Covid-19 Vaccinations and Contract Tracing Addressed at Cook County Health Board Meeting

Cook County Health (CCH) Board of Directors Meeting  –
February 26, 2021

Public Testimony: 

• Regarding the SEIU Local 73, 12-hour strike on December 22, 2020 by CCH essential workers, union representatives gave testimony regarding President Preckwinkle's pushback and CCH's investigatory hearings of members.  The strike came after union members were unable to come to an agreement over pandemic pay and safe working conditions: short staffs and lack of PPE.
• A group of CCH employees from several departments was recognized. for their efforts to improve inpatient bill collections.   Discharged Not Final Billed (DNFB) collections: a delay in completing an inpatient's bill on discharge due to coding or documentation gaps that leads to a delay in payment.  Employee cooperation from IT, Health Information Management and Finance lead to completing patient bills within 4 to 6 days after discharge meeting the target in December 2020 for DNFB collections.

Human Resources (HR)

• Their 2023 Strategic Plan focus includes: an increase in hiring bilingual employees; reduction in the time to hire; developing the cultural competency of the workforce; and maximizing HR information systems. 
• The staff at CCH numbers 6,054 employees, based on the 12/4/2020 payroll. 
• The people leaving CCH through January 31, 2021 have been retirees at 65% and resignations at 29 %.  There is an Employee Exit Survey and the response rate is 26 % which falls within the Industry Wide Standard. By job category, nurses are the largest group to complete the Exit Survey.
• First Quarter FY 2021 filled positions is very high due to Contact Tracing hires.  The Average Time to Hire in FY20 and FY21 has met the goal of 90 days during the Covid pandemic. 
• Covid 19 Contact Tracing Hires:  As of 1/31/2021 285 positions have been filled, 71 case investigators, 203 contact tracers, 6 supervisors/managers, and 5 other. 228 positions are in the hiring process with CCH leading Hektoen Institute in the hiring process.
• CCH is developing an improved volunteer program.  304 National Guard are unpaid vaccination personnel: 143 at Tinley Park Convention Center; 36 at Triton College; 89 at Health Centers North Riverside/Morton College, Robbins & Cottage Grove, Arlington Heights, and Blue Island; 18 at Stroger/Provident/Core and 18 at McCormick Place (not a CCH site).  For the Covid-19 Hot Line launched 12/21/20, 34 volunteers are assigned to give out test results.

CountyCare Medicaid Managed Care Plan

• As of February 4, 2021 County Care has a total membership of 385,741, of which 39,751 are in CCH clinics.  This total member increase is 5,300 more over last month, due to increase plan choice and auto-assignment by the state.  There are 1,000 more members in CCH clinics over last month. 
• CountyCare's 31 % market share of all Cook County's Medicaid Managed Care Plans has held steady.  CountyCare's enrollment has increased 17.4% over the past 12 months following the trend of all Cook County Medicaid Managed Care Plans.

Financial Update

• The December 2020 Net Patient Service Revenue was better than expected due to slightly higher charges.  The December admissions were less than a year ago.  A one-time payment of $6M was received from BCBS Equity Program.  
• From the CARES ACT, approximately $6M is to be reimbursed for Covid-19 expenditures. 
• First Quarter FY2021 is on pace to save $5M from completed/near completed Vendor contract negotiations.  Uncompensated care decreased in December 2020 from Dec 2019 and Medicaid revenue increased in Dec 2020 over Dec 2019. 
• Payment denials/write offs met the Dec benchmark of 5%.  More than half of denials were related to prior authorization (focus is on infusion, radiology, outpatient surgery). 
• On an accrual basis, interim financials show that CCH is ending December 2020 $2.32M ahead of budget.  December 2020 Health Plans Financials showed a Loss of $1.6M consists of $0.4M from CountyCare and $1.2M from Medicare.  Membership in Medicare is lower than budget, driving lower than expected revenue and members have more serious health conditions.
• Contracts were approved for purchasing specialty surgery supplies, instrument & equipment repair, mammography equipment upgrades, an ultrasound system, neurological power tool accessories, medical/surgical acute care beds, aortic endo-grafts used by surgeons to repair the aorta, and job posting system maintenance/enhancements.  A software company contract was approved for the "CMS Interoperability and Patient Access Final Rule Integration".  Interoperability is the ability to share data between different computer systems.  Goal is to have data flow securely between CMS regulated payers, providers and to give patients access to their health information.
• Two grants were received and filed for approval by the Cook County Budget Director:  An IDPH grant for "Cities Readiness Initiative Program" which is designed to enhance the response to large public health emergencies needing medicine/medical supplies in large metropolitan centers.  A second CCH Foundation Grant is for mass vaccinations/ support patient recovery.

Cook County Dept. Public Health (CCDPH) serves CC suburbs: 

• The Public Health Accreditation Board has continued accreditation of the CCDPH for 5 years. 
• CCDPH in collaboration with Hektoen Institute has awarded nearly $5M to 42 community-based organizations (CBO) for a 6 month project Dec 2020 to May 2021 for Covid-19 Community Supports and Worker Protection Programs.  Investing in existing community assets, since they are credible and trusted places, will help to reach populations where hesitancy and distrust exist.  These programs are in communities/populations most disproportionately impacted by Covid-19.  The Community Supports program provides outreach, education, expansion existing programs/services, testing.
• The Worker Protection Program provides employers and workers information, resources and support to minimize the spread of disease to promote health and safety in workplaces.

Covid-19 Vaccination: 

• As of 2/16/20, 70% of CCH staff and 56% of CCH employees have been vaccinated. 
• As of 2/19/21 vaccine doses distributed at Chicago & Suburban CCH Points of Distribution (POD) to CCH patients and public who meet current eligibility = 43,636. 
• Vaccine doses distributed to general public who meet current eligibility at Mega PODs = 46,453 and vaccine doses distributed to specific eligible populations at Targeted PODs = 1,264. 
• Other community vaccination access is from CCDPH Mobile Units, CCH/CCDPH Strike Teams (homeless shelters, home-bound and hard to reach populations), Drive-Thru at CC Forest Preserve District sites,  Loyola and Advocate hospitals, Pharmacies, Federally Qualified Health Centers, and Oak Street Health. 
• CC is currently in Vaccine Allocation Phase 1b which includes individuals 65 and over and frontline essential workers. 
• Vaccination registration & appointment information is available at Website: vaccination.cookcountyil.gov     Call center: 1 833 308 1988, M-F  7am to 7 pm.
• Covid-19 Vaccination at CC Department of Corrections & Juvenile Temporary Detention Center; Staff: since 1/20/21 more than 3,500 doses have been administrated.  Detainees and prisoners are Phase 1b.  To date, nearly 1,300 detainees have received their first dose.

CCH Covid-19 testing: 

• As of 2/21/21, from all tests conducted at CCH (107,334) the positive rate of patients is 8%.
• Covid-19 testing at Cermak (CCH health center at CC jail) remains a high priority and plays a critical role in the containment of Covid-19 at CC jail.  The rolling 7 day positivity rate as of 2/23/21 = 0.8% even as the jail census as of 2/22/21 = 5,435.

Observer:  Michele Niccolai                                   Virtual Meeting length:  2+ hours