value Existing Vendors Discussion How Lee Health s Operating Spend compares Industry Trends that are impacting the IT Operating Budget 1

Major Components of the IT Operating Budget Staff costs Non-staff costs examples Application Software maintenance Hardware maintenance Data Network Services Voice/Cellular Services Software/Cloud computing subscription fees Security vendor software and hardware Professional services (implementation services, vendor support services) IT consulting Training/Travel expenses 2

Optimizing IT Investment Value IT Project Processes/Methodologies: Project Requests Assessment Clarification of Anticipated Return/Accountabilities for Achievement Objective Vendor selection process to Achieve Maximum Value Contract Negotiating for Best Terms IT Project Implementation Methodology Post Implementation Value Review/Adjustments Oversight by IT Governance Steering Committee 3

Key Cost Components of an IT Project Application Software i.e. Epic, Infor, MedeAnalytics, etc. Underlying software vendors such as Oracle, IBM, Cache, Underlying data center hardware vendors such as IBM, HP, Cisco, Microsoft End user device vendors for workstations, printers, bar code scanners, Network expansion Certain facilities expenses Data Networking Vendors to including cabling vendors, communication vendors End User Training Expenses including salary 4

Relative Cost of the Application Vendor Software A review of the Epic Decision 5

Epic Clients

How does Lee Health IT Operating Spend Compare 14

Trends Affecting IT Operating Expense Growth Industry-Wide Transition from perpetual licensing to subscription models Shift from Locally Hosted to Cloud Increased Redundancy/Fault Tolerance Cyber Security Requirements New Information Delivery Platforms Remote Capability Expansion Mobile Platform Growth Web Enablement Telehealth More Consumer Facing Predictive Analytics, Pop Health, AI 15

Trends Affecting IT Operating Expense Local: Epic Enterprise Licensing offers some new modules without capital but does require operating expense increase Lee Health Need for more IT Applications Growth of Lee Health size/footprint More users More locations More patient visits/volume Technology upgrades/replacements due to age, capacity needs 16

Summary Lee Health has implemented steps of achieve high value from IT Investments The IT Investments Lee Health has made are high quality, sustainable, and serving us well We can expect internal and external factors to drive some growth in our IT spend The key is to adopt and leverage the technology to improve care, improve the patient experience, displace other costs, and grow new business 17

Thank You

BOARD OF DIRECTORS WORKFORCE PLANNING UPDATE (Kristy Rigot, System Director of Recruitment & Retention) (Michelle Zech, Business Partner) Lee Memorial Health System Board of Directors

Workforce Planning and Collaboration Presented by: Michelle Zech, Human Resources Strategic Business Partner Kristy Rigot, System Director Recruitment and Retention #3400.159 Rev. 10/16

Help Wanted Help wanted: Jobs plentiful in Fort Myers, Cape Coral Casey Logan Fort Myers News-Press USA TODAY NETWORK - FLORIDA How low will unemployment rates go? 3.4% December 2017 3.6% September 2017 4.7% a year ago 1

Unemployment Trends 12.0% 10.0% 8.0% 6.0% 4.0% 2012 2017 2.0% 0.0% U.S Florida MSA Lee Provided by CareerSource SWFL 2

Current Challenges Currently approximately 11,127 job seekers in Lee County Job growth expected to increase by 15.2% from 2016 2024 Information provided by CareerSource SWFL 3

Current Challenges Entry Level Companies willing to increase their wages for entry level positions Lee Health s entry level turnover Position Turnover Medical Assistant 18.23% Customer Service Rep. Certified Nurse Asst. 20.68% 15.78% Food Service Asst. 35.42% Housekeeper 24.61% Support Services Assoc. (Transporter) 29.93% Affordable Housing/Transportation 4

New Workforce Needs 5

Overall Recruitment Metrics FY17 63,782 applications 8,230 HR interviews conducted 4,183 positions filled 51 days overall time to fill 3.7% overall vacancy rate 4.5 overall customer satisfaction 7

Workforce Planning & Recruitment Success The new Golisano Children s Hospital of Southwest Florida opens its doors with talented staff! 8

Nurse Residency Program Positions filled FY17 Date of Residency Lee Memorial Hospital Gulf Coast Medical Center Cape Coral Hospital HealthPark Medical Center Golisano Children's Hospital of SW Florida Rehabilit ation Hospital Home Health Total Oct 16 4 9 5 11 4 1 0 34 Nov 16 9 7 2 10 1 0 0 29 Feb 17 13 18 9 16 8 3 0 67 Mar 17 13 10 3 12 6 1 0 45 April 17 5 14 5 7 2 1 0 34 May 17 5 7 3 6 0 0 0 21 June 17 4 6 8 6 2 0 1 27 July 17 6 12 10 12 5 0 0 45 Aug 17 7 20 9 4 2 0 1 43 Sept 17 2 8 1 1 1 2 1 16 Totals 68 111 55 85 31 8 3 361 9

Building Career Pipelines Workforce Champion Award Creation of a Pharmacy Tech Program Pharmacist Residency Program CNA Program Medical Assistant Program 10

Collaboration is Key! K-12 Participation STEM/Medical Academies Customer Service Representative Medical Administrative Specialist Program Cape Coral Technical College (CCTC)and Ft. Myers Technical College(FMTC) CSR position in LPG 11

Workforce Successes English as a Second Language (ESOL)/General Educational Development (GED) Classes Entry level jobs Career pathways Partner with Cape Coral Technical College/Fort Myers Technical College, Florida Southwestern State College and CareerSource SWFL Reconfiguring our current Advanced Provider Internship Program Attainable Housing Coalition 12

Our Why - Build programs and relationships with community partners and employers that coincide with our strategic plan - Recruit and retain - Enhance lives! Deshana Levy 13

Thank You

BOARD OF DIRECTORS MENTAL & BEHAVIORAL HEALTH STRATEGY (Lisa Sgarlata, Chief Patient Care Officer)

Behavioral Health Lisa Sgarlata, CPCO John Chomeau, CPHO February 8, 2018 #3400.159 Rev. 10/16

May 25, 2008 2

Lee Health - Behavioral Health Road Map Strategic Model of Care Lee Health Dyad Lead(s): John Chomeau Lisa Sgarlata Methods and Practices Lee County needs to extend outreach to undiagnosed and under treated Access to care is underdeveloped due to limited and expensive clinicians Focus on beds and face to face encounters presents too narrow of a model of care National Managed BH Providers building a tiered systematic approach for access 10 years of Clinical trials and published peer reviews prove CBT is effective Existing Roadmap 2018 Launches Lee Health is rolling out computerized CBT across all employees and dependents CBT and Tele-Psych rolling out to all ED s, LPG Primary Care and the FQHC s LH is building the integrated 4-tiered, BH model of care for Population Health (ACO) LH is considering a Pediatric focused model of care building upon Golisano and leveraging Beacon Health for the Medicaid PSN Operations Plan Strategic Model of Care Levels of Care Intensity Target Status Key Elements Tier 1 Cognitive Behavioral Therapy Tier 2 Tele-Psychology Tier 3 In Person Counseling Tier 4 Inpatient or Intensive Outpatient GO BUILD ALIGN BUILD ALIGN BUILD Cobalt by Magellan : Randomized clinical trials and peer reviewed. 15 years in market. Clinical Screener and practice protocols for PCP, FQHC and Employee engagements (English/Spanish) Non-Medication outcomes for: Depression, Anxiety, Insomnia, Substance Abuse, OCD, PTSD, Suicide Clinical Escalation linked to ED, PCP, FQHC, Care Manger or Employee EAP encounters No patient stigma, required travel or time off work Beacon Health provides a FL based, fully credentialed and contracted network in Lee County Need to build a seamless escalation path and medication management model Community resources are available but operate in siloes Need to bring together a community partnership Path of Care is to efficiently move cases into Tier 4 and then support the return to community Opportunities and Leadership Opportunity Owner Potential Impact What is Needed to Resolve? Target Model of Care Alignment John C. Autism (Pediatric/Adult), Senior Care Lisa S. Culture and Change Management Path of Care Lisa S. & John C. Reach to 85-95% of patients not receiving any care/support Develop Centers of Excellence for kids, young adults and age 50+ patients Screen 100% of all patients over 2018 and 2019 Common understanding that BH requires a SYSTEM of CARE DEC 2017 Leverage Beacons NCQA Accreditation to build the COE (s) Establish the Lee Health ACO and PSN models of care Imbed Cobalt screening into the LH ED s, PCP s, FQHC s and Employee Clinics. Feed the Pathways of Care DEC 2017 2018 1 2 3 4 CBT Tele-Psych Consultation In/Out

Behavioral Health Screening Cobalt Computerized Cognitive Behavioral Therapy (CCBT) April, 2018 Cobalt by Magellan: Randomized clinical trials and peer reviewed. 15 years in market. Clinical Screener and practice protocols for Primary Care Physicians, Fed Qualified Health Centers and Employee engagements (English/Spanish) Non-Medication outcomes for: Depression, Anxiety, Insomnia, Substance Abuse, Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Suicide 4

Medicaid Provider Service Network Behavioral Health and Community Services 5

Provider Services Network Leverages all 4 Tiers of our Behavioral Health model Includes Medicaid behavioral contract improved for outcomes Addition of Cobalt for adults and pediatrics Tele-psych (Beacon) Provides primary care physicians and pediatric physicians with case management strategies Tiger Teams: Developing evidence-based clinical workflows through clear care management guidelines 6

Behavioral Health Center (Outpatient) 8

Behavioral Health Center January December, 2017 Clinical Intake Assessment: 1831 referrals Dept. of Children and Families Grant 170 for review Renal Transplant Referrals: 29 referrals Medication Management: 2280 visits Lee Community Health: 112 evaluations (May, 2017) 10

Program Development Program Target Date Intensive Outpatient Program (Track 1) Opened: December, 2017 LCH Tele-health Pilot February 14, 2018 Group Programming for Outpatient Clients (Medicare patients)(8-24 week programs) Depression Anxiety Co-Dependency Problematic Dual Diagnosis Post-traumatic Stress Disorder DBT: Dialectical Behavioral Therapy Lee Community Health North Providing ARNP services for Medication Management Expansion to other LCH sites Employee Assistance Program (EAP) Access for WebTPA clients Extended Therapy Hours Currently 1 Day a week Expanding in the coming months based on need April, 2018 Pending hiring of 2 nd Advanced Provider (In progress) Discussion in progress Expanded hours 1-2 providers (Dec, 17) Expanding to 4 providers (Feb., 17) 11

Future Opportunities Outpatient Profitability opportunities include: Expansion of services covered for addiction, including more Intensive Outpatient Program (IOP) and Outpatient Programming Value Based Payment models: Continued investments in ambulatory services, including screening, prevention and acute outpatient interventions such as Intensive Outpatient Programs. Long-term Impact (trends) 2017-2027 Reinvestment in Intensive Outpatient Programs as alternatives to inpatient admission for patients who are either approaching crisis or in crisis will decrease growth in admissions 12

OLD BUSINESS Lee Memorial Health System Board of Directors

NEW BUSINESS Lee Memorial Health System Board of Directors

Board Chairman to Governance Liaison: GOVERNANCE BOARD OF DIRECTORS MEETING Thursday, February 8, 2018 Nancy McGovern Board Member

BOARD OF DIRECTORS BOARD OFFICER ELECTIONS (Jim Humphrey, Board Counsel) Lee Memorial Health System Board of Directors

February 8, 2018 Governance Meeting Election of Board Officers (Jim Humphrey, Board Counsel) Board Policy 10.55A: Board Officers Duties and Election Consistent with the Lee Memorial Health System Enabling Act and this policy and procedure, the Board of Directors (The Board) will elect annually from its members a Chairman, Vice Chairman, Secretary and Treasurer, who shall be the officers of the Board. All officers shall be members of the Board. Officer Positions: Chairman Vice Chairman Treasurer Secretary The Board Office has received nominations for the following Officer positions: Chairman: Stephen R. Brown, MD Sanford Cohen, MD Vice Chairman: Donna Clarke Chris Hansen Treasurer: David Collins Secretary: Jessica Carter Peer Therese Everly Lee Memorial Health System Board of Directors

ADJOURNMENT DATE OF THE NEXT REGULARLY SCHEDULED GOVERNANCE MEETING THURSDAY, June 28, 2018 1:00 P.M. Gulf Coast Medical Center- Boardroom Medical Office Building 13685 Doctors Way Ft. Myers, FL 33912

BOARD OF DIRECTORS BOARD MEETING CRITIQUE Lee Memorial Health System Board of Directors

Summary of Board Meeting Effectiveness Dashboard January 25, 2018 The Board Meeting Effectiveness Dashboard as completed by Board members at the meeting. The following information was taken from the Dashboard forms and shared with all Board members at the meeting. Process Measure Number of Responses January 25, 2018 Red Yellow Green Did Not Meet Criteria Mix of meets and did not meet Consistently Meets Criteria 1. Effective Use of meeting time 2 5 2. Pre-Meeting Materials distributed on time 2 5 3. Board Members stay on track 3 4 4. Presentation at Right level of detail 1 2 4 5. Effective Decision making process 2 5 6. Meeting Ends in Timely manner 1 6 What Went Well in the Meeting? (by Process Measure) 5. Effective Decision Making Process By Board Members who did research to inform us of areas needing to be considered. What Needs Improvement (by Process Measure) 2. Pre-Meeting Materials Distributed on Time Some agenda items were delivered late, but still a lot to have enough time to read. 3. Board Members Prepared This particular BOD meeting, I did not get a chance to read all material. To the best of our ability. Difficult to assess with no committee meetings. 4. Presentations at Right Level of Detail Green sheet on Med Plaza one motion lacked key components of the contract. Land Lease When present of any leases or real estate, we need all the material to best make an informed decision. Suggestions for Improvement or Observations (by Process Measure) 5. Board Members Prepared Others did some good research to help make more informed decisions. Next steps for improvement will be discussed at a future Board meeting.

Summary of Board Meeting Effectiveness Dashboard January 11, 2018 January 25, 2018 (Inclusive) The Board Meeting Effectiveness Dashboard as completed by Board members at the meetings. The following information was taken from the Dashboard forms and shared with all Board members at the meeting. Number of Responses Summary January 11, 2018 January 25, 2018 Red Yellow Green Did Not Mix of meets and Consistently Meets Process Measure Meet Criteria did not meet Criteria 2 12 1. Effective Use of meeting time 2. Pre-Meeting Materials distributed on time 3. Board Members stay on track 4. Presentation at Right level of detail 5. Effective Decision making process 6. Meeting Ends in Timely manner 2 12 4 10 1 3 10 2 12 2 12 What Went Well in the Meeting? (by Process Measure) 1. Effective Use of Meeting Time The meeting moved along well with the exception of one topic Great use of time Staff stayed on tempo and Chair kept meeting on agenda 2. Pre-Meeting Materials Distributed On Time For the most part 3. Board Members Stay on Track It is obvious by the questions that we all prepared 4. Presentations at Right level of Detail It came back under another section Board members and admin appeared to be in sync with agenda 5. Effective Decision Making Process By Board Members who did research to inform us of areas needing to be considered. 6. Meeting Ends in Timely Manner Moving towards reducing overall time What Needs Improvement (by Process Measure) 1. Effective Use of Meeting Time Even the one topic; little extra time was spent in time

2. Pre-Meeting Materials Distributed on Time No negative remarks Some agenda items were delivered late, but still a lot to have enough time to read 3. Board Members Stay on Track This particular BOD meeting, I did not get a chance to read all material. To the best of our ability. Difficult to assess with no committee meetings. 4. Presentations at Right Level of Detail For the most part - One subject Peds was noted at the wrong point in presentation Green sheet on Med Plaza one motion lacked key components of the contract. Land Lease When present of any leases or real estate, we need all the material to best make an informed decision. 6. Meeting Ends in Timely Manner Still needs more work Suggestions for Improvement or Observations (by Process Measure) 5. Effective Decision Making Process When redirect was needed the members supported each other to redirect Others did some good research to help make more informed decisions. 6. Meeting Ends in Timely Manner Again, we all have a right to ask questions to presenters ahead of time to reduce the number at the table. We made it through a very lengthy meeting in a timely manner. Let's keep it up!

BOARD OF DIRECTORS BOARD OF DIRECTORS REPORTS Lee Memorial Health System Board of Directors

BOARD OF DIRECTORS DATE OF THE NEXT REGULARLY SCHEDULED MEETING: QUALITY, SAFETY & EDUCATION & FULL BOARD OF DIRECTORS MEETING Thursday, February 22, 2018 1:00 p.m. Gulf Coast Medical Center Boardroom, Suite 190 13685 Doctors Way Fort Myers, FL 33912 Lee Memorial Health System Board of Directors