Cook County Health (CCH) Board of Directors Meeting
April 28, 2023     

CEO Rocha, Chief Operating Officer, Dr. LaMar Hasbrouck and staff presented the Cook County Department of Public Health’s (CCDPH) product from a collaborative and participatory strategic planning effort begun in 2022.  The resulting 2023-2025 strategic plan for CCDPH, “Putting the Public in Public Health,” defines CCDPH’s vision, mission, and values.    Based on feedback from across a variety of assessments and many facilitated planning sessions and conversations with staff, community partners, and the Strategic Planning Advisory Group, CCDPH identified five strategic pillars where CCDPH must focus its attention to be successful at advancing its vision and mission over the next three years.  The foundational pillars are:

• Pillar 1:  Strategic Communications.
• Pillar 2:  Community Partnerships and Collaboration.
• Pillar 3:  Workforce and Workplace 
• Pillar 4:  Infrastructure and Operations.
• Pillar 5:  Integration and Systems Alignment.

In brief, Putting the Public in Public Health is the guide that CCDPH has chosen for transformation during 2023-2025.  The strategy within the plan is dynamic and intended to evolve over time.  Metrics that matter will be developed for all major services, programs and initiatives including the strategic plan.  The plan will also serve as a blueprint for accountability as it strives to optimize community health and advance health equity for the residents of suburban Cook County.  A letter from Cook County President, Toni Preckwinkle praising the plan was included stating that “The Covid-19 pandemic illuminated not only the importance of having a strong public health system and infrastructure in times of crisis, but also the ongoing need for investment in proactive approaches to promoting community health and wellbeing.”    

CEO Rocha noted that effective Monday, May 15th masks will be strongly recommended but optional for many patients, visitors and staff.  Masks will remain a requirement for staff providing direct patient care, entering an occupied patient room or in high-risk areas.  Tests and vaccines for COVID will continue to be available at primary care medical homes.

The Community Murals Project unveiled three new murals at Provident Hospital, Blue Island Health Center and the Professional Building on central campus.  Paint parties were held where patients, staff and visitors came together to paint sections of the murals.

Committee Reports:
Human Resources –

• Remains up to 95 days to fill positions but trending down.  Maintaining 4% turnover compared to nationwide average in double digits.   Still catching up from COVID losses.  
• A letter sent by and read into the record by Mr. Lenny D. Asaro, attorney at Faegre, Drinker, Biddle & Reath, LLP seeking “. . . clarification regarding Cook County Health and Hospitals System’s policy in reference to offshoring jobs to India.”  Mr. Asaro referenced RFP #H21-0026, Addendum No.1. requesting 250 full-time equivalents to support the end-to-end revenue cycle. Mr. Asora claimed the RFP was service-based v. technology and does not require technical support for any type of technology.

Finance –

• Eight contracts exceeded $1M including for Nurse Registry services ($70M); two contracts for recruitment (totaling $8.6M); and two contracts for computer software and hardware (totaling $12.9M)

What to Watch for in the Future:

• Although it was indicated that great efforts were being made to reach out to Medicaid patients in their communities and in the health centers to encourage cooperation with renewal, it may still have an impact on enrollment.

Observer - Peg Moster

Cook County Health Board Meeting 
March 31, 2023              Virtual Meeting

Emergency Medicine at Cook County Health remains one of the most competitive physician residency programs nationwide drawing from the brightest graduating medical students.  Minority and underrepresented groups account for 16% of the internal medicine residency slots beginning with the 2023 class.
Strengthening the multicultural diversity of primary care physicians (internal medicine, Family Practice) training at Stroger, Provident Hospitals and affiliated clinics is a priority of CCH’s DEI plan (diversity, equity & inclusion) Dr. Claudia Fegan, Chief Medical Officer, expounded. 

• Employment Plan Compliance officer, Kimberly Craft noted that while the CCH push to improve and streamline hiring was a priority goal, compliance with Federal & State labor law as well as collective bargaining agreements require enhanced written documentation supporting the hiring/termination/discipline policies.
• Provident scholarship program: up to $20,000 for graduate level medical/dental & Advanced Practice Nurse students and up to $10,000 for undergraduate and Allied Health Professionals.   It is hoped that these students will remain at CCH for their career. 
• Directors poised questions on the status of the initiatives to accelerate the hiring process which Valarie Amos, Chief HR Officer, noted was down to 119 days from posting the job to filling a position versus 160 days in FY 2022.  8 job Fairs in FY23 were successful in garnering 401 interviews with 152 acceptances of the 166 offers.   Many acceptances were made the same day as the offer! Decreasing “temporary agency” cost for high use temporary staffing categories is anticipated.

Items to Watch for in the Future:
Redetermination for CountyCare managed Medicaid plan members is likely to eventuate in decreased plan membership in the June 2023 Managed Care data, noted Aaron Galeener, Chief Administrative Officer for CountyCare.

Observer - Susan Kern

Cook County Health (CCH) Board of Directors Meeting
February 24, 2023

CCH Human Resources’ goal toward maximizing efficiency and decreasing the time in recruitment and hiring receives continuing support from outside consultants.

• Slalom has taken the lead with HR by adding technology, department staff training and analyzing HR processes with a focus on efficiency.
• Deloitte has reviewed job descriptions, undertaken compensation analysis, added technology focused on employees and revised new hire orientation.  Deloitte’s job recruiters have reduced administrative burden.
• Cross Country has organized monthly job fairs, helped with recruiting and has created marketing strategies and campaigns using Tik Tok, videos, fliers, and social media.
• Brazen- has added virtual job fairs and a virtual hiring platform.

Human Resources Committee

• FY2023 Year to Date through 1/31/2023, filled positions is 253, with 156 positions external hires.  Most of the 127 separations were due to retirement.  The time to fill from the day the job is posted to the day the offer is accepted is 120 days, which is a significant decline from FY2021. 
  
• CEO Rocha added that CCH is a great academic training center and staff gain great skills in their first to fifth year of employment and become very marketable.  Once employees hit the 10 to 15 year employment, pensions and other benefits become important and they tend to stay at CCH.  The retention of the 5 to 10 year employee is CCH’s focus.

Finance Committee

• A contract extension and increase was approved for the The Chicago Lighthouse to be a backup for the patient support center to help with scheduling, registration and insurance verification assistance.  The Chicago Lighthouse was founded in 1906 and provides jobs for the blind and visually impaired, disabled and Veteran communities.
• Interim financials FY2023 ending Dec 31, 2023: On an accrual basis show that CCH ended December with a $37M favorable variance to budget.  On a cash basis, the county’s preliminary cash report on revenues and expenses show a $49.7M favorable variance.  CountyCare shows an operating gain of $6.1M.
• GPO Presentation: A GPO is an organization that through a group’s collective buying power obtains better pricing and value for its members.  Most of all health systems in America are GPO members contracting for medical/surgical supplies, drugs, food, purchased services, technologies, etc.  CCH begins at the start of FY2023 to solicit proposals from vendors and after analysis and attending presentations decides on a GPO by 3/20/2023.

Managed Care Committee

• As of February 7, 2023 CountyCare membership is 450,264 with 41,800 in CCH clinics.  Through December 2022, CountyCare has a 32.6% share of Cook County managed Medicaid market.  Membership is still high as Redetermination has not yet started.  Once it starts April 1st membership numbers are expected to drop. CEO Rocha said a CCH goal is to assist members in the redetermination process.

Items of Interest

• Cook County Dept Public Health Quarterly Report 2023 on the “Suburban Cook County Healthy Work Initiative”.  This report highlighted the plight of essential workers especially during the pandemic.  Another focus is precarious workers.  These are low wage workers with unpredictable/unstable work conditions, work with hazards and without regulatory safety standards.  The goal of this initiative is to improve worker safety and addressing these issues was highlighted.
• CEO Rocha introduced the “One Source Enterprise” project to transform patient access and patient experience.  After calling the Contact Center for non-emergency care needs, a caller can talk to a real person.  The caller can receive  virtual care through nurse triage, connection to  a provider or referral to urgent care sites.  A caller can also  schedule appointments, refill prescriptions, and ask other care questions.  A limited 1st phase urgent care rollout will be spring 2023.  Virtual RN positions at CCH are a competitive opportunity for nurses. 

Observer - Michele Niccolai

Cook County Health Board of Directors Meeting
January 27, 2023

Board Action:

• A $30M request was approved to increase existing contract with Vaya Workforce Solutions, LLC through 9/24/23 for agency nurse staffing to fill vacancies.  The Chief Nursing Executive stated the hourly wage for agency nurses has decreased from slightly over $200 to currently $150 to $175 depending on the specialty needed.  A dilemma was brought up by Board members regarding agency nurses vs employed staff nurses.  Agency nurses go for the increased hourly wages, more control over their lives and younger nurses may not have a long term career view.  Cook County Health (CCH) has advantages over agency nurses: CCH staff has good pension and other benefits for long term career plans.  There are work rules, free tuition and many resources available.  CEO Rocha added that closing the HR gap in hiring nursing staff is a major goal.  Other goals are empowering the employee experience, commitment to continuing education, building flexible staffing pool options, adding employee councils and addressing work and life balance.
• -Two contracts for a total of $32M were approved through 11/30/23 for temporary staffing. Positions include transporters, supervisors, Covid screeners, greeters, Lab personnel.  
• A 2M contract was approved to continue with Slalom Consulting through 7/19/23 for Human Resources.

New Cook County Health Board Members were approved by the Cook County Board of Commissioners at their meeting on 1/26/2023. The new members are Tanya Sorrell, PhD, PMHNP-BC and Mia Webster Cross, MSN, RN. These new board members have replaced Mike Koetting and Dr Heather Prendergast

Committee Reports:

• Finance Committee: On an accrual basis, interim financials show CCH ended November 30, 2022 with a $15.8M unfavorable variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $366.4M favorable variance.  This is due to the timing of how each records revenues and expenses.  These are preliminary numbers as the FY2022 financials will be audited April 2023.  CountyCare showed an operating gain of $11.5M.  CCH’s More Care, Medicare Advantage Plan, was discontinued as of December 31, 2022 because of low membership and revenue loss.
• Quality and Patient Safety Committee: Quality and Safety rating sites to check hospital and providers were mentioned that anyone can go to:   medicare.gov/care-compare/    (star ratings) hospitalsafetygrade.org     (Leapfrog hospital safety grade)
• CountyCare: CountyCare membership as of January 5, 2023 was 449,565 with 9.3% using CCH clinics.  This is an all time membership high, reflecting month over month growth since Medicaid redetermination has been paused.  Redetermination, an annual review of Medicaid eligibility, will begin in April 2023.  Renewal forms will be mailed to 1/12 of membership each month over the next year with CountyCare staff assisting members in this process.  Membership losses would start to show up end of June and July 2023.  The Board pointed out that continuation of care for those who will lose Medicaid is vital as conditions such as hypertension, diabetes and asthma can lead to major health costs down the road.  In 2022, CountyCare developed reserves of $100M and plan to increase this to $150M in 2023.  In 2022 CountyCare added over 100 urgent care sites providing an alternative to E.R. usage and housed 53 members in the Flexible Housing Pool Program and 14 members through the Community Transitions Initiative.  
• Human Resources: In FY2023 (Dec 1 to Dec 31, 2022), 119 positions were filled with 72 external hires.  Internal hires (some are promotions) help with employee retention.  16 offers were declined and the #1 reason was salary.  In FY2023 there were 90 separations, 73 were due to retirement.  HR is hosting monthly job fairs and can now offer recruitment and retention bonuses.

CEO Rocha reported that CCH with support from the CCH Foundation has selected local artists to lead mural projects at three health system sites.

Observer:  Michele Niccolai

Cook County Health Board Of Directors Meeting
December 9, 2022 

Cook County vaccination rates, particularly the 3rd booster is extremely low.  Board members stated that the system has an obligation to target communities most in need.  Dr. Hasbrouck, Public Health, said that he is building an outreach team to work with providers and to also go into homes.  He noted that people are “vaccine tired”.  Financial incentives and a mobile vaccine clinic have been initiated.  Directors noted that schools should also be targeted.  A $700,000 grant was received to raise the vaccination rates. 

Finance Committee [based on 9-30-22 reports].  CCH ended the 3rd quarter with a $15.8 M unfavorable balance to budget.  On a cash basis, the variance was favorable by $201,000 due to timing of reimbursement rates. Managed Care expenses are higher than budget due to higher membership rates.
During procurement coverage, board members were concerned that the System is paying premium dollars to outside agencies to fill such jobs as janitors from the same local market as CCH is recruiting.
Also under procurement was a new contract for a new service to provide medically tailored meals to patients outside of the hospitals.  The Greater Chicago Food Depository and local minority vendors will be used.  Director Story asked for an evaluation tool by 2023.

Charity Care reporting now expanded 
                                                                      2021 Actual        2022 Budget         2022 Actual/Projected
Traditional Charity Care                                $162,626           $152,827                       $134,772
Other Uncompensated Care                        100,894             109,162                          164,595
Cermak & JTDC Health Services                  104,465             106,405                         106,405
Public Health                                                       16,908               17,763                              17,763
Other Public Programs and Services           68,750              66,321                              66,321 
         TOTALS                                     $453,643      $452,478                 $489,856
        % of Costs                                    27.9%              36.3%                      34.5%
        % of Revenues                             38.6%             36.3%                       41.1%

Managed Care:   Membership is at 443,470 which is 32.5% of the total management care population in Cook County.  40,940 or 9.2% use CCH services at Stroger, Provident, or ambulatory clinics.  Vaccination rates among managed care members is in line with overall county rates.  Seniors lead the numbers at 52%; Adults 26-65 at 26%; Adults 19-25 at 17%; Adolescents 12-18 at 16%, Children 1-11 at 4% [23% for 2nd dose].  

Human Resources:  Filling nursing positions continues to be a huge challenge.  The use of temporary hires was discussed, and Director Koetting noted that over 20% of total employees are out on FMLA at any one time.

Observer:  Diane Edmundson                                             Absent Board Members:  Deer, Kim, Reiter 

Cook County Health (CCH) Board Of Directors Meeting
October 28, 2022 

Approximately 4,000 asylum seekers have arrived to date with the majority coming from Venezuela and the balance from other Central American countries.  They are residing at 23 locations across Cook County in 12 shelters and 11 hotels.  At the peak, there were 109 arriving per day but that is now trending down due to changes in policy at the border.  Most of the health screening is routine and outpatient with most common complaints a cough or headache. A telephone triage center staffed by nurses has been established for after hours.  A total of 183 Cook County Health staff have provided refugee health care to date.  The center is establishing medical homes for the refugees and tracking expenses.  A Resolution was introduced and approved to accept donations from individuals who have contacted CCH wishing to contribute a monetary amount in support of the services being rendered by Belmont Cragin to the migrant population.  
CEO Israel Rocha, announced a Cook County Health/U. S. Navy Training Partnership centered on the Resuscitative Surgical System (ERSS) which began in October. Navy personnel will train at Stroger Hospital with staff knowledgeable in ERSS.  When complete they will return to their assignments and possible deployment. 
Due to an outbreak of Ebola in the Sudan, County Health is closely monitoring the situation and clients.  Covid-related calls both inbound and outbound have declined as the numbers of Covid patients has decreased.  CountyCare is providing rewards to its patients who are getting their Covid shots and boosters.  
Provident Hospital is now providing hemodialysis services to serve the population in need of that service.  
Dr. Sam Robinson’s appointment to the Board which was deferred at the September meeting has since been approved.

Committee Reports
Human Resources:  Chief of Human Resources Valerie Amos provided metrics on recruiting indicating 647 positions filled year-to-date at an average of 65 per month.  The turnover rate is steady at 9.9%.  There have been month over month increases in new hires.  Resignations continue to outpace other types of separation i.e. retirements or discharges.  Multiple hiring fairs have been conducted and the on-line presence improved for internal and external use.  
Audit and Compliance Committee:  The schedule of meetings for 2023 was not firm yet.  The Committee’s focus is on CountyCare, Community Education and the metrics for CCH and CountyCare.  There were no action items.
Quality and Patient Safety Committee:  In an update on future directions for Stroger and Provident Hospitals the following initiatives are being pursued:  Building Stroger’s Neuro ICU to a Level 1 Neurosciences ICU; Establishing Stroger as a Thrombectomy Capable Stroke Center; and Provident as a Stroke ready or Primary Stroke Center.
Managed Care:  CountyCare continues at 32.7% of the Cook Market Share and has increased 7% over the past 12 months -– ahead of the Cook County increase of 4%.  Enrollment continues to exceed budget projections.  HEDIS rates remain stable.
Finance Committee:   On an accrual basis, interim financials show that CCH ended August with a $6.7M positive variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $204.4M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses.  Year to date revenues better than Budget due to catch up payments from the State and higher than budgeted CountyCare membership. Other Non-operating Revenue negative variance due to fluctuations in County property tax collection.    CountyCare membership remains over 400,000 which is greater than the 381,000 budgeted.
 Contracts in excess of $1M were submitted and approved as follows:

• Konica-Minolta Business Solutions – One Year Extension - $1,500,000 (Print, scan and copy service for 1 year – RFP to follow); 
• Housing Forward – Two Year renewal -Sole source $3,769,450 (ARPA funded), (Temporary recuperative housing for homeless); 
• Atos Healthcare Services - One Year Extension - $33,000,000 (Information Technology management services – increased  because of additional resources pre and post-pandemic -RFP to be issued in January); 
• McKesson - $4,029,363 (Information Technology management services – Pharmacy Point of Service, Lab and Stores management – Original sole source contract extension through 2027); 
• CDW Government, LLC  - additional Microsoft Defender 365 - $1,314,953 (security licenses, retroactive to 6/2022 through 5/2024); 
• ADT Commercial Government LLC - $1,767,915 (equipment and installation of new nurse call and paging system at Provident Hospital to replace obsolete and ineffective system); 
• Professional Clinical Laboratories LLC dba PCL Alverno -  one year extension $1,814,577 (histology services); 
• Executive Building Maintenance dba EBM Inc. – 6 month extension $2,394,426 (Environmental cleaning and terminal cleaning services for Stroger – RFP in development to consolidate environmental services); 
• ABM Healthcare Support Services, Inc. – 6 month extension $1,315,770 (environmental management service for Stroger and other CCH locations – RFP in development to consolidate environmental services)

Recognitions:  Thanks and kudos to retiring Commissioner David Munar; Team award for ambulance runs at Provident - 70 in the first week; Cardiology team awards by the American Heart Association. Pinnacle awards on healthcare marketing for the My Shot Covid campaign for the CountyCare team.

Observer:  Peg Moster