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Cook County Health Continues to Have Funding Challenges

10/25/2019

Cook County Health (CCH) Board of Directors Meeting
October 25, 2019

Board Discussion:
CEO Dr. Jay Shannon summarized recent Cook County Health (CCH) positive developments:

The IL Health Facilities Board has approved the application for a new Provident Hospital;
The National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings;
The US Congress passed a continuing resolution through November 21, to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.

But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.

Committee Reports:

Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire.
Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days.
Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average.
Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, Emergency Room visits down 2%, deliveries up 5%.

Significant contract awards:

Cerner Corporation for software support - $191m for 5 years, $38.2m per year
Medline Industries for medical and surgical supplies - $70m for 36 months;
Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.

Observed by: Linda Christianson Meeting Length: 3 hours

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Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

10/4/2019

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Cook County Health (CCH) Board of Directors Meeting
September 27, 2019

What did the Board Decide:

Cook County Health (CCH), CEO Shannon explained that underestimation of external claims from non-CCH Network providers of the Managed Medicaid/CountyCare program exceeded the total appropriated dollars. Payment of these bills necessitates transfer of funds from other CCH budgeted items still showing a positive balance. Over $80M was transferred form special Purpose and Wage Funds to cover the claims.

The Board voted to purchase a renovated Blue Island building replacing the closing Oak Forest Clinic for $15.3 million, a savings over a 10 year $17.3 million lease.

Located at 12757 S. Western Ave. servicing the same population as Oak Forest Clinic/hospital, it will be a multi-disciplinary clinic including radiology, lab, specialty and primary care services.
Several Board Directors expressed concerns over the lack of parking and access as the nearby L station is slated to be shuttered. Administration pointed out that “L” station closing would open up their parking lot, and an adjacent building might be purchased for parking.

What else did the Board discuss or refer to committee?

New vendor using “Big Data” and algorithms identified $1.9 million in overpayments which CCH hopes to recoup.
Cultural Competency course & training program for CCH staff in development. Leadership are contributing components. Director Gugenheim urged that all levels of the organization be involved in its creation.
Dr. Mason, CEO of Cook County Dept. of Public Health reported adoption of the Good Food Purchasing Program (GFPP) by Chicago Public Schools; soon to extend to the County Sheriff’s Office and Juvenile Detention Center. It is a national organization and movement to bring ecologically positive changes to food sourcing including: 1) locally grown food 2) animal welfare and nutrition 3) environmental sustainability such as compostable cutlery and plates
Public Speaker, Laurie Cohen, of the Chicago Civic Federation called for greater transparency in presentation of CCH's finances. She alluded to the Board’s Sept. Finance Com. discussion & PowerPoint which states : CountyCare-CCH reimbursement rate has been adjusted to 100% of the Medicaid rate for current fiscal year. There was no explanation of how this impacted the system or budget.

CEO Shannon responded at the end of the meeting: Medicaid rate education would be considered. This response does not seem to address Ms. Cohen’s concerns that the consequences of various financial metric variations are not elaborated on to the public.

Observed by: Susan Kern, MD and Megan Kennedy Meeting Length: 2 hours and 45 minutes

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Cook County Health Continues to Have Funding Challenges

Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

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