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Energy Stewardship Gundersen Health System’s Approach

Wisconsin Office of Energy Innovation Summit

Jeff Rich, Executive Director – Envision, Gundersen Health System

May 24th, 2018

Gundersen Health System

• Organizational Profile – Currently have 41 clinic facilities

– 325 bed tertiary care hospital

– Physician-led Integrated delivery system

• ~700 providers and ~7,500 employees

– Residency and medical education programs

– Multiple Top 100 Hospital &Service Line recognition

– Health Plan

– A variety of affiliate organizations including EMS ambulance service, rural hospitals, nursing homes, hospice, etc.

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Our Mission

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Our Envision® Program

Energy Management

Waste Management

Recycling

Sustainable Design

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A Look in the Mirror Maintaining Consistency with our Mission

• Pollutants from the burning of fossil fuels cause: – Birth defects1

– Negative effects on the kidneys, lungs, and nervous system1

– Cardiovascular deaths and stroke2

– Increased carcinogens contributing to cancer risk

• According to the Department of Energy, hospitals are 2.5 times more energy intensive than other commercial buildings3

– This is inconsistent with our mission… we are responsible for contributing to disease through our wasteful consumption.

5 3Source: http://www.energy.gov/news2009/7363.htm

2Source: American Heart Association Scientific Statement: DALLAS, May 10, 2010

1Source: American Lung Association , Emissions of Hazardous Air Pollutants From Coal - Fired Power Plants: EH&E Report 17505, March 7, 2011

Date

To

tal B

TU

/S

qft

Mar

-08

Oct-07

May

-07

Dec-06

Jul-0

6

Feb-06

Sep-05

May

-05

27500

25000

22500

20000

17500

15000

MAPE 3

MAD 577

MSD 575272

Accuracy Measures

Actual

Fits

Trend

Forecasts

Variable

Model for Total BTU / Sq. Ft.Additive Model

The Business Case for Change

Energy Bill in 2008 $5,300,000

Price Increasing >$350,000

Energy Use Increasing ~4%

Year

$/

kW

h

20102005200019951990

0.065

0.060

0.055

0.050

0.045

0.040

0.035

0.030

Electricity Cost Trend

The need for affordable healthcare compelled us to address this trend

Set a Transformational Goal

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We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too. - John F. Kennedy, May 25th, 1961

First Objective

Energy Independence:

Produce more power than Gundersen consumes from fossil fuel sources

– Makes our healthcare delivery more affordable to patients

– Benefits human health

– Strengthens our regional economy

– Improves our environment

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Understand Your Opportunity

Energy efficiency does not get better with age!

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80% of Gundersen’s energy use and energy cost contained in 6 Buildings

Focus on the Biggest Opportunities First

“Don’t let the things that matter most be at the mercy of the things that matter least” -Johann Wolfgang von Goethe

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Advantages: • Reduces waste

• Opportunities exist everywhere

• Best financial returns

• Easy to implement

• Quick success gains momentum

• Can save 20%-30% of energy use

• Builds credible stewardship

• Lessens renewables investment

Improve Energy Efficiency Before Renewables

GHS Energy Efficiency (Utility purchased kBtu per square foot per year)

12 2017 energy efficiency benefit: $3,026,400 Cumulative benefit since 2008: $17.1M

Renewable Energy Projects

Solar P.V.

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Biomass CHP

Solar H.W. Manure

Digesters

Geothermal

Landfill

Gas CHP

Wind

There is no “Silver Bullet” Technology

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15

Foss

il Fu

el U

se

Emis

sion

s

Fina

ncia

l Ret

urn

Capi

tal I

nten

sity

Regu

lato

ry R

isk

Ener

gy In

depe

nden

ce

Mai

nten

ance

Cos

t

Capa

city

Fac

tor

Back

up P

ower

Cap

abili

ty

PR /

Mar

keti

ng

Com

mun

ity R

elat

ions

Loca

l Eco

nom

ic B

enef

it

Wat

er Q

ualit

y

Wild

life

Inte

ract

ions

Reso

urce

Ava

ilabi

lity

Solar P.V.

Wind

Geo-Exchange

Geothermal

Biogas CHP

Biomass CHP

Fossil Fuel CHP

Energy Efficiency

Conventional Coal

Nuclear

Gas Turbines

Hydro

Hydro-Kinetic

Best

Good

Fair/Helpful

Poor

Worst

There is no “Silver Bullet” Technology

Tip: Seek the proper balance for your organization’s values & mission!

Use What is Available Locally

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Engage Partners

Solar Projects 600 kW of Installed P.V. Capacity plus 250kW of Community Solar P.V.

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Wind Projects Lewiston, MN • Project produces 9,000,000 kWh annually

• 2 x 2.475 MW Turbines, 80m towers

• Started production in December 2011

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Cashton, WI • 50/50 joint venture with Organic Valley

• Project produces 11,000,000 kWh annually

• 2 x 2.499 MW Turbines, 100m towers

• Started production in May 2012

Biomass Boiler CHP Project Renewable, Locally Sourced, Wood Chip Fuel

• Project generates 1,500,000 therms and 2,250,000 kWh annually

• Produces the majority of heat / steam used by the health system

• On-site electricity production with back pressure steam turbine

• Annual payment to local woodchip suppliers ~$700,000

• Started production in spring of 2013

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Landfill Gas CHP Project • Partnered with La Crosse County Solid Waste Department

• Tri-generation which produces 6,000,000 kWh and 120,000 therms and A/C annually

• Annual biogas fuel payment to La Crosse County ~$200,000

• Started production in March 2012

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Dairy Manure Digesters

Middleton, WI

• Project produces ~16,000,000 kWh annually

• Removes phosphorous from groundwater in watershed

• Composted fiber byproduct sold as a soil amendment

• Started operations in December, 2013

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Sun Prairie, WI

• Project produces ~5,000,000 kWh annually

• Protects nearby stream from manure spill

• Fiber byproduct used for animal bedding

• Started operations in April, 2014

2017 Clean Energy Production GL Envision, LLC

23 2017 grid energy production = 39,340,209 kWh or 134,268,134 kBtu

Review Progress with Executive Leadership

24 Results require that leaders communicate priority and engage

Review Progress with Executive Leadership

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Topic Feb-18 Mar-18 Apr-18 May-18 Jun-18 Jul-18 Aug-18 Sep-18 Oct-18 Nov-18 Dec-18

Community Sustainability Boards

Fleet Vehicle Transformation

Waste Management / Recycling

Green Purchasing

Community CSA/Farmer's Market

Walk/Ride/Share_Stairway Challenges

Locally Grown Foods Adoption

Water Management

Food Waste

Farm-2-School Program

Employee Engagement

Sustainable Design

Energy Management Program Update

Envision Consulting Services

Envision Operations Update

Energy Independence! 1st Day October 14th, 2014

62 days of energy independence in 2017

1st Health System In the world to produce more power than it consumed (10/14/14)

26 GHS 2017 estimated fossil fuel energy offset = 66%

Emissions(1,2,3,4,5) (lbs.) 2008 2017 % Reduction

Carbon Dioxide(1,3,4) 72,386,372 5,886,101 (92%)

Particulate Matter(1,5) 434,928 42,214 (90%)

Mercury(1,2) 2.39 0.33 (86%)

2016 asthma attacks avoided: 8.6

(2)

GHS Emissions Improvement

Sources: 1US EPA AP-42 2Practice Greenhealth’s Energy Impact Calculator Data Sources: http://www.eichealth.org/calctest2.asp# 3U.S. EPA eGRID Version 1.0 Year 2010 Summary Tables: http://www.epa.gov/egrid 4U.S. EPA eGRID Version 2.0 Year 2014 Summary Tables: http://www.epa.gov/egrid 5Air pollution from electricity-generating large combustion plants (pdf), Copenhagen: European Environment Agency (EEA), 2008, ISBN 978-92-9167-355-1

Note: The 2017 CO2 value is the net sum after adjusting facility utility energy consumption with clean energy produced by GHS renewable energy projects.

*Numbers are projected with 11 of 12 months’ consumption history in 2016 27

2017 Regional Economic Benefits From Homegrown Energy!

Landfill Gas Project

2016 Biogas Payment to La Crosse County Tax Payers

Biomass Boiler Project

Est. 2016 Fuel Payments for

Regional Wood Chip Suppliers

$730,300 $205,630

Technician jobs for wind and biogas projects: >$700,000 per year

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Learn From the Mistakes of the Past

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East Building

Onalaska Clinic

Learn From the Mistakes of the Past

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Many are never originally commissioned – Typically a 1% add to project cost

– Life cycle costs are not understood by owners

Stakeholders seek to limit scope – Priority is to deliver under capital budget and on schedule

– Energy efficiency targets are not required by owners

– Tight project scopes reduce the chance of integrating with existing systems

– Duplicative capacity is the simplest way to reduce risk & liability for designers

Why Don’t Buildings Perform Well?

Learn From the Mistakes of the Past

Learn From the Mistakes of the Past Leverage New Knowledge in Design & Construction

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Energy Efficient Design Principles GHS Method

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1. Set a Transformative Performance Goal for New Facilities • Integrate into Design and Construction contract language

2. Develop & Utilize Energy Design Standards and Guidelines 3. Budget for a Third Party Energy Model of Design Alternatives

• Evaluate options based on the life cycle cost of ownership

4. Third party commissioning 5. Integrate Opportunistic Energy Improvements into Renovations

*Not adjusted for energy price inflation 34

Sustainable Design

GHS Legacy Hospital Building, La Crosse, WI Opened: January, 2014 Building Size: 433,000 square feet Energy Intensity: 125 kBtu/square foot/year

$4.5M additional energy infrastructure investment $650K in annual energy savings 50 Year Lifecycle Savings: $32.5M*

Significant Energy Saving Features: Geothermal heat pump Occupancy sensors and zone scheduling Heat recovery chillers Building envelope thermal integrity Desiccant wheel dehumidification in OR suite L.E.D. Lighting

Sustainable Design

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GHS Clinic, Sparta, WI Opened: January, 2017 Building Size: 34,800 square feet Energy Intensity: 33 kBtu/square foot/year

$900K additional energy infrastructure investment $80K in annual energy savings 50 Year Lifecycle Savings: $2.3M

What’s Next?

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• Renewable natural gas • Electric transportation fleets • Solar plus storage • Micro-grids

Keep Moving! Don’t let adversity paralyze you…keep moving toward your goal

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“Greatness is not a function of circumstance. Greatness, it turns out, is largely a matter of conscious choice, and discipline.”

- Jim Collins

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Envision®

www.gundersenenvision.org