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:

• Is a new CCH initiative to develop a comprehensive, academic, world-class, equitable, cardiac care program spanning from prevention to complex heart disease. 
• Radiology and Cardiology disciplines have been collaborating since 2021 on new interventional services including balloon valvuloplasty (of heart valve) and transcatheter aortic valve replacement
• Outpatient access to cardiology subspecialties (Cardiovascular genetics, heart failure, lipid disorders and electrophysiology among others) in suburban locations (Blue Island) Sengstacke at Provident Hospital with other locations being considered.

Monkeypox:

• CEO Rocha, Dr. Welbel, CCH Division Chair, Infection and Hospital Epidemiology, and Dr. Hasbrouck, Director of CC Department Public Health gave a data-intense update on the monkeypox cases in Cook County (800 cases in CC with 45 hospitalizations of which 77 cases and 7 hospitalizations were CCH cases)
• More information about Monkeypox can be found on the CCH website 

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:

• Offers made within 72 hours
• 20 nurses sourced per week
• Train 100% Hiring Managers
• 6 Hiring Events by Sept 1, 2022     200+ positions    
• Increase frequency of new employee orientation by 50% as needed
• To help with this a contract was made with a third recruiting company

Appointments/Recognitions:

• Arnold Turner has been named Chief Hospital Executive for Provident Hospital, Aaron Galeener has been named Chief Administrative office of Health Plan Services and Karolina Duszczak will be Interim chief operating officer of Health Plan Services.
• US News and World Report named Stroger as a high performing hospital in four categories: Chronic obstructive pulmonary disease • Pneumonia • Heart attack • Heart failure.
• Chicago Magazine recognized Dr. Elizabeth Marcus as a top doctor for breast oncology. Dr Mike Alebich was identified as an emerging leader by Health & Medicine Policy Research Group.  
• Becker’s Hospital Report recognized Andrea Gibson as Great Health System Chief Strategy Officer and Linh Dang as Outstanding Health System Chief Experience Officers.

Public Health Update:

• An overview on Monkeypox was presented along with the midyear budget review.
• Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health) presented the quarterly report from the Cook County Department of Public Health- Building Healthy Communities: Initiative and funding process overview.
• The CCH board signed on to the Cook County Board’s PROPOSED RESOLUTION REGARDING AN ASSAULT WEAPONS BAN.

Committee Reports:

• Managed Care: As of 7/5/2022 County Care has 32.6% of market share, up from 32.5% the previous month but the actual number of members is 433,248 compared to 434,021 last month. Initial target was set to develop $50M in reserves in FY 2022. To date, total reserves have been funded at $75M. The public health emergency has been set to end October 15, 2022. At that time redetermination is set to begin 60 days later and 1/12 of membership will be looked at each month.
  
• Audit and Compliance: A review of the CCH Compliance Program & Regulatory Environment was presented. It included a presentation on the Boards fiduciary and oversight obligations. 
  
• Quality and Patient Safety: Provident CAP (College of American Pathologists) Survey occurred May 12, 2022.  There were three low-level citations and actions were submitted and received acceptance of    those actions on June 30th.
  
• Finance: On an accrual basis, interim financials show that CCH ended May with a $36.1M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $225.5M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses. While there was a lot of discussion on the $75 million  request for Vaya Workforce Solutions, it was approved.

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.

Committee Reports:

• Finance:  Through March,  the System reported a $1.2 million positive variance to budget partly due to lower than budgeted Surgical and OP volumes and lower than budgeted CountyCare claims expense.  CountyCare showed an operating gain of $10 million.   Chair Reiter reported that Deloitte Consulting has been hired to reduce reliance on sole-source contracts by looking at and recommending better time-line planning; and if needed, a restructure of the procurement department. 
• Managed Care:  As of May 6, CountyCare membership was at 434,021 of which 10.3% or 44,704 use Cook County Health services.  The Plan continues to have the largest membership in Cook County at 32.5%.  Second on the list of six is Blue Cross Blue Shield with 25.7% or 336,328.  Fifty percent of CountyCare members are fully vaccinated.  Recognizing the difficulty of increasing this metric, Director Koetting stressed the importance of continued efforts.  
• Quality & Patient Safety:  62.4% of patients recommend Stroger Hospital against a target rate of 71.1%. Readmission rates for the hospital were at 8.75% in January of 2022 against a 9.93% target.
• Human Resources:   The Department is now keeping metrics on its optimization strategy to improve and accelerate the hiring process.  Its monthly report stated that CCH must hire over 2,000 new employees – yet the current hiring process takes an average of 4-6 months per position.  HR has secured four consulting partners to streamline the HR processes and technology.  One of the partners, Incredible Health, has been hired for immediate nurse recruitment.
• Public Health:  HUD provided a grant for CC Public Health to begin work on 9 housing units in April; and the Epidemiology Unit will launch the CC Health Atlas Website for the public by the end of May.

 
Observer:  Diane Edmundson 

Cook County Health (CCH) Board of Directors Meeting
June 24, 2022

Board Report Highlights:

• Board Chair Rocha reported 15 confirmed cases of the viral disease monkeypox in Illinois. CCH and CCDPH are monitoring the situation. Dr. Wellbell is leading the operation. Historically monkeypox has not been fatal in the US and not expected to spread widely. CCH is prepared to diagnosis and immunize.  Priority will be given to those considered high-risk; the vaccine is limited. Director Harrington stressed the importance of messaging and the limitations of vaccines.
• COVID Mortality Rate is at a record low. CCH will provide vaccination for children under five next week. Chairman Reiter questioned whether CDC has guidance on second boosters for those under 50 years and 6 months out from first boost, with high risk for pre-exposure or post exposure, and rebound cases. Rebound cases have different isolation periods. To date, CDC has not provided additional information. The boosters need to be toward omicron variant.
• The Department participated in City of Chicago and Human Resources public safety training, including, Full-Scale Disaster Response Training and Stop the Bleed, a national prevention program.  STOP the Bleed offered Training to NPF organizations, individuals, first responders, and elected officials on how to stop a bleed from gun violence. In a separate event, CEO Rocha joined President Preckwinkle, and Senator Durbin, held a press conference to advocate for gun reform.

Human Resources Report:

• Metrics Review reported separations, 265 resignations, exceed new hires (43 monthly hires), and current vacancies of 263. The strategic plan is to use modernized technology, contemporary practices and external partners in recruitment and retention. Director Harrington commented that COVID impacted the dynamics of care and staffing. 
  
• The department plans to target staffing at Providence and Stroger first. Resources and outside partners are driving force for virtual job fairs and having timely information from a nursing data base. Dr. Hasbrouck asked if salary surveys had been conducted. Plans to review RFPs will address CCH competitiveness and salaries.
• Recruiting and staffing are streamed lined through Brazen Online Platform, Solum, and Incredible Health and launching a Key Hiring Metrics Dashboard improves real time decision making and information.

Managed Care Report:

• Membership increased to 436,000, Managed Medicaid Market is at 32.5, Trends versus CC Market overall up 5% and CC up 8%. Membership versus budget; CCH Continues to exceed budget by a significant margin; it is driven by PHE’s redetermination 50% auto assignment.
• Operations show steady performance and IP Acute Admits. Vaccination rates increased to 56-57%. Claims payment is less than 11 million for claims over 30 days.
• Director Story raised a discussion about the impact of re-determination on the budget and Domestic Spend. CCH is financially stable, due in part to the extended Public Health Emergency Period.  PHE is expected to continue through October (CMS will issue a 60-day notice).  Domestic spend, CCH has seen stable utilization of facilities and planning initiatives to increase utilization. More Care expected to end this December and planning the transition process.

Observer: Gwendolyn Maxie-Brown

Cook County Health Board (CCH) of Directors Meeting
April 29, 2022

Israel Rocha, CEO and Andrea Gibson, Chief Strategy Officer presented a draft FY23-FY25 Strategic Plan   for Board consideration and input. 

• The timeline for approval is the May Board meeting followed by preparation of a 3 year financial outlook with FY23 budget to be presented at the August Board. 
• In September both the Strategic Plan-informed budget and the 3-year financial outlook will come before the CCH Board for final approval and submitted to the County Board in tandem with the 2023 budget in October.   
• In brief, the draft Strategic Plan was summarized by its shortened but direct Mission Statement, “Establish universal access to the world’s best care and health services for all Cook County residents, regardless of the ability to pay, so all may live their healthiest life;” Vision Statement, “To ensure healthcare as a human right;” and Values Statement “ICARE - Innovation, Compassion, Accountability, Respect, Excellence & Education.” 

The presentation evoked a great deal of input from the Board concerning its lofty goals given the ongoing shortage of staff as well as having heard the same goals in years past.  This was addressed by CEO Rocha who indicated that although it was currently necessary to continue using agency nurses while they continued their ongoing efforts on retention and recruitment outlined in the Strategic Plan.  Further, he referenced an announcement made on April 26 by himself, President Preckwinkle, Commissioners Deer and Lowry, and the County Health Foundation of a $1M Provident Scholarship Fund to support students who are from, and committed to caring for, underserved communities.  The Fund will administer 60 scholarships this summer as follows:

• 30 to Health Professionals including medical and dental students;
• 20 to High School senior students entering a health care program; and
• 10 to students in the Allied Health/Undergraduate Program. 

CEO Rocha announced that the 1 millionth dose of COVID vaccine was administered on April 28th.  It was also reported that the Report Contact Tracing effort was scaling down from 300 staff at its peak to a core of 50 trained tracers while the balance of staff have either left or are being absorbed into other duties.  Beyond the immediate goal of tracing, the team increased relationships within the communities through networking and education which is being sustained and expanded.

Committee Reports

• Human Resources Committee – Due to ongoing use of agency nurses and not keeping pace with hiring, Deloitte Consulting to assist with recruiting efforts.
• Audit and Compliance - The results of the financial audit will be presented at next month’s Board Meeting 
• Finance Committee – Three contracts in excess of $1M for software support, maintenance, enhancements and hardware; for shuttle bus service; and for testing, maintenance and repair of building automation, security and radio transmission.

Item to watch for in the Future:  During his presentation CEO Rocha referenced establishing a “Mental Health Authority” to build out the behavioral and mental health footprint throughout the county.  He was challenged by several of the Commissioners on the term “Authority” and ceded that it might be an office or department as the Board cannot create an authority which implies a taxing body.  

Observed By:  Peg Moster

Cook County Health (CCH) Board Meeting
​March 25, 2022     

Enrolled in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), since 2014, Stroger is now winning big for patients by decreasing surgical site infection rate from 1.5 times the national (NSQIP) average in 2016 to 0.77 of the rate in 2022!  Annual Stroger savings of $237,210 with avoidance of prolonged hospital & ICU stay and even death of patients who suffer from post-op wound infections is the bonus.  Accomplished by implementation of rigorous procedures for disinfection of skin prior to surgery, additional pre and post-op antibiotics, changes of gowns, gloves and instruments twice: for surgery and again for wound closure and patient education were key elements of this successful plan.  Surgeon Wille notes that this is an ongoing process, with direct comparisons of outcomes to other hospitals nationally on the numerous targets of enhanced quality with decreased cost that are being studied.  Initially there was skepticism of the program Dr. Fegan, Chief Medical Officer, at CCH commented but the successes are now making believers of surgeons from all CCH specialties.  CCH’s low rate of surgical morbidity/complications for its patients places it in the top 20% of all NSQIP hospitals for 2021. 

Highlights from Board Reports:

• CCH Financial Report: $5.156 million positive operating margin year to date, vs budget which predicted loss ($19,257) - Gain due to higher inpatient volumes and decreased County Care claims expenses.  Pension costs ($160 million/year) not included.
• CCH hospital and CountyCare (Medicaid plan) financials combined - not separate accounting 
• Human Resources: 4 new outside contracts to improve hiring/retention/technology
• Charity care cost: projected $464.5 million to exceed 2022 budget of $452 million 
• CountyCare: 429,256 members slightly increased YTD 2022, largest managed Medicaid organization in Cook County followed by BCBS 334,273
• Redetermination for CountyCare membership delayed by State- is expected September.  CCH outreach efforts to retain members described for the Board.
• Hospital volumes: Admissions, patient days, average daily census, Emergency Room Visits, surgeries and ambulatory visits All still lagging 2020. 

Items to Watch for in the Future:

• Aaron Galeener still listed as Interim Chief Executive Officer, Health Plan Services (CountyCare, Medicare).  When will a permanent CEO of CountyCare be appointed?

Observer - Susan Kern, MD