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FireCloud Health (FCH), currently rebranded from Midwest Regional Health, is a company with a 4 billion dollar turnover ‘integrated health care system’ that was founded 15 years ago as a merger between two competing regional hospitals – one for-profit and one nonprofit. The hospitals and supporting facilities are non-profit; other services are for-profit. Located in the midwestern United States, FCH currently is characterized by the following:

• Two Level 1 trauma centers;

• Air ambulance service;

• Six general hospitals (emergency departments, operating rooms, intensive care units [ICUs], progressive care units [PCUs], maternity, pathology labs, full diagnostic services with various hospital-based outpatient clinics);

• Five specialty hospitals: Children’s Hospital, Cardiac Care Hospital, Women’s Health, long-term critical care and rehabilitative facility;

• 15 rural critical access hospitals;

• 2,300 licensed inpatient ‘beds’;

• 350 ambulatory outpatient clinics;

• 1,500 physicians, 500 medical providers (that is, any person providing health services, who are typically reimbursed directly by the ‘payer’ [insurance, government programs such as Medicare/Medicaid, etc.]);

• Health insurance plan with 700,000+ plan members (and growing);

• 20,000 employees and 2,500 volunteers;

• Partnered with a privately funded regional medical research group and a major state university-sponsored medical school.

FCH has become aware of the VeriSM™ approach and is applying the concepts to support its digital transformation efforts. As part of the governance activities, FCH has defined its mission (purpose and reason for being). The mission is to improve the health of the communities they serve. Additionally, the vision (what we aspire to be) is to be a national leader for health by 2025. The strategic enablers (the capabilities that facilitate strategic execution to meet the vision) and values include:

• Strategic enablers:

✓ People;

✓ Critical thinking;

✓ Innovation;

✓ Agility;

✓ Information Technology;

✓ Finance.

• Values:

✓ Excellence;

✓ Integrity;

✓ Compassion;

✓ Teamwork;

✓ Respect.

Note: the values listed will help to define the Service Management Principles.

This complex, sophisticated and vital health system is accredited through the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). However, one of FCH’s hospitals is in jeopardy of losing the accreditation and is to be audited within the next 30 days. Additionally, FCH (the non-profit portion) maintains an Aa3 credit-rating from Moody’s Investors Service and an AA rating from Standard & Poor’s (S&P). Health premiums for medical insurance from the health plan rank in the lowest quartile when benchmarked against regional competition.

The strategic direction of the organization, in order to fulfill the health care system’s vision, is to ensure that all services (for example hospital functionality, insurance programs) are streamlined, secure and take full advantage of technology enablers. There are currently several system-wide strategic initiatives, including:

• Continue to meet the criteria for Accountable Care Organizations as defined by the Patient Protection and Affordable Care Act of 2010 (the 2017 repeal efforts are not highlighted in this case).

• Continue to grow – the success of FCH has created ever-increasing use of the clinics and hospitals as well as the health insurance program. As such, there is an opportunity to merge 1-3 new hospitals into the current organization.

• Expand proactive health programming to the communities through partnership with various public and private sector businesses (for example after school programs for all grades, prison healthcare, Senior and Assisted Living programming).

• Upgrade their Electronic Medical Record (EMR) system to comply with Meaningful Use Stages 1 and 2 requirements stemming from the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009.

• Upgrade their inpatient revenue systems to comply with the Department of Health and Human Services’ (DHHS) latest round of Electronic Data Interchange (EDI) standards (“ICD-10”) stemming from the Health Insurance Portability and Accountability Act of 1996 (HIPPA).

• Create an Enterprise Compliance Office headed by a Chief Compliance Officer (CCO) responsible for ensuring compliance with U.S. Federal regulations, JCAHO requirements, and corporate policies (for example HIPPA, EMR, patient information security, and enterprise information security).

FCH is structured as follows: