Cook County Health (CCH) Board of Directors Meeting
November 22, 2024; 9 am   

Aaron Galeener, Chief Administrative Officer CountyCare, the County Health and Hospital System’s Medicaid managed care organization, responded to questions by Board Directors on how the incoming Trump  administration might affect the Hospital System.  Lots of concerns that the Hospital’s Medicaid block grants might be at risk noted Galeener.  CountyCare was founded utilizing a 1115 Medicaid waiver.  CFO Cassara added that CCH leadership would be conducting strategic discussions on possible impacts.  Governor Pritzker, Cook County Board President Preckwinkle and others will support CCH initiatives others commented.  Should CCH be concerned Director Robinson queried, with Galeener responding that they were hoping moderating influences would prevail.

Board Action: 

• Lyndon Taylor was re-elected unopposed as Chair of CCH Board by Directors.
• CC Commissioner William Lowry was elected unopposed as Vice Chair of CCH Board of Directors.
• Contract and Procurement items were all approved with: 

• Director Bhatt dissenting and voting “present” rather than “yes” on items 11 (Deloitte Consulting LLP: service-supply chain optimization consulting $598,095 extension of existing contract) and 20 (Deloitte Consulting LLP: service-human resources optimization, consulting and support services; $9,211,367 competitive bid RFP ).
• Likewise, Director Sorrell voted “present rather than yes for items 7 (Rush University Medical Center: service-clinical services agreement—no fiscal impact, extension of sole source contract) and 43 (Rush University Medical Center: service-renal biopsy studies, consults & conference moderation; $149,999, extension of contract--competitive bid RFP).  No discussion on reasons for dissent.
• Sept. 30, 2024 CCH Financials show $51,255,000 unfavorable variance to Budget for line item: supplies & pharmaceuticals.  This was attributed to increasing use of expensive biologic and genetic drugs, such as sickle-cell anemia gene treatment and others. 

Research and Grant Funding Discussion:

• Discussed the Life Science Department, newly established in 2024 to win research and other grants and contracts and manage them to increase a larger flow of extramural funds and expand the base of funders with the goal of supplementing revenue to CCH.

• Hektoen Institute has historically managed CCH’s grant solicitation and management.  Transition of Hektoen staff to permanent CCH positions is on-going with nearly 100 FTEs expected to transition by March 31,2025 at comparable salary & benefits.
• Directors posed numerous questions: 

• Institutional Review Board required to enroll human subjects— who will manage IRB, obtain informed consent, process research grant specimens? Answer: The program that sponsors the grant will manage IRB .  Clinical trial lab specimens will be processed at CCH.  
• Will participants recruited for clinical studies reflect CCH population? What about patients not eligible for study enrollment?  
• Grant funders have asked serious questions about the capability of CCH to manage their research grants. 
• Hektoen charges an 11% management fee—can CCH really provide services at this financial break point?  Will we generate more revenue than currently using Hektoen?
• How will we retain clinical investigators at CCH to be competitive?
• Director Reiter, Acting Board Chair in the absence of Lyndon Taylor, tabled the topic for further discussions at subsequent meetings.

Items to Watch for in the Future:

• Hektoen transition of grant management to new CCH Life Sciences Department status in 2025.
• Potential changes to Medicaid and healthcare provision impacting CCH in 2025 under new USA administration. 

Observer - Susan Kern, MD


Cook County Health Human Resources Committee Meeting
 November 14, 2024

Dr. Mikaitis introduced the newly hired Chief of Human Resources, Mr. Win Buren who joined the System just three days before on November 11.  The interim Chief, Carrie Pramuk-Volk was thanked for her leadership during the position search.

Metrics October 30, 2024:

• 1700 vacancies – 1200 of which are currently in the HR hiring/replacement process
•   113 days on average to fill positions and a 64% offer acceptance rate
• 1060 total filled positions of which 725 were external hires

December 1 – October 31 metrics:

• 290 Nurse hires and 173 separations:  117 net new nurse additions
•   107 days on average to fill positions
•   173 Retirements
•   216 Resignations
•     56 Discharges

September Agency Hires:  1,378                      October Agency Hires:  1,224

Recruitment Process Improvements: 40% reduction in positions not posted within 14 days of approval
Decision to Hire packets not completed within 14 days of submission also showed a 40% reduction.

Provident Scholarships:
2022    31 scholars $348,000 awarded           
2023    60 scholars $900,000 awarded
2024    91 scholars $1.3million awarded 

Observer - Diane Edmundson     

Cook County Health Board of Directors Meeting
October 25, 2024   

After securing approval of the AFSCME31 and SEIU 73 contracts, Acting Chair of this meeting, Robert Reiter, JR. (also the Chairperson of the Finance Cmte) revealed that the number of nursing staff vacancies has been frozen at the request of the County Board.  Although the number of budgeted positions is fixed, there is an increased need for staff due to increased patient load, new services, etc.  In turn, there is increased utilization of registry, which continues to negatively impact finances and employee morale.

The first public speaker, Dominica Flanagan, RN, SANE (Sexual Assault Nurse Examiner) in Pediatrics, 

• expressed her concern for two pediatric victims of sexual assault because she was not called in to interview the victims and assist due to the Executive Order to not call her on her day off.  

Before recessing to executive session, a second speaker, Mr. Blakemore, stated that

• “Health is Wealth.” and wants all CCH employees to use CCH for their health care.  And, US citizens to go to the front of the line.

Board members drilled down into the data in the just received 2022 Public Health report.

• 12-month delay on producing an annual report.  
• Faster results, like those for Covid are less accurate, have duplication and incorrect locations: address of report vs actual location.
• Items discussed were rates based on income and race for: 
  • pre-term birth, stroke mortality, equity and health equity, language preference, sexual orientation, lead abatement.
  • using opioid deaths to focus on specific communities for distribution of Naloxone/Narcan to specific organizations and businesses.  

Discussion of the late addition to the agenda: VI Action Items E. regarding the proposed resolution regarding agency usage and strategies promoted discussion and was referred to Finance Committee for more conversations with the labor partners. 

• CCH Board wants to maintain control and not have the Commissioners take over. 
• The turnover rate is at 18% which is less than the national average of 20%.
• 1264 vacancies; 
• 50% are in interview/offer stages.  
• 38% decrease in resignations over 2022/2023, but December sees higher rate of retirements.  
• 98 net new hires as of now, was 23 last year at this time.  
• 18% utilization of agency (averaged across all Depts & roles).

Other Items of Note:

• New device:  CCH has acquired and deployed a new robotic Lung Cancer Biopsy tool.
• Leader Rounds: 2-3 CCH Board members will make “rounds” to departments.
• New Leadership: Dr. Erik Mikaitis was introduced as the new CEO.
• New Board members: Maya Green, MD, MPH, FACHE and Dr. Inger Burnet-Ziegler
• Departing Leadership: Robert Currie

Observer -  Victoria L Cerinich

CCH Managed Care Committee Meeting –
October 18, 2024

Metrics Reported:
Members as of September 5:                    417,175
ACHN Members                                             31,621
% of CountyCare Members that use CC Health     7.60%

​Highlights from the meeting:

• CountyCare achieved a 90% redetermination rate to continue to lead the Managed Medicaid Market in Cook County with 34.2% of the total market share as of 6/24
• CountyCare received an award for its Food Insecurity Program
• In August 100,000 transportation requests were received.  Previously, LWVCC reported that CountyCare has switched to a new and broader transportation program including public and for-hire options.
• To Increase the 7.60% cited above, CountyCare staff is working with Cermak inmates to build relationships and trust before they are released.in order to retain them for CCH services.
• CountyCare led in the 2024 NCQA Health Plan ratings with prevention and equity, earning a 3.5 Star with the highest measurers for adolescent immunizations, BME percentile assessment, and prenatal immunizations.
• CountyCare working on a TeleHealth RFP which would have the potential for on-demand care for those that need it.  Implementation for selected vendors in early 2025.  To date.  CountyCare has contracted with 10 telehealth providers, adding at least 84 practitioners to the virtual care network.  Behavioral health is the domain more generally available.

Observer:  Diane Edmundson