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CountyCare Enrollment Must Increase for Cook County Health System to Remain Viable

8/29/2017

Cook County Health & Hospitals System (CCHHS) Finance Committee Meeting - August 25, 2017

Significant Topics Discussed:

The State of IL retroactively (to January 2016) lowered the reimbursement rate to CCHHS for health services covered by Medicaid. How could this happen? Because the rate was not “recertified” every year, CCHHS must cover the outstanding cost for these services.
Pharmacy costs are $24m over budget for the first 6 months of 2017. Dr. Shannon identified pharmacy costs as one of the “holes” in the Affordable Care Act. Pharmaceutical firms may charge very high rates for rare but needed specialty drugs.
Can CountyCare increase from its current 141,000 to 225,000 members? Finance committee Chair Ric Estrada pointed out that customer service is key. Deputy CEO Doug Elwell summarized, “If the patient experience doesn’t go up, we’re not viable.”

June 2017 statistics:

$132m shortfall in CountyCare revenue
Patient visits and discharges slightly below 2016 levels
Deliveries and surgical cases up slightly

Draft 2018 Budget Projections - subject to public review and final approval by the Cook County Board:

The 2018 budget assumes: an improved patient experience, with 10% increases in surgical cases, primary care, specialty care, and deliveries. The budget also assumes CountyCare growth, personnel cost increases, a decline in overtime, increased uncompensated care, and increased pharmacy costs.
Based on these assumptions, overall revenue is projected to total $2,178b, with expenses to total $2,417b, yielding a deficit of $239m.
Sources of revenue: DSH (federal Disproportionate Share Hospital allocation) $134.7m; CountyCare $1,205.1b; Medicaid, Medicare, and private insurance payments $460m; BIPA (federal Benefits Improvement Protection Act allocation to safety net hospitals providing medical education) $132.7m; and the remaining $245m from grants and other revenue..
HHS predicts the number of FTEs (full time equivalents) at 6856, a very small decrease.
Cook County support for HHS will total $294.3m including $184.3m for pension, $6.9m for hospital/ambulatory services, and $103.1m correctional health (for jail detainees).
Chairman Hammock commended the staff for the quality of the information delivered to the board.

Observer - Linda Christianson Meeting Length - 2 hours

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Decision on Illinois' Managed Care Reorganization Due in August - How Will CountyCare Fit In?

8/1/2017

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Cook County Health & Hospitals System (CCHHS) Board Meeting - July 28, 2017

Beginning January 1, 2018, all Illinois managed care organization members, including those enrolled in CountyCare, will have 90 days during which they may opt for a different plan.

Significant Topics Discussed:
CountyCare (Managed Care):

Managed Care Director Steven Glass departs his post for a job in the private sector.
CountyCare seems likely to be chosen by the state of IL as one of 4-6 managed care organizations in the state’s reorganization of the delivery of managed care, with a decision on this due in August. Once the reorganization takes effect on January 1, 2018, Medicaid reimbursement rates to managed care organizations are likely to decline.
CountyCare enrollment continues at 141,000, 1.5% under budget.

Finance:

CCHHS will lease 13,700 square feet from Westside Health Authority to accommodate the behavioral health services currently housed in Fantus Clinic, with the anticipation that an additional site for behavioral health services will be identified on the south side.
For the first 6 months of 2017 revenue was $103,000 below budget projections, attributed to overtime (8% of payroll) and external claims expenses, including CountyCare payments to non-CCHHS providers.
2018 budget planning assumes an anticipated need of $84 million before considering any new expenditures and must include $30 million for staff pay increases; $28 million in capital needs; $26 million in furnishings and equipment for the new facilities.
73% of CCHHS budget is personnel-related; 90% of staff are unionized.

Quality and Patient Safety:

65% of Stroger patients would recommend the hospital, cleanliness the most pressing concern. A Director of Environmental Services has yet to be approved.
69% of ambulatory care patients expressed satisfaction with their patient visits.

Human Resources:

715 identified vacancies, 117 days required to hire a new Full Time Employee (FTE), a 4% turnover of total FTE’s, a 5.4% nursing turnover. The board raised questions concerning the length of hiring time.

Other Comments:

“To survive we must grow.” Deputy CEO Doug Elwell spoke of the “bolus” of uninsured patients CCHHS is committed to care for. CCHHS looks to improve the patient experience, increase volumes, sustain its financial position, sustain and grow CountyCare membership.
Public speakers representing nurses spoke of ICE agents entering CCHHS buildings without authorization.

Observers - Linda Christianson and Jackie Buttafuoco Meeting Length - 3 hours

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CountyCare Enrollment Must Increase for Cook County Health System to Remain Viable

Decision on Illinois' Managed Care Reorganization Due in August - How Will CountyCare Fit In?

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