Cook County Health and Hospitals System Board Meeting - May 27, 2016

Strategic Plan Update:
Using input received through Cook County Health and Hospitals System (CCHHS) staff interviews, Richard Sewell, Associate Dean for Community Health Practice at UIC’s School of Public Health, presented an external, internal, and situation analysis of the CCHHS system that identified features of the system’s current state,as well as assumptions, strengths, challenges, and opportunities concerning its future.  Sewell will release the preliminary strategic plan for board review on June 17, after which the board will have two meetings (including the scheduled board meeting on June 24) to select about five key priorities along with cost associated with each priority, then approve the draft plan before it is released for discussion and input at a series of public meetings.  Once the three-year plan receives final approval at the CCHHS board meeting on July 29, it will serve as the basis for the 2017 budget negotiations to follow, as well as a guide for the budgets of the two subsequent years.

Significant Topics Discussed:

• Board transitions.  Two board members, Lewis Collens and Dr. Erika Marsh, have resigned.  The terms of Mary Richardson Lowry, Carmen Velasquez, and Dorene Wiese will expire on June 30.  The nominating committee has met, and decisions on new members are anticipated in the next two months.
• Due to a “labor hold”, only 99 vacancies have been filled this year, leaving 635 open positions.  At this time last year 448 positions had been filled.  Time to hire: 102 days.
• CCHHS has 66 days of cash on hand, with 100 days as a goal.  Charles Jones, chief of Supply Chain Management, explained the five sole source contracts. Sodexo American was awarded a contract for $8,300,000 to provide food and nutrition services. 
• Terry Mason, Chief Operating Officer, Cook County Department of Public Health, illustrated in a power point presentation the effect of the 1934-68 practice of “redlining”, defining which neighborhoods could receive mortgages.  The practice resulted in still-extant concentrations of poverty, where residents have fewer educational opportunities, shorter life expectancies, and poorer health outcomes.   Mason proposed support for pro-equity policies to equalize access to healthcare; training for staff in bias awareness; and stratifying quality metrics by race, ethnicity and primary language.  He also proposed an aggressive lead abatement program in affected neighborhoods that conforms to the CDC recommendation.

Observer - Linda Christianson                               Meeting Length: 3 hours

Cook County Health and Hospitals System Board
Special Meeting - May 5, 2016

Purpose of Meeting: An update for Cook County Health and Hospitals System (CCHHS) Board Members on how health policy and financial decisions in Springfield and in Washington DC may influence what happens within CCHHS in the next 3 years. Presenters were lobbyists who work with Illinois and Federal Government representatives and officials on Health Policy and County Government. This meeting is part of the planning process leading to the development of the CCHHS 3 year Strategic Plan to be approved in June. 

Significant Topics Discussed:

• Part of the Affordable Care Act (ACA) was the phase out of Medicaid Disproportionate Share (DSH) payments which have been a part of the CCHHS budget for many years - $162m in 2015. DSH payments in the past have been made to those hospitals serving a large number of uninsured and Medicaid patients but with the expansion of Medicaid as part of the ACA it was thought that these payments could be phased out within a few years. The phase out that was scheduled to begin in 2014 has been pushed back to 2018 and the presenters indicated that they did not think the cuts to DSH are going to happen any time soon. The money received in DSH is being monitored closely with ongoing audits and County had to have $362M in cost to justify their reimbursement of $162M in 2015.
• Another possible revenue stream that could be investigated is federal money that is allocated for health care of Native Americans. Director Wiese stated that most of that money goes to Indian Reservations but a large percentage of Native Americans no longer live on reservations and perhaps some of that money would be available for health care of persons in Cook County. 
• The Medicaid Managed Care Rule was released on 4/25/16. Outcome measures are a very important component of the ruling. Another component is the “whole person” concept of medical care - how is health care coordinated with other services such as substance abuse treatment, housing, mental health, social services, and nutrition. How can a Public Hospital change the way they deliver care to work with others to attain good outcomes and spend as little as possible? The challenge for CCHHS.
• Pertinent Statistics - 1 in 4 Illinois Residents is on Medicaid and 37% of the population of Cook County is at or below 200% of the Federal Poverty Level.

What to Watch for in the Future:
The Board will be developing the 3 year Strategic Plan in the next few months. They will be developing strategies with measurable goals to achieve the identified priorities that have already been determined.

Upcoming Meetings in the Strategic Plan process:

• May 16 and 17 from 6-7:30pm Town Hall Meetings - to gather input from the public
• May 23 from 4-7pm - Another Board Strategic Planning Session to develop Action Plan
• May 27 - 9am Board Meeting - more work on Action Plan
• June 24 - 9am Board Meeting - adopt Proposed Plan 
• A Public Hearing will be scheduled after adoption of Plan

All information on the Strategic Planning Process is available on the CCHHS Website.

Observer - Cynthia Schilsky                          Meeting Length: 3 hours
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Cook County Health and Hospitals System Board - April 29, 2016

Significant Decisions Made:
Approval of $112,700,000 Contract for New Health Center which will adjoin John Stroger Hospital, replacing 3 aging structures: Fantus Clinic , the current administration building on Polk St.  and the Hektoen Building.

• Via RFP (request for proposal) Clayco, Inc was selected to lead the development, design and construction of this new nine-story Health Center housing expanded outpatient services and administrative space and adjacent future parking structure. 
• Completion is expected in 2018 at a cost less than estimated for deferred maintenance on the old buildings.
• CCHHS are gambling that a more attractive, efficient facility will serve to retain patients, who are now insured under Medicaid (under the Affordable Care Act) and are increasingly choosing to go to other hospitals.  
• Board members commented that great care was taken in the contract to mitigate cost over-runs and insure local hires.

Significant Topics Discussed:
Concern was expressed by Director Erica Marsh, MD, that the nearly 800 employed HHS physicians  are not being assessed for productivity.  The number of physicians per patient is high compared to other hospitals.

• Doctor generated RVU (Relative Value Units: standardized measure of value for physician reimbursement) are used by other health care organizations to hire or retain and in some cases a doctor must meet a 50% or higher threshold compared to peers to be retained.  This, or comparable data (number of patient visits/encounters per day) is critical to predicting the fiscal sustainability of the organization and should be included in the HHS Strategic Plan under discussion. 
• Dr.Claudia Fagan agreed that there have been complaints that some physicians may only be seeing a couple of patients a day and they are not required to time -in or out.  There is a history at CCHHS of paying lower salaries and not particularly being concerned about the amount of work, because this was a charity hospital.  Most of the physicians are employed and belong to the union. 
• Director Lerner stated that there needed to be a new medical staff structure for the Strategic Plan including labor partners. 
• Productivity monitoring and performance achievement are needed added CEO Shannon.  Dr. Fagen responded “you cannot change culture overnight; it has always been like this at County”. 
• Director Junge (labor attorney) countered that the doctors have employment contracts.

Unexpected Events:
CCHHS Board Member, Lewis Collens, has unexpectedly resigned. The resignation was announced by Chair Hammock who noted the dedicated service as Chair of the Finance Committee that Director Collens had given to CCHHS.  He mentioned that the resignation was for family reasons. 

In an unscheduled visit to the Board meeting, Senator Dick Durbin,  our Illinois US Senator, cautioned the Board on the heroin epidemic. He noted that opiate abuse was on the rise and HHS will be at the forefront. 

• He also noted that the Zika Virus was unlikely to be of much concern to our region this year
• Both of these are central to the mission of CC Dept of Public Health which is administratively a component of HHS.                               

Observer: Susan Kern                                Meeting Length: 3 hours 45 minutes