Cook County Health, (CCH) Board of Directors Meeting
August 27, 2021

A Special Meeting of the Finance Committee of the CCH Board was held on 8-23-2021, Public Hearings were held August 23 and 24 and individual budget briefings with community partners including the League of Women Voters of Cook County, were convened to deliberate the proposed preliminary County Hospital System’s budget for fiscal year ending in 2022

County Health Board of Directors voted to adopt this proposed budget which will now be forwarded to the Cook County Board, representing the Unit of Government responsible for adopting any final Appropriations Bill.  Cook County Public Hearings on the County Health System’s proposed budget will be scheduled on a date not yet determined  in October/November 2021.

Proposed 2022 budget Highlights:

• Nearly 4 billion dollars ($3,889,000,000) an increase of $501 million dollars over last year
• 758  additional Full Time Employees for total of 7,560 FTEs
• Increased revenue assumptions include: 1) Enhanced utilization of CCH services by CountyCare members 2) Increased volume of surgical cases and procedures 3 )Increased Federal Medical Assistance payments (DSH/BIPA) 4)newly eligible for IL. State Medicaid ,undocumented population 55 years and older (IL Legislation 2021/2022, state funded; no federal funding)                    
• Board members requested regular updates on volumes and revenue for surgical cases, emergency, primary care and specialty care visits, deliveries and bed utilization census: projected increases  in most of these categories are cited in the 2022 budget 
• Cook County taxpayer Support of Cook County Health included in proposed 2022 budget is $137,700,000
• Additional Cook County taxpayer Support of Cook County Health not included in 2022 budget - Pension cost of $162,900,000; Debt Service $136,400,000; and Capital Equipment $9,000,000

Items to Watch for in the Future:  Cook County Board hearings on this Cook County Health System budget in October 2021.  Will there be amendments or significant changes to the proposed budget approved by the Cook County Health Board ?

Virtual Meeting Observer:  Susan Kern, MD             Meeting Length: 2 ½ hours

Cook County Health (CCH)  Special Board Meeting
August 9, 2021
Preliminary Presentation of 2022 CCH Budget

Highlights of the Presentation

• Cook County Health’s preliminary $3.9 billion budget for the 2022 fiscal year factors in an expected boost in surgical procedures and Medicaid managed care plan enrollment. Spending will increase by $501 million.
• The assumption is that next year will look more like the patient volumes experienced in 2019, but CEO Israel Rocha warns it will take years for Cook County to fully recover from the COVID-19 pandemic.
• Compared with fiscal 2021, the proposed 2022 budget would increase spending by $501M, or nearly 15 percent. The bulk of the growth is related to CountyCare, the health system’s Medicaid managed care plan, which is growing faster than expected with about 410,000 members.
• Cook County Health covers Stroger and Provident hospitals, a network of neighborhood clinics, Medicaid and its new Medicare Advantage health plans, the County’s Department of Public Health, and medical services for detainees at the Cook County Department of Corrections.
• The health system is set to get a tax allocation of $137.7 million from the county. While the majority of the funds would be used to cover public health and correctional health operations, about $8 million would go toward providing free care to low-income patients, according to Andrea Gibson, Interim Chief Business Officer. The health system previously has not received money from the county to cover charity care expenses.
• Ms. Gibson noted that charity care costs are expected to increase 6 percent to $384 million in fiscal 2022.  This does include bad debt, which is billed but not recovered. Costs associated with charity care declined during the pandemic as more people became eligible for Medicaid and others avoided medical care. 
• The preliminary budget also includes investments in neurology, cardiology and oncology to help grow the health system’s patient base. Currently, one of the reasons that CCH loses patients to other specialty care providers is its long wait times. 
• Full-time equivalent (FTE) employment is expected to rise by 780 FTEs or 11% to 7,583 FTEs. New positions in behavioral health and other areas aim to improve services and reduce patient wait times. Plus a “float pool” of employees will be put in place for FMLA coverage and to reduce the use of agency nurses.

Observer:  Diane Edmundson 

Cook County Health (CCH) Board of Directors Meeting    
June 25, 2021
All board members were in attendance.  It was Director Mary Driscoll’s last meeting and she was lauded.

Highlight of the Meeting:

• Cook County Health has received a $25,214,437 federal grant. It will be a two-year project  (June 1, 2021 – May 31, 2023) The focus will be on priority communities and populations, with an expectation that this funding will impact 100% of jurisdiction through systems change.

There was no public testimony received at this meeting.

What did the Board decide?

• Approved 12 month purchase of reinsurance for CountyCare Health plan not to exceed $1,559,000.00. Since the inception of CountyCare, Cook County Health (CCH) has purchased reinsurance to offset the risk of its high-cost members. Claims costs incurred in excess of a per member threshold amount within a calendar year are reimbursed to CCH. Coverage is priced on a PMPM basis for Medicaid and Medicare by population type (e.g. FHP, SPD, ACA Adults, MA, SNP).
• The CCH policy is issued under a County-wide insurance brokerage contract with Alliant Insurance Services, managed by the County’s Office of Risk Management. CCH recommends entering a stop-loss policy coverage for twelve months, through December 31, 2021. Based on the bids submitted, and pricing and risk analysis, the recommended policy would establish a threshold for reinsurance at $2,750,000 for Medicaid and $300,000 for Medicare.
• Approved transfer of funds from salaries to contract position.  This was not connected to the strikes but due to delay in FEMA funds.

Committee Reports:
Human Resources Committee:

• Very little change in vaccination rates from last month. The union is working to encourage members to get vaccinated and VP Kamala Harris visited the CFL. 
• There have been 2 strikes this past month.  Both nursing and SEIU struck because of overdue contracts and staffing shortages.  There has been a significant increase in resignations this year
• New Chief Human Resources officer is Valerie Amos
• New Chief Revenue Officer is Curtis Haley

Finance Committee:

• Discussion on y-t-d financials, accrual vs cash methods.  Positive variance using accrual but negative variance using cash method

Quality and Patient Safety Committee:

• Elevated 30 day readmission rate with sepsis overtaking Congestive Heart Failure (CHF) as top diagnoses.

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues regarding strikes and open positions due to increase in resignations

Observed by:     Lisa Slankard                               Meeting Length:     2 ¾ hrs  

Cook County Health Board of Directors Meeting
May 28, 2001

Covid Vaccine Update:
Director Gugenheim was surprised at the Low 63% Employee COVID Vaccination Rate. Director Gugenheim further asked whether the Cook County Health System was working with their “Labor Partners” to increase employee vaccination.   Yes, but vaccination is voluntary and vaccine hesitancy has been an issue, staff replied.  

• Employee vaccination by race/ethnicity as of 4-30-21 reported as: Black/African-American 49.4%; Hispanic/Latino 67.6%; White 76.1%; Asian 81.7%.
• Vaccination by Job Category:  Nursing 63%; Doctors 85%; Administrative/Clerical, Non-clinical Leadership, Pharmacy and Public Health 100%
• Vaccination by Union & Non-Union:  Non-Union 76%; Union 61%

30 minutes of Public Comments addressed to the Board by employees and groups of employees largely centered on ongoing Labor Union negotiations.  Assertions included: lack of leadership by Administration & managers, unwillingness of Administration to negotiate on salaries and work rules, understaffing, and untrained Agency temporary nurses.  Strike threat was voiced by one speaker.

​Board Reports:

• CountyCare managed health plan: 20% increase in members over last 12 months-- total 398,534 exceeds budget and unexpected higher capitation rate awarded by State Medicaid yielded a small net operating profit.
• System wide financials, net loss of $21,802,000 is a result of increased claims cost but is less than budgeted loss of $32,551,000. 
• Compassionate Care initiative introduced in the Hospital System Ambulatory Clinics to address low (56% in hospital rankings) “Likelihood to Recommend” on Hospital System patient surveys. There are 3 Key Drivers impacting the ranking:  1) Courtesy of Registration Staff  2) Sensitivity to patient’s needs       3) Concern for Patient’s privacy
• Cook County Public Health Department’s Dr. Joshi reported on the Opioid epidemic: significant incremental increase in opioid-related deaths in Cook County 1,121 in 2018; 1,227 in 2019; 1,771 in 2020.   Chicago & CC Suburbs all showed increases.  Deaths due to Fentanyl far exceed those from heroin or prescription pain relievers.

Items to watch for in the future:

• Board attendance by new Board Directors, selection of Board Chair, selection of new Chief Financial Officer & new CEO of CountyCare.

Observed by: Susan Kern, MD                                               Meeting Length:  3 hours

Cook County Health (CCH) Board of Directors Meeting
April 30,2021

What did the Board decide:

• The Core Foundation property that was being leased by the County for The Ruth M. Rothstein Core Center for the treatment of infectious diseases will now be owned by the County as the lease has been terminated 6 years early..

Committee Reports:

• Human Resources - no meeting this month. Hiring continues. There is an increase in unfilled open positions. Even though more people have been hired than last year, more separations were reported and more positions were created due to grants received. Most of the openings are in nursing.
• Managed Care- CountyCare membership continues to increase. Up 1.4% over February for a total of 395,477 members. Plan Initiatives activity was presented. The Finance Initiative goal is to reduce cost by 50 million dollars.  Member Experience Initiative reported that over 5.1 million text messages were sent to members.
• Quality and Patient Safety- The 30 day readmission rate is up to 9.81% against a goal of 8.56%. 10% of readmissions were from Covid hospitalizations for a variety of reasons. The goal was met for surgical clinical documentation but not medical. Top Box score had a slight improvement and Communication with nurses and cleanliness had the highest percentile rank for Stroger.  The lead person on JCAHO left the organization.
• Finance- $5.5M  grants received for Covid vaccines. On an accrual basis CCH is ending February $12.1M ahead of budget. Net patient service revenue was better than expected  - lower than expected volumes, more than offset by better rate and payer mix. CountyCare capitation significantly higher than expected.

Board Chair Hammock Report

• A Foundation Gala will be held on October 28, 2021 in the old Post Office building to celebrate the 10th anniversary of the Foundation.

CEO Rocha Report

• The Daisy Award was given to Anu Thomas RN.
• Covid testing statistics were presented.
• There are 725 detainees awaiting transfer to IDOC. They must be fully vaccinated prior to transfer. This is the highest priority right now.
• 80% of CCH Staff  and 62% of CCH employees  have  been vaccinated.  Statistics on the breakdown of vaccinated employees by age, race, job category, union membership  and race/ethnicity were provided.
• A review of COVID vaccination activities was presented. In addition to marketing efforts, significant outreach and special events are planned for mass vaccination sites including: • Restaurant Worker Day Monday, May 3 • Mother’s Day Promotion at all sites Saturday, May 8 • Partnership with Chicago Medical Society physicians to refer patients • Efforts to encourage college students at schools where vaccines will be mandatory not to wait to get their vaccine until the Fall.  
• The My Shot outreach program is moving to phase 2 and targets 18-34 year olds. This is a change from a campaign for access to a campaign for advocacy and access.
• There has been a huge surge in CCH social media reach.
• The Leapfrog score (a hospital rating score) is up to a D. The CMS score is now 2 stars. This is from 2019 data. While this is still not good it is an improvement.

Items to Watch for in the Future:

• Covid rates and vaccination data.
• Financial situation of CCH

Observer - Lisa Slankard                                       Meeting Length:    2.5 hr                                                                     

Cook County Health (CCH) Board of Directors Meeting
​March 26, 2021

The 2020 five “ICARE” (Integrity, Collaboration, Accountability, Respect, Excellence) Employees of the Year were congratulated at the board meeting by Joseph Flanagan, Chairman of the Cook County Health Foundation. 

Committee Reports to the Board:
Human Resources:

• CCH labor union contracts are being negotiated with CC Bureau of Human Resources. 
• As of 2/28/2021, 290 Contract Tracers have been hired, 79% by CCH and 21% by Hektoen and 137 positions are in the CCH hiring process. 
• FY2021 Quarter 1 filled positions is greatly increased over FY2020 Q1 due to Contract Tracing hires.

Quality and Patient Safety:

• The Joint Commission, which accredits healthcare facilities after an inspection reviewing facilities, was recently at Provident Hospital.  The end of survey meeting was very positive and CCH is awaiting the official report.
• The 30-Day Stroger Readmission Rate (unplanned admission to Stroger within 30 days after being discharged from an earlier Stroger hospital stay) for Nov 2020 was 9.05% and was closer to the target of 8.56% as previous 2020 monthly readmission rates trended high. 
• he Medical and Surgical Case Mix Index for December 2020 was higher than target which is favorable for reimbursement.

Finance Committee:

• Two grants were received and filed for CC Board/CC Budget Director approval.  A grant from the Dept of Health & Human Services, Substance Abuse and Mental Health Services Admin, will support acupuncture use in the Emergency Dept as a pain reliever in order to reduce admissions.  A second grant from the IL Health & Hosp Assoc is for training/updating staff working with Covid-19 patients and preparing for future disease outbreaks. 
• The finance committee will hold a special future meeting to review all care management contracts. 
• On an accrual basis, CCH is ending January 2021 $3.35M ahead of budget.  The Net Patient Service Revenue was lower than expected due to lower volumes in Jan.  The Jan 2021 Medicare health plan membership is lower than budget, lowering revenue. 
• The Board approved purchase of “Syntellis Performance Solutions”- financial analysis software designed for the complexities of hospitals.  This software will help with future financial planning, the budget process, and decision making because the software will provide a more detailed financial look into CCH’s services and departments.

Managed Care:

• As of 3/4/21, CountyCare has 392,417 members (a 6,600 increase over 2/4/21) with 40,721 enrolled in CCH clinics. 
• CountyCare members increased their use of CCH health services. 
• CountyCare enrollment is expected to increase due to the temporary stopping of state Medicaid eligibility redetermination through 2021 and the 50% auto-assignment increase to CountyCare beginning Feb 2021.

Board Action:

• Mildred Williamson’s appointment to the CORE Foundation Board
• Provident Hospital Emergency Dept Triage & Triage Intervention Guidelines were approved

CEO Rocha Report:

• As of 3/22/21, from all tests conducted at CCH (119,237), the positive rate is 8%.  At Cermak (CC Jail Health Center) testing is done on site with rapid test, then confirmed at CCH.  There is robust testing at Cermak of all detainees to determine health care and housing.  At Cermak, the rolling 7 day positivity rate as of 3/24/21 is 0.4% with a jail census of 5,613.  Testing is important to respond to Covid-19 clusters.
• Monoclonal Antibody treatment is available in the ER when a patient is identified as Covid-19 pos in order to prevent hospitalization.  
• Vaccinations:  As of 3/19/21 Total Doses (1st & 2nd) given to Dept of Corrections & JTDC Employees & Contractors = 4,434 and given to Cermak Health Services Patients = 2,600.
• As of 2/28/21 CCH staff vaccinated = 74% and CCH employees vaccinated = 58%.  As of 2/28/21 there are 5,196 union employees-55% are vaccinated and 896 non-union employees-73% are vaccinated.  
• Vaccination sites:  On 3/22/21, Cook County moved into Phase 1b+. - CCH has five Mega PODs (points of distribution)- open to general public who meet current eligibility criteria. Sites continue to be added for varying populations.
• CCDPH Vaccine Equity Strategy prioritizes communities most disadvantaged and socially vulnerable.  32 suburban communities have been prioritized.
• Since Jan 25, 2021, CCH has administered more than 290,000 doses of Covid vaccine as of 3/26/21.
• Education: March 15 “My Shot” public awareness campaign launched.  Residents of CC share their reason to be vaccinated using billboards, bus shelters, transit, digital, social media and radio.  CCH is working with community based organizations to spread the word in areas most impacted by Covid.  Next phase will focus on 18-34 year olds.
• CCDPH Contact Tracing in suburban CC has more than 180 contact tracers and 60 case investigators.  In February 2021, there were 9,400 actionable Covid pos cases (92% called and 65.4% interviewed) and 91.2% close contacts called and 76% interviewed.  176 cases needed special resources from the Complex Care Coordination Team in order to quarantine or stay in isolation- 32% needed food, 28% needed income assistance, 11% needed medical assistance and 11% needed cleaning supplies.
• CEO Rocha stated Covid variants are in Illinois.  (Check the Illinois Dept of Public Health website for information on variants)

What to look for in the future: 

• The financial impact of the “American Rescue Plan Act of 2021” for CCH

Observed by:  Michele Niccolai                                                 Virtual Meeting length:  2 ½ hours