CCH Board Observer Reports

CountyCare Enrollment Declines by 33,000 in 2019

4/28/2019

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Cook County Health (CCH) Board Meeting - April 26, 2019

CountyCare - Managed Care Organization Update

Medicaid enrollment in CountyCare, Cook County's managed care organization, has declined by 33,000 from January-March of 2019. And statewide, since its April 2018 peak at 2,298,000, membership in Illinois' managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence of this decline for CCH is that the number of uncompensated emergency and primary care visits will increase.
CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share.
CEO Shannon praised new healthcare leadership in Springfield, including former CCH Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program.
Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully to offset threatened funding cutbacks.

What did the Board discuss?

Personnel status - 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.

Items to Watch for in the Future

Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.

Other Comments or Observations

Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.

Observer - Linda Christianson Meeting Length: 3 hours

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Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

4/7/2019

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Cook County Health (CCH) Board Meeting
March 29, 2019

Director Mary Richardson-Lowry was elected Vice Chair of the Board replacing the long serving Commissioner Butler who resigned from the Board in 2018. Director Richardson-Lowry has been a member of the Hospital Board since 2015, Chairing the Human Resources Committee. A partner in the Chicago office of Mayer Brown law firm, her illustrious career includes having served as Commissioner of the Chicago Department of Buildings, Past President, Chicago Board of Education and Metropolitan Family Services Board member.

What did the Board Discuss?

Using locally sourced, market-savvy investigators, 2 million dollars in overpayments to providers in the 4th Quarter of last year were identified, only a small fraction has been recovered thus far, pending the appeals process.
Net operating loss exceeds budgeted loss of $72 million by $35 million in first 2 months of fiscal year due to persistent excess external claims expense paid to non-CCH network providers. Increasing use of CCH facilities is the challenge with below budgeted volumes this year of primary & specialty care, surgical cases and deliveries. Director Reiter said the financials are comparable to previous years.
Willingness to recommend Stroger and Provident Hospital in the bottom 40% of hospitals.
45% uninsured system-wide, composed of 32% African-American, 47% Hispanic, 4% Asian and approximately 17% White. Director Suleiman Gonzalez requested uninsured data based on language spoken to capture data on the numerous Polish and Middle Eastern groups.
Strategic Plan updates:

Dr. Fegan reported on the medical staff demographics (PowerPoint on CCHHS website), challenges of a unionized medical staff which has a lack of job title specificity, incentive structure and slow implementation of use of Relative Value Units, the industry standard measuring “work”. High value specialists are not retained. Board discussed hybrid system for physicians of unionized with incentives.
E-consult communication of physician with patients has been implemented with positive patient response.

Items to Watch for in the Future

CEO Shannon said the new merger of Healthcare companies Centene and WellCare will result in the largest Medicaid insurer nationally with 12 million beneficiaries and anticipated major savings in their cost of care provision which will threaten CountyCare’s current dominant position in the Cook County Medicaid market.

Observed by Barbara Hayes and Susan Kern Meeting Length: 3 hours 15 minutes

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Cook County Health to Host Housing Summit in May

3/18/2019

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Cook County Health Board Meeting - February 28, 2019

What did the Board Discuss:

The first Cook County Health (CCH) Research and Innovation Summit was held February 20, 2019 on the topic of opioids. More than 120 individuals attended. This summit was designed to share CCH's efforts and plans to address the opioid epidemic with other established interest groups and included action planning with health and community leaders.
County Care managed care members as of February 7, 2019: 320,994 of which 13.7% are using CCH services. These latest numbers are down 10% from the same time last year. The target for 2019 membership is 345,000. Annual redetermination of Medicaid members is a review of their eligibility for Medicaid and requires submission of redetermination forms in a timely manner. Now an automated system drops individuals from Medicaid rolls if the forms are not completed on time. If dropped, the individual looses continuity with their Primary Care Provider and case managers. In order to keep its members, County Care offers to help with the redetermination process. County Care has raised concerns about this process with Governor Pritzker.
FY 2019 CCH system wide uninsured numbers captured by visit is 44%. The FY 2018 uninsured numbers were 42%. There is a need to get details of these uninsured to see if some are eligible for Medicaid, then assist them in enrollment.
Governor Pritzker announced that Dr Ngozi Ezike was appointed Director of the Illinois Department of Public Health (requires state Senate approval). She served for more than 15 years at CCH and most recently served as a physician at the Juvenile Temporary Detention Center.
The Cook County Department of Public Health (CCDPH) has a tobacco prevention and control unit and its goal is to eliminate exposure to secondhand smoke, promote quitting, and prevention of youth smoking. In Suburban Cook County, 16.7% of adults are current smokers. E-cigarettes are currently the most used tobacco product among youths and its use in this group has increased last year. E-cigarette liquid contains chemicals and carcinogens and this liquid can poison children through ingestion or skin absorption.
It was announced that there would be no election of the CCH Board Vice-Chairman at this meeting.

Board Decision:

A contract with the Bobby E. Wright Comprehensive Behavioral Health for mobile crisis outreach team. This is a nonprofit on Chicago's Westside that provides mental healthcare, addiction treatment and developmental disability services.

Items to watch for:

The final audit of FY2018 in May 2019
The second CCH Research and Innovation Summit to be held May 22, 2019 on the topic of housing.

Observed by: Michele Niccolai Meeting Length: 2 hours 30 minutes

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New Director Appointed to Cook County Health Board

2/15/2019

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Cook County Health Board of Directors Meeting - January 25, 2019

Items of Note from Reports to Board

At the January 24, 2019 Cook County Board meeting, Commissioners approved the appointment of Michael Koetting to the Cook County Health Board of Directors. Mr. Koetting is a healthcare and strategic planning consultant as well as an adjunct member of UIC's faculty. From 2010-2015 he served as Deputy Director for Planning and Reform Implementation for the Illinois Department of Healthcare and Family Services.
Managed Care: Total CountyCare members as of January 7, 2019 is 326,026 of whom 45,446 are served by Cook County Health clinics (13.9%).
The Arlington Heights Health Center opened January 14, 2019. This new 35,000 sq ft center has 24 exam rooms, six dental suites, WIC nutritional services, mammography, behavioral health services and on-site lab. The comprehensive patient care team includes bilingual Spanish speaking staff members.
Through January 3, 2019, Cook County Health's (CCH) Fresh Truck partnership with the Greater Chicago Food Depository has resulted in 152 visits to 12 CCH health centers. Collectively, theFresh Truck distributions have totaled more than 420,000 pounds of fresh produce delivered to individuals, most of whom are food insecure. Access to better nutrition can lead to better health outcomes.
February is Heart Health Month and the American Heart Association's Go Red for Women. CCH and CountyCare sponsored several programs to increase women's heart health awareness.
Governor Pritzker named Theresa Eagleson as new Director of the IL Dept of Healthcare and Family Services. This agency oversees the state's Medicaid Managed Care programs and child support services.
Recently approved state rules lowered blood lead levels to 5 micrograms/deciliter. This rule change will allow children to be identified as having lead exposure when their blood lead levels are at or above 5 micrograms/deciliter. This earlier detection of lead exposure is important as it will result in more children receiving public health intervention.

Post Meeting Review Report submitted by Michele Niccolai

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Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

1/6/2019

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Cook County Health (CCH) Board of Directors Meeting - December 21, 2018

What did the Board Discuss?:

Commissioner Deer, 2nd District, has a background in health care. After being appointed to replace retired Commission Jerry Butler as Chair of the Cook County Board Health Care Committee, he was then appointed to the Cook County Health Board and assumes the role of Vice-Chair. Newly elected Cook County Commissioner Donna Miller (6th District), also in attendance at the meeting was introduced to the Board by Chairman Hammock. She expressed her long-held interest in the health care services provided in and by Cook County. Commissioner Deer noted that he will be advocating for more minority contract opportunities.
CountyCare, the county's managed care health plan, is aggressively marketing its benefits to current and potentially new customers during this year’s Medicaid open enrollment period due to close the end of January 2019. Current membership stands at 333,704 against a 2019 target of 345,000. Of particular note - two out of every three CountyCare members do not use Stroger, Provident, or Cook County ambulatory clinics as their primary provider. CCH is aggressively working to change this metric.
The interim Human Resources (HR) Director implemented a new technology and outreach plan in an effort to achieve its goal of a 90 day hiring cycle (current average is 96.4 days). In 2018, 15 new bilingual hires were added to the work force with another 10 in the pipeline, and 30 more job titles with bilingual ability as a minimum requirement are under review to establish new job codes. In addition to adding bilingual staff and working to improve cleanliness perceptions, CCH is focusing on decreasing waiting times and improving phone access. A revised performance management policy [employee evaluation] is to be rolled out early in 2019 with on-line performance management to follow.
The Finance report through the first eleven months showed no new surprises. The CFO noted that CountyCare has contributed $184.5 million to date to the Revenues. He also noted that while Cermac Health Services, the correctional system health operation, has seen fewer patients, those seen require more resources. The top three referrals are oral care, ear, nose, and throat, and visits to the hand clinic.
The Quality and Patient Care Committee noted that the willingness to recommend Stroger to others has increased but statistics were not cited. Each Tuesday the in-charge coordinator for cultural improvement is going on rounds throughout the hospital and asking two questions: 1) What are your concerns? and 2) How can we help? One other item pulled from committee metrics is that at any given time, about 80 surgical residents are working in the County hospitals.
Board member Gonzalez asked Dr. Mason, CC Public Health Director, for a geographic mapping for HIV, Hepatitis C, and all sexually transmitted disease cases. This request followed a slide presentation mapping the “suburbanization of poverty” areas in Cook County. Dr. Mason added that the mortality rate for African American mothers is 3 times that of Caucasian mothers, and he said that the number of African Americans living in Chicago has dropped by 15% while the number of Hispanics in Cook County has risen by 20%.
Dr. Shannon recognized the retirement of the highly esteemed IT Director, and she gave a brief presentation to the board including what the future in IT holds for the System: artificial intelligence, predictive analysis, and prescription analytics. Dr. Shannon also noted that the newly implemented Kiosk check-in is being well received.

Items to Watch For in the Future
Ongoing:

Director Lowery asked for a comparison of the System’s nursing openings to other like institutions across the country.
Board Chair, Hill Hammock, asked for feedback on what percentage of claims are never collected because of coding, timeliness, and/or processing issues.
Chair, Hill Hammock asked for a detailed dive into pension costs, projections, and percentage of takeover from the County by the Cook Health System.
A Board decision on CountyCare’s proposal to stop paying providers who treat CountyCare patients when the patients’ visit is outside their assigned network of providers.

New

The Fiscal Year ended on November 30. Watch for final revenue/expense variances, and metric results vs targets (e.g., hiring cycle and higher revenue specialties such as surgeries and maternal deliveries).
The new Vista Clinic in Arlington Heights with preventive and specialty care services such as dental and behavioral health delayed its opening to January 14, 2019 with the grand opening to follow sometime soon. A similar model clinic in Riverside is scheduled to open by mid-year. Look for details on the openings as tours will also be scheduled for those interested.
2020-2022 Strategic Plan presentations and discussions will likely get under way in earnest at the January Board Meeting and go on through the May meeting.

Observer - Diane Edmundson Meeting Length: 2 ½ Hours

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Cook County Health Board Undertakes Strategic Planning

12/8/2018

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Cook County Health Board of Directors Meeting - November 30, 2018

CountyCare Update:

Total CountyCare Medicaid managed members September 2018 is 335,126.
50,149 of CountyCare members are receiving their care in Cook County Health clinics.
Medicaid Open Enrollment has started. Open enrollment happens once a year when Medicaid members can change plans. Illinois Healthcare and Family Services began mailing out letters letting members know the date they can sign up for 2019 plans.
CountyCare is promoting itself during open enrollment as the largest Medicare managed care plan in Cook County by using texts/emails to members and providers; by sponsoring member events; by using social media, Facebook and You Tube; by using website information; and with ads on bus shelters, CTA, and banners.

Recent statistics show system-wide, Cook County Health provides 42% of charity care in Cook County. Illinois non-profit hospitals receive property tax exemptions based on the charity assistance given to their communities even though there is a wide definition of charity care and community benefits. The subject of Cook County non-profit hospitals providing charity care is an issue.

Subjects to be addressed in future countywide Cook County Health strategic planning:

locations of health care delivery systems
social determinants in life expectancy
population shifts
population demographics
suburbanization of poverty
elderly and disabled populations and their special needs
access to healthy food, food insecurity
areas of high unemployment rates as economics affect health and social conditions
suburban public transportation
Primary Care Physicians as key entry to Cook County Health specialists
if Cook County Health clinics have followed population shifts
competition with large non-profit health system

Observer - Michele Niccolai Meeting Length: 2 hours

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CountyCare Enrollment Declines by 33,000 in 2019

Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

Cook County Health to Host Housing Summit in May

New Director Appointed to Cook County Health Board

Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

Cook County Health Board Undertakes Strategic Planning

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