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.
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:
Observer: Peg Moster
Cook County Health Board of Directors Meeting
September 30, 2022
KImberly Craft gave the semiannual EPO (Employment Plan Officer) report. As with other departments she had staffing issues which made it difficult to monitor the plan. A new Program Manager and Information Coordinator have recently been hired. There were an unusually large number of vacancies during the reporting period. The hiring process was revised and a new plan was rolled out in July. There were a number of hiring problems found. Part of the problem was in coordinating plan rules with the outside vendors. The 22-page report is informative and detailed.
CountyCare's 10th anniversary was celebrated. Cook County Health’s emergency medicine and preventive medicine residency programs were recognized in Becker’s Hospital Review for being among the best clinical training programs, according to Doximity’s 2022-2023 Residency Navigator.
Cook County Public Health has sent out a survey to collect data from 34,000 adult (18 and older) suburban Cook County residents concerning their health-related risk behaviors, chronic health conditions, and access to health care. Using startup funds from CDC’s Health Equity Grant, CCDPH’s Epidemiology Unit is collaborating with UIC’s PHAME Center and Metopio to design and deploy an online atlas for exploring and sharing health information concerning the suburban residents of Cook County. The atlas allows stakeholders to examine, visualize and download health data using maps, charts and tables. The site is at https://cookcountyhealthatlas.org/
Iliana Mora, Chief Administrative officer for Ambulatory Services reported on the Asylum seekers that were bussed to Cook County from Texas. All seekers were seen by medical staff promptly and screened for disease and vaccinated. Children received all vaccines needed to attend school. Ambulatory staff handled everything, but additional help is needed if this is to be a continuing need. Contracted staff will be onboard next month. Money was allocated for this but CCH is working with state and federal agencies for reimbursement.
An overview of the Substance-Use Disorder program was presented by Dr. Juleigh Nowinski Konchak. It is a Multidisciplinary and Patient-centered plan.
An overview on Monkeypox was presented by Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health).
Human Resources: While there is still a lot of work to be done to get staffing levels up, there has been a slight improvement and several vendor agencies have been contracted to help with the process. Slalom Program Management will ensure the vendor resources are allocated effectively to accelerate hiring. The other HR partners are:
Managed Care: CountyCare’s enrollment has increased 7% over the past 12 months, ahead of the Cook County increase of 4%. CountyCare’s enrollment decreased 0.1% in July 2022 compared to the prior month, ahead of the Cook County decrease of -0.2%. The vaccination rate of CountyCare members is still too low, especially among children. Only 21.78% of children 1-11 years are fully vaccinated. And only 45.2% of all members are fully vaccinated.
Quality and Patient Safety: Committee minutes were presented. Dr. Erik Mikaitis was hired as Chief Quality Officer. The readmission rate was down to 7.49% in May, the lowest it has been in the last year and well below the goal of 9.93%. The case mix index for surgical patients, the top box score and the HbA1C goal were not achieved.
Finance: The finance committee met this month. On an accrual basis, interim financials show that CCH ended May with a $13.4M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $300.2M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses.
There was no public speaker testimony and no closed session this month.
Observer: Lisa Slankard
Cook County Health (CCH) Board Meeting
August 26, 2022
Cook County Health CFO Cassara presented the 3-year financial forecast which supports the 2023-2025 Strategic Plan approved earlier this year. It was developed in concert with the proposed FY2023 CCH budget which was also approved at today's meeting.
Accrual basis budgets show a deficit of $41M for 2023; $48M for 2024 and $47M for 2025. CFO Cassara commented that closing these “deficits will require management interventions”.
Support to the Health System from Cook County totals $228M in 2023 including $80M CCH pension allocation and $148M Cook County tax allocation for health services, correctional and public health departments.
Cook County Health Heart Institute:
Observer - Susan Kern, MD
Cook County Health (CCH) Board Of Directors Meeting
July 22, 2022
Human Resources Report:
Currently Stroger Hospital is operating with a staff level of 65% of budget. This has led to adding $75 million to the outside staffing budget for the remainder of the fiscal year and has had some effect on Quality metrics. It also has led to increased resignations of existing staff. The Human Resource committee presented their statistics and the current hiring is barely keeping up with the staff losses and not helping make up for past separations. Before starting the new goal of hiring 400 new employees between 5/16 and 9/1, it has taken 36.8 days on average from the time an offer has been requested to the offer being made to the applicant. 450 offers were made and 317 were hired. The ultimate goal has been to cut the 36.8 days to THREE days. From May 16 to July 22, 220 candidates accepted offers. Since 94 were internal hires, the net result was 126 new employees.
The hiring initiatives are as follows:
Public Health Update:
Observer: Lisa Slankard
Cook County Health (CCH) Board of Directors Meeting
May 27, 2022
During Public Comments, eight nurses and nurse representatives reacted to the Cook County Commissioners 10% pay raise approved by the CC Board earlier in May. The comments were pointed and the tone angry. For two months nurses have been asking for a $5.00 per hour increase as Retention Compensation for their work and their loyalty over the past two years of the COVID pandemic, noting that the System is hiring contract nurses at much higher pay. They are also unhappy that they must use personal sick pay for personal COVID absences.
Having been discussed at several previous meetings, the proposed 2023-25 Strategic Plan was approved by the board with little comment. The Theme for the next three years is: Impact, Change, Equity. Strategic Planning Officer, Andrea Gibson, noted that the data table will now include the years 2019-21 and also stated that Disability Access has been moved to a higher priority based upon public feedback. With approval, the next steps include developing detailed work plans and integrating them into a three-year budget. Chair Taylor commended the process and said it is a very good framework to deliver quality care over the next three years.
Observer: Diane Edmundson
Individual authors are credited at the end of each report.