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

Cook County Health Strategic Plan Town Hall Meeting #2
March 2, 2022

The meeting opened with a welcome and thanks from Israel Rocha.  He then turned it over to Andrea Gibson. She gave an overview of CCH’s scope and accomplishments. She next explained the SWOT process to be  used to obtain feedback from employees, community, labor,  and the CC Board of Commissioners.  S=strengths W=weaknesses O=opportunities T=threats.

• The first speaker was MCS from PASO, a west suburban action group.  She said the people she dealt with were helpful. Weaknesses noted were waiting time, navigating services, motivating patients to have conversations with healthcare providers and mental health access. She said that the COVID vaccination sites are an opportunity to bring more patients into the system.
• The next speaker BT said that climate change is a serious threat and cited heat issues, blackouts and flooding.
• Next was SK who said that the buildings, structures and advanced technology is a strength but labor discord is a weakness. The increase is charity care and lack of reimbursement is a threat.
• SA said that turning over patients to collection agencies is a weakness and not in line with the County goal of abolishing medical debt. Mr. Rocha explained that an attempt to collect copays must be made for claims covered by insurance and that there is now no copay for Carelink.
• HP asked about community health workers being able to go into the hospital again. Mentioned were the NICU club and lactation experts. Dr Fagan said they have hired a lactation specialist.
• Also mentioned was simplifying the process to enroll in Medicaid.

Observer: Lisa Slankard

Cook County Health Strategic Plan Town Hall Meeting #3
March 3, 2022

The Thursday morning virtual meeting began with an introduction by CEO Israel Rocha followed by Chief Strategy Officer, Andrea Gibson, presenting the initial process for the 2023-25 Strategic Plan which included three town halls (one in Spanish) the week of March 1.  A survey was sent to Stakeholders using the SWOT process of Strengths, Weaknesses, Opportunities, and Threats.  Ms. Gibson stated that no ideas would be presented by CCH at the town hall meetings as the purpose is to gather opinions and suggestions from the Stakeholders and the Public.

General feedback regarding CCH and the Public Health Department included:

• The COVID pandemic has expanded trust in the System and this is the moment to take advantage.
• The greatest emphasis from multiple speakers is the request to expand the CCH's Public Health Department.  I.E., ramp up the comprehensive development of services including maternal and child health.
• Consistent requests also centered on expanded mental health and addiction services.
• Ms. Gibson said that the CCH leadership has gotten the message that it needs to leverage what services have been offered throughout COVID.

Strengths:

1. The System's extraordinary team and its commitment to provide access to all individuals regardless of ability to pay.

      2)  CCH's Public Health Department but it needs more budget and staff.

Opportunities:  

1. Better communication across the System and within every department to make them aware of the resources available.                   

    2)  More collaboration with community based organizations. 
    3)  Create sustainable programs.
    4)  Increase birthing opportunities - for example "free standing birth centers."
    5)  Can long term care be made available?
    6)  Need more health services in the South Suburbs - population not dense but covers a  
          wide area – therefore, it is not easy to get to CCH health care sites.
    7)  Increased emphasis on the fact that "housing is health care".
    8)  Role out a #988 phone number for crisis calls.
    9)  Incorporate "peer support groups" into county services particularly for addition and 
         Mental health.

Weakness/Potential Threats:

1. Social Worker turnover at Stroger - Suggestions:  Hire more workers to lighten workloads and provide more defined career path[s].

    2)  Stroger being a learning institution often leads to a constant change in providers.
    3)  Medicaid application process for immigrants.
    4)  Turnover of nursing staff.   It was stated by a speaker that 50% of the current nursing     
          staff is from outside contractors.
     5)  Length of time needed to fill positions - particularly nursing.  

Observer:  Diane Edmundson

Cook County Health (CCH) Board Meeting
February 25, 2022

The timeline for the FY23-FY25 Strategic Plan introduced 

• In February/March an online survey asks for feedback from all employees/communities. 
• Promotion will occur through emails, community newsletters, and social media. 
• Town Hall meetings with employees, communities (one in Spanish), labor management, and Board of Commissioners are scheduled. 
• CCH provides significant amount of charity care as compared to other Cook County hospitals.  CCH includes eight Primary Care Centers, four Regional Outpatient Centers, a Child & Adolescent Service, two hospitals, Public health and two Correctional Health Services. CCH has administered more than 300,000 Covid tests, initiated Covid mitigation and prevention at Cook County Jail, and administered approx 1 million doses of Covid-19 vaccine. Cook County Dept of Public Health set up contact tracing program for Suburban Cook County.

Finance Committee

• On an accrual accounting basis, CCH ended Dec 2021 with a $15M positive variance to budget and Health Plan shows an operating gain of $8.7M as of December 31, 2021. 
• The nursing dept request to increase the existing contract with Vaya Workforce Solutions, LLC for Contract Management and Nursing Registry services (not to exceed FY$64M) as needed, for the remainder of the contract through 9/24/2023 was approved. 
• Dr B. Peters, Chief Nursing Officer stated in years past the hourly wages for agency nurses was around $20/hour and now the wages are around $200/hour.  She pointed out the need to continue to supplement the CCH staff, especially nursing, due to vacancies and retirements.

Managed Care Committee

• As of February 4, 2022 Total CountyCare membership is 425,981, of which 10.5% are using CCH clinics.  CountyCare’s enrollment has increased 11% over the past 12 months.  As of 2/4/2022 40.62% of vaccine eligible membership are fully vaccinated.  
• Dr Collins, Chief Medical Officer CountyCare, talked about Homelessness programs in her Health Equity Initiatives presentation.  Medical Respite care is acute and post-acute care for homeless who are not ill enough to remain in a hospital but are too ill to recover on the streets.  The Flexible Housing Pool addresses homelessness by connecting people to stable housing along with health services which decreases Emergency Room visits and hospitalizations.

Human Resources Committee

• FY2022 through 1/31/22: HR received 1,545 Requests to Hire:  1,238 positions in progress, and 82 vacancies filled. Also in this time period there were 149 separations due to retirements and resignations.  The big challenge is the retention of CCH’s nursing staff. 
• HR is actively recruiting by working with colleges and universities, marketing in communities and hosting job fairs. 
• Automation plans include adding Salesforce.  A key initiative is to partner with the new Chief Experience Officer.

Quality and Patient Safety Committee

• The new Chief Experience Officer and  the office’s Strategic Plan were introduced. 
• The Plan includes 4 top goals: Patient Satisfaction Goals, implement “C I Care” behaviors (connect, introduce, communicate, ask/anticipate, respond, excellence), workforce wellness programs, and goal orientation for new hires. 
• Some initiatives are wellness lounge, employee events, art murals for group participation, farmers market, hire chaplains, newsletter, Gemba walk (gemba means “actual”) where leaders actually step out of their offices and walk to work stations to connect with staff to gain knowledge of work processes. 
• All the new initiatives are designed to enhance both the patient and employee experience as positive experiences for both create a stronger organization.

Observed by:  Michele Niccolai