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Cook County Health Board Approves Preliminary 2020 Budget

9/20/2019

Cook County Health Board Meetings
August 30 and September 13, 2019

Special Meeting - September 13

With two abstentions, at a special meeting on September 13, 2019, the Board approved its 2020 preliminary budget for presentation to the County Board on September 26. The abstentions were in support of more revenue from the County for the Health System. CEO Shannon described it as “no doubt the most challenging budget” to prepare and meet since he became CEO in 2014. The $2,966 billion budget includes cuts to headcount in the form of eliminating 400+ vacancies in ambulatory care clinics and up to another 200 vacant positions in other areas.
Investments made over the last four years, primarily funded by the revenue brought in from its County Care Insurance Program, include substantially increased behavioral health and drug addiction services; a broader care management approach focusing on preventive care and housing/food insecurity; transportation services; a County authorized Direct Access Insurance Program* for the uninsured; and investment in new facilities, equipment and technology. This while absorbing a decrease in county funding from 25% in 2013 to 5% in 2020.
Expense drivers include Uncompensated Care which has risen almost 88% from $314 million after the ACA was enacted in 2014 to a projected $590 million in 2020, employee compensation, overtime, and rising prescription and medical supplies. Uncompensated Care includes charity care and bad debt. Dr. Shannon stated there is “no question other providers are redirecting charity care to CCH” and that the system cannot cut its way [expenses] out of the increase cost of charity care.
For more information on the preliminary 2020 budget CLICK HERE:

* Direct Access is a subset of Charity Care and county residents qualify based on income. About 50% of charity care costs is attributed to the Direct Access Program.

Committee Reports from August 30, 2019 Board Meeting:

Human Resources: 7,200 total positions, 836 positions in process, 628 positions filled year to date. Average days to hire 102. Average vacancies per year 1100 to 1200.
Managed Care: CountyCare membership trending up to 318,676. Cook County continues to have a 31.6% market share, which is the largest among the seven Managed Care Operations in the county. However, when Meridian’s merger is completed at the end of 2019, it will pass CCH in market share. While state approval time for Medicaid applications is improving, there is still a 100,000 backlog to get initial application and redetermination applications approved. Illinois is looking at outside contracting for help in reducing the backlog.
Finance: The 2020 preliminary budget was pulled from the August 23 agenda to be further worked on and presented at the August 30 board meeting. See above September 13 board meeting text, as presentations and discussion at the August 30 meeting were similar except there was no vote.
Requests: Chairman Hammock asked for a longitudinal chart on monthly memberships in the Health System’s County Care Insurance Program. He did not specify how far to go back.

Other information of note:

The Deloitte forensic audit of the Health System’s County Care financials and the System’s overall method of accounting was completed, and on September 4, 2019, CEO Shannon submitted the Deloitte report and the Health Systems response to the highly critical Inspector General (IG) Report of June 26, 2019. CCH Executive Management stood behind its initial public response that the IG got it wrong and provided a 15 page rebuttal. It also claimed in public comments that the Deloitte report mainly agrees with CCH. The County board will review both the Deloitte report and the Health System’s response at its September 26, 2019 meeting. CCH Management will attend as likely will the Cook County Inspector General.

Observer - Diane Edmundson Meeting Length: 4 hours total

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Cook County Health Approves Preliminary 2020 Strategic Plan

7/30/2019

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Cook County Health (CCH) Board of Directors Meeting - July 26, 2019

Board Decisions:
The board unanimously approved the preliminary 2020 strategic plan, which will be available for public input later this summer and presented to the Cook County Board in September.
The plan calls for:

Increased surgeries, emergency visits, primary care, specialty care, and deliveries;
5% cost savings; and
Sustaining CountyCare membership,

Challenges to the system include:

Salary increases,
Increased cost of equipment and supplies;
Revenue loss in CountyCare;
Consolidation of hospitals
A $52m pension requirement.

CEO Dr. Jay Shannon pointed out that CCH needs to attract and retain paying patients When CCH loses CountyCare patients, there is a 53% chance they will present for charity care, which consumes 25% of CCH revenue.

Committee Reports.

Human Resources: 7,265 total positions, 1,151 vacancies, 830 positions in process, 364 external positions filled. Hiring for coders and billers difficult; not enough qualified candidates.
Managed Care: CountyCare membership 316,730 as of May 2019, 31.6% of market share. Home visits to high risk patients to encourage them to use CountyCare. Commissioner Sidney expressed concern that patients were being “auto-assigned” to health care plans without patient input.
Quality and Patient Safety: CCH has a 16% readmission rate (near national average), attributed to hypertension and kidney disease; 8 falls with injury per month average; no hospital acquired conditions in last 3 months, but some infections. 74% willing to recommend Provident, 69% to recommend Stroger.
Finance: Budget 23% below target due to increased (1) charity care, (2) clinical activity and (3) pharmacy costs. “We need to be better compensated for care to the uninsured,” CEO Shannon commented. Finance Chair Robert Reiter pointed out that CCH provides half of the charity care countywide; other hospitals are providing less. Commissioner Mike Koetting emphasized the “centrality of making sure we are the provider of choice; otherwise the percentage of charity care will continue to grow.” 45% of CCH patients are now uninsured. 51% of patients identify as African American; 32% identify as Latino.

CCH Board Chair Hill Hammock announced that the Deloitte accounting firm will examine CCH’s financial books and accounting principles, with a response from CCH by the end of August.

Observed by: Linda Christianson Meeting Length: 3 hours

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Cook County Health Nearing Completion of 2020-22 Strategic Plan

6/15/2019

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Cook County Health (CCH) Board Meeting - May 31, 2019

What did the Board discuss:

The 2020-22 planning process started in the Fall of 2018. After months of considering key issues, industry trends, looking at future needs, and seeking input through community town halls and surveys, the Cook County Health (CCH) Strategic Plan 2020-22 is nearing completion.
CCH recognized its nurses May 6 - 12 during the annual National Nurses Week.
CountyCare, the CCH Medicaid managed care organization, numbers were slightly down again as of May 5, 2019 to 316,831 members. The Illinois spring legislation addressed problems with Illinois Medicaid: reducing lapse of care when benefits are terminated, and establishing an easier process for initial Medicaid applications and redetermination for individuals to stay on Medicaid. CountyCare will benefit from these improvements.
CCH committed $1 million toward the Flexible Housing Pool- a partnership that has the goal of housing vulnerable homeless and connecting them with support services. Overall this support is a cost effective way to help them improve their lives and health.
The Board acknowledged the Cook County Health Foundation. This foundation partners with CCH giving financial support to further the health systems mission of health care to residents regardless of their ability to pay. The foundation increases awareness of CCH and raises money to help the health system build for the future and remain a leader in public health.
A May presentation "Diabetes Update" explained that over time elevated blood sugar (glucose) levels damages both large and small blood vessels. This damage can lead to complications that affect the whole body. A CCH study showed that a gain in patients' knowledge of diabetes management is associated with better blood sugar control.
CCH contracted with an architectural consulting service to review the physical spaces of its out-patient clinics. The goal is a positive patient experience in waiting areas and a good experience when being efficiently moved through clinic areas.
The Board approved a furniture contract for new clinics in Hillside, North Riverside, and Blue Island.

Observer - Michele Niccolai Meeting Length: 3 hours

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CountyCare Enrollment Declines by 33,000 in 2019

4/28/2019

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Cook County Health (CCH) Board Meeting - April 26, 2019

CountyCare - Managed Care Organization Update

Medicaid enrollment in CountyCare, Cook County's managed care organization, has declined by 33,000 from January-March of 2019. And statewide, since its April 2018 peak at 2,298,000, membership in Illinois' managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence of this decline for CCH is that the number of uncompensated emergency and primary care visits will increase.
CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share.
CEO Shannon praised new healthcare leadership in Springfield, including former CCH Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program.
Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully to offset threatened funding cutbacks.

What did the Board discuss?

Personnel status - 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.

Items to Watch for in the Future

Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.

Other Comments or Observations

Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.

Observer - Linda Christianson Meeting Length: 3 hours

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Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

4/7/2019

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Cook County Health (CCH) Board Meeting
March 29, 2019

Director Mary Richardson-Lowry was elected Vice Chair of the Board replacing the long serving Commissioner Butler who resigned from the Board in 2018. Director Richardson-Lowry has been a member of the Hospital Board since 2015, Chairing the Human Resources Committee. A partner in the Chicago office of Mayer Brown law firm, her illustrious career includes having served as Commissioner of the Chicago Department of Buildings, Past President, Chicago Board of Education and Metropolitan Family Services Board member.

What did the Board Discuss?

Using locally sourced, market-savvy investigators, 2 million dollars in overpayments to providers in the 4th Quarter of last year were identified, only a small fraction has been recovered thus far, pending the appeals process.
Net operating loss exceeds budgeted loss of $72 million by $35 million in first 2 months of fiscal year due to persistent excess external claims expense paid to non-CCH network providers. Increasing use of CCH facilities is the challenge with below budgeted volumes this year of primary & specialty care, surgical cases and deliveries. Director Reiter said the financials are comparable to previous years.
Willingness to recommend Stroger and Provident Hospital in the bottom 40% of hospitals.
45% uninsured system-wide, composed of 32% African-American, 47% Hispanic, 4% Asian and approximately 17% White. Director Suleiman Gonzalez requested uninsured data based on language spoken to capture data on the numerous Polish and Middle Eastern groups.
Strategic Plan updates:

Dr. Fegan reported on the medical staff demographics (PowerPoint on CCHHS website), challenges of a unionized medical staff which has a lack of job title specificity, incentive structure and slow implementation of use of Relative Value Units, the industry standard measuring “work”. High value specialists are not retained. Board discussed hybrid system for physicians of unionized with incentives.
E-consult communication of physician with patients has been implemented with positive patient response.

Items to Watch for in the Future

CEO Shannon said the new merger of Healthcare companies Centene and WellCare will result in the largest Medicaid insurer nationally with 12 million beneficiaries and anticipated major savings in their cost of care provision which will threaten CountyCare’s current dominant position in the Cook County Medicaid market.

Observed by Barbara Hayes and Susan Kern Meeting Length: 3 hours 15 minutes

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Cook County Health to Host Housing Summit in May

3/18/2019

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Cook County Health Board Meeting - February 28, 2019

What did the Board Discuss:

The first Cook County Health (CCH) Research and Innovation Summit was held February 20, 2019 on the topic of opioids. More than 120 individuals attended. This summit was designed to share CCH's efforts and plans to address the opioid epidemic with other established interest groups and included action planning with health and community leaders.
County Care managed care members as of February 7, 2019: 320,994 of which 13.7% are using CCH services. These latest numbers are down 10% from the same time last year. The target for 2019 membership is 345,000. Annual redetermination of Medicaid members is a review of their eligibility for Medicaid and requires submission of redetermination forms in a timely manner. Now an automated system drops individuals from Medicaid rolls if the forms are not completed on time. If dropped, the individual looses continuity with their Primary Care Provider and case managers. In order to keep its members, County Care offers to help with the redetermination process. County Care has raised concerns about this process with Governor Pritzker.
FY 2019 CCH system wide uninsured numbers captured by visit is 44%. The FY 2018 uninsured numbers were 42%. There is a need to get details of these uninsured to see if some are eligible for Medicaid, then assist them in enrollment.
Governor Pritzker announced that Dr Ngozi Ezike was appointed Director of the Illinois Department of Public Health (requires state Senate approval). She served for more than 15 years at CCH and most recently served as a physician at the Juvenile Temporary Detention Center.
The Cook County Department of Public Health (CCDPH) has a tobacco prevention and control unit and its goal is to eliminate exposure to secondhand smoke, promote quitting, and prevention of youth smoking. In Suburban Cook County, 16.7% of adults are current smokers. E-cigarettes are currently the most used tobacco product among youths and its use in this group has increased last year. E-cigarette liquid contains chemicals and carcinogens and this liquid can poison children through ingestion or skin absorption.
It was announced that there would be no election of the CCH Board Vice-Chairman at this meeting.

Board Decision:

A contract with the Bobby E. Wright Comprehensive Behavioral Health for mobile crisis outreach team. This is a nonprofit on Chicago's Westside that provides mental healthcare, addiction treatment and developmental disability services.

Items to watch for:

The final audit of FY2018 in May 2019
The second CCH Research and Innovation Summit to be held May 22, 2019 on the topic of housing.

Observed by: Michele Niccolai Meeting Length: 2 hours 30 minutes

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Cook County Health Board Approves Preliminary 2020 Budget

Cook County Health Approves Preliminary 2020 Strategic Plan

Cook County Health Nearing Completion of 2020-22 Strategic Plan

CountyCare Enrollment Declines by 33,000 in 2019

Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

Cook County Health to Host Housing Summit in May

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