Cook County Health Board
Finance and Human Resources Committee Meetings
January 18, 2024

The fiscal year for Cook County Government runs from December 1 to November 30 of the following year.  On an accrual basis, interim financials show that CCH end November 2023 with a $362.1M favorable variance to budget.  On a cash basis, it showed a $252M favorable balance primarily due to the timing difference in CountyCare’s reimbursements.

2023 Financials                           Actual               Budget
Revenue                                                 $4,746 B           $3,844 B
Expense                                                    4,528 B             3,992 B

Stroger Hospital                              Actual             Budget
Average daily hospital census                      306                     267
Emergency room visits                              85,843                 95,006
Surgeries                                                        11,490                    11,436 

Provident Hospital
Average daily hospital census                        20                        26
Emergency room visits                              26,180                29,994
Surgeries                                                          3,442                  3,248

ACHN Patient Activity
Primary Care Visits                                 237,076               281,649
Specialty Care Visits                               378,305               274,000
                                                                                                                     
 COOK COUNTY HUMAN RESOURCES FISCAYEAR-END SNAPSHOT 
Positions Filled                                         1,359
External Hires                                              853
Retirements                                                  192
Resignations                                                 325
Discharges                                                      45

TOTAL                                             562  *
* 9.8% against a national benchmark of 2023

Observer - Diane Edmundson

Cook County Health Board of Directors
Quality & Patient Safety Steering Committee
​January 18, 2024 - No meeting this month - report based on dashboard slides

In 2023, data was reported in monthly increments.  In 2024 the committee will look at most of the data on rolling 12-months increments to better quantify improvements. Not all data will have this format to start with. 

In 2024 control charts have been added for performance monitoring data for many items. Control charts are visual depictions of quantitative data. They can be used for common variation monitoring or new process parameters (good/bad).  The new areas of focus are listed below:

Stroger Hospital 
Patient Experience
    Improve % Top Box for Communication with Nursing Domain
    Improve HCAHPS Survey Response Return percent
Clinical Outcomes
    Reduce CLABSI,( central line-associated bloodstream infection ) and 
   CAUTI (Catheter-Associated Urinary Tract Infection) & CDIF Volume of occurrences    
Reduce PSI - Patient Safety Indicator PSI12 Perioperative Pulmonary Embolism or Deep Vein Thrombosis volume of occurrences
Readmissions
     Reduce House wide Readmissions all Payors-including patients admitted elsewhere
Throughput
     Reduce timeline of Inpatient Ordered to physician verified (Diagnostic Radiology Orders)
      Improve GMLOS (geo-metric mean length of stay) variance
Clinical Documentation
     Increase Overall Medical & Surgical CMI 

Provident Hospital 
Patient Experience
     Improve % Top Box for Communication with Nursing Domain
     Improve HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)      
     Survey Return percent 
Clinical Outcomes
     Improve SEP-1 (Severe Sepsis and Septic Shock Management Bundle) Compliance Rate
     Improve HH (hand hygiene) Compliance and coach clinicians where we are not meeting the  
     compliance.
Throughput 
     Improve LWBS ( left without being seen) Rate

Observer - Lisa Slankard

Cook County Health Board of Commissioners  
​Managed Care Committee
​January 19, 2024

The MANAGED CARE COMMITTEE accepted an emphasis on the expansion of the telehealth service into urgent care by Quarters 3 and 4, 2024.  There was no discussion and no details were provided to the committee at the meeting. 

REPORTS
Report on CountyCare Health Plan Metrics (in power point slides) was presented and discussed:

• Total Enrollment as of 01/05/2024 is 432,589 which is a 32% market share.
• Medicaid managed care enrollment decreased 2.7% county-wide each month, since redetermination resumed in June 2023, with CountyCare enrollment decreasing at the same rate.
• 2023 metrics
  • Increase in call abandonment rate from .35% on 47,791 calls in Oct2023 to .82% on 41,586 calls.  Almost 1% of calls abandoned on 13% fewer calls.  Still meets State Goal of < 5%. 
  • 6.4% fewer calls answered < 30secs in Dec 2023 to 91.43%.
  • Acute admits decreased slightly from 2022-2023.
  • Covid vaccination rate for one dose = 49.9% & 44.97% for series. CDC benchmark = 94.45%.
  • Highest rating from National Committee for Quality Assurance (NCQA) across all MCO’s.
  • 53 of 230 new provider organizations added in 2023 were for Behavioral Health.
  • FY2024 focus includes 
    • Expansion of Telehealth in three phases
      • Q1&2 2024    Telepsychiatry, 
      • Q3&4 2024    Urgent Care, 
      • Q1&2 2025     Other specialties.
    • Reduce unpaid claims using population-based payment, in which CountyCare leads other MCO’s.

ITEMS TO WATCH:

• State of Illinois (SOI) is publishing RFP for Managed Care in Q2 2024.  First draft of response is completed. Consultant will be selected in the near future

ITEMS OF INTEREST:

• The actual enrollment for Dec 2023 and Jan 2024 were 25,000 and 40,000 higher than the budget projected.  
• More abandoned calls and longer delay before answered over three-month period Oct-Dec 2023.
• Less than 50% uptake on Covid vaccinations, less than 12% on Covid Booster.
• Unpaid claims over 60 days are decreasing.

ITEMS PROMPTING THE MOST DISCUSSION

• Flexible Housing Program – source of funding is ARPA and Illinois “Quality” $ from top ratings. 
• Workforce- Hired 231 positions, 80% team satisfaction.  Moving away from contracting labor.
• Housing Programs, Increased health benefits for immigrant (any status) adults and seniors.
• Health Benefits for Immigrant and Adults & Seniors (HBIA/S) (started by SOI 18-24 months ago) current enrollment is 9,217, projected at 40,000 between Jan-Apr2024.
• CountyCare is the only MCO that removed co-pays and cost-sharing for HBIA/S.  Committee was complimentary of assistance to this population, but wants report again in three months.

Observer - Victoria L Cerinich

Cook County Health (CCH) Board of Directors Meeting
January 18, 2024

Tom Nutter MD, CCH Chief Behavioral Health Officer, talked about the newly formed CCH Office of Behavioral Health (BH) and the upcoming Cook County (CC) Behavioral Health Summit on February 15, 2024.  Invitations have been extended county-wide to mental health and addiction disorder colleagues to convene together.  The emphasis will be listening sessions from all stakeholders to get feedback on issues such as inequities in BH care, the need for improved BH care and need for increased access to BH care.  This summit will help to develop a CC Behavioral Health Strategic Plan.  There will be upcoming community-based funding opportunities from CC government because of the American Rescue Plan.  The Summit’s listening sessions will also help with guidance for awarding future Behavioral Health grants.  March 6, 2024 will be the date to submit requests for grant funding proposals.

The CCH Board approved a Memorandum of Understanding to be a member of the new corporation, West Side United Not-For-Profit.  Launched in 2018, West Side United is an organization initiated by West Side Health Care Institutions (including CCH), whose main goal is to close the life expectancy gap in the west side diverse neighborhoods of Chicago where there is a high level of poverty.  People in these neighborhoods experience barriers to health and wellness because of education inequities, employment, access to healthy food, safe housing, violence, transportation issues and access to banking.  The founding West Side Health Care Institutions determined that a not-for-profit corporation was needed.  

The CCH’s Patient Bill of Rights & Responsibilities document includes the right to provide “interpreter services, free of charge, including sign language” and information written in other languages.  Two contracts were extended by board approval for phone interpretation, document translation and interpreting services by video remote.

Observed by   Michele Niccolai