Cook County Health (CCH) Board of Directors Meeting
August 25, 2023  -  9AM

Board Action and Reports:

• Unanimously approved with minimal discussion, by the CCH Board (who were all present in person or virtually or excused) the budget now heads for final approval to the Cook County Board.  Increase of $265 million from the 2023 budget of $3.992 billion is attributed to a ramp up of new service line investments in cardiology, neurology and cancer center and by rising costs and utilization rates for lab, registry temporary services, medical and pharmacy supplies.  Defraying these expenditures are projected enhanced revenues from federal programs $196 million (DSH/BIPA/GME/Direct Payments), increased CCH net patient revenues $62 million and additional Cook County tax allocation of $10 million (total tax allocation $157.7 million).
• Aaron Galeener, Chief Admin. Officer of CountyCare managed health plan reported on the redetermination of Medicaid benefits for plan members which was on pause during COVID.  Rolling numbers of members each month will be required to submit information to confirm eligibility starting June 2023 through May 2024.  Favorable retention rate to CountyCare of 85% vs 69% Statewide is recorded for the early months.
• Asylum Seekers program at Belmont Cragin ACHN (Ambulatory & Community Health Network clinic of Cook County Health) celebrated their 1st year anniversary providing healthcare including mental/behavioral health and transportation to appointments for immigrants.  Craig Williams, Chief Admin. Officer, Operations & Development detailed the services and noted that the cost of $1.8 million a month was funded by charitable support from the City of Chicago, CareLink, and other organizations. 
• Emergency increase of $36 million to the 5-year $400 million pharmaceutical contract generated the most animated discussion by Board Directors who were concerned that the contract amendment had not gone through the Finance Committee scrutiny on August 17, 2023 as is standard contract compliance governance.  Directors Currie, Robinson, Harrington, and Garza voiced disquiet that the “add on contract” was not in the Board packet. Director Reiter, Finance Committee Chair and CEO Rocha defended their decision as necessary to prevent an over-draft of the contract which was imminent due to a significant increment in the cost of pharmaceuticals which had not been anticipated.    

Items to Watch for in the Future: 

• Many of the Health System’s Board are newly appointed.  Will there be changes in governance philosophy?

Observed By: Susan Kern

Cook County Health (CCH) Board Meeting
July 28, 2023

Four CCH nurses spoke during the public comment period and talked about the continued staffing shortage, its impact on staff safety, and the time it takes to onboard even agency hires.  Several board members asked pointed questions during the presentation from HR Director, Valerie Amos.  Questions included:

1. How long does it take to onboard agency hires:  Ans:  3-4 weeks including orientation to CCH rules, procedures, policies, and methods of operations.
2. Has management communicated with staff nurses about what HR is doing to increase hireing:  Ans:  Yes.  Nursing leadership held a town hall meeting to explain HR hiring process and onboarding process.  

CEO Rocha commented on staff shortage by saying that there is a higher-than-expected patient onboarding.  That and summer vacations led to even more agency hires. A question was asked about planning for System retirements as the average age of nurses is 51.  Amos acknowledged the challenges facing the system and thanked the board for approving increased staffing.  She started with 3 recruiters and now has 10 plus outside consultants to help streamline the process.  Plus the retention bonus that went to 58% of the nursing staff helped keep turnover down this year.  The System expects the recently approved 12 week paid parental leave to benefit recruitment of nurses and other staff.  

The Cook Couty Department of Public Health reported on their 3rd quarter report that focused on the Sexually Transmitted Infections (STI) Program and the Youth Tobacco Ordinance Awareness Program.
Key points highlighted in the STI's Program:  

1. This program covers all of Suburban CC except  for Evanston, Oak Park, Skokie, and Stickney Township which each have their own Public Health Departments.
2. Engages in surveillance, investigation, interviews, partner services [including sending condoms], education, and support.
3. Reportable STI's include Chlamydia, Gonorrhea, Syphilis, HIV, Mpox, and Chancroid.
4. The data indicate that the number of cases of Chlamydia and Syphilis are increasing as are the number of persons living with HIV;  whereas the number of Gonorrhea and new HIV cases are stable.

Compliance with the Youth Tobacco Ordinance
This fall in partnership with the CC Sheriff’s Office, the CC Department of Public Health will conduct random, inspections at locations where tobacco products are sold in unincorporated CC to ensure compliance with the sales restriction on Flavored Nicotine Products.  These restrictions went into effect on July 23, 2023.
 
In CEO Rocha’s monthly report, he noted a $21 million dollar grant for nursing, several awards, upcoming events, and focused on CCH’s Dialysis Success with the goal to move the conversation from kidney disease to kidney health.  The head Nephrologist stated that race is no longer considered a factor.  Weight and gender are the primary factors.

Observer:  Diane Edmundson

Cook County Health Board of Directors Meeting
June 30, 2023
 
Dr Rami Doukky presented an overview of the interventional cardiac services. In January 2023, a new Cardiac Unit opened. There are 13 beds. Also in January, the Watchman procedure was added to procedures performed. In May, Mitraclip was added. There was discussion on obstacles to overcome regarding the continued expansion of the unit and services.

Committee Reports

• Human Resources – Metrics continue to slowly improve.  Turnover rate is well below the national benchmark. 
• Managed Care
  • CountyCare’s enrollment
    • increased 4% over the past 12 months, behind the Cook County increase of 5%
    • increased 0.3% in April 2023 compared to the prior month, behind the Cook County increase of 0.6%
  • There are 2 paths for redetermination. The first group are members who have information in the system and are auto renewed. The next group there is no information in the system and they must complete a form to confirm eligibility.  In June, 66% of members were redetermined. There is a 30 day grace period and efforts are being made to reach those who still need to submit forms.
• Finance –(from Committee meeting) - During the discussion of the information provided regarding the Health Plan Services Financial Results, the Committee discussed the subject of redetermination. Aaron Galeener, Chief Administrative Officer for Health Plan Services, provided information on current strategies being used to increase awareness and responsiveness for those who must go through the process to determine whether they qualify for Medicaid assistance. A question was raised regarding whether there is a mechanism available for outreach to families via students enrolled in the Chicago Public Schools (CPS). Mr. Galeener stated that he will look into the question to see if there are any opportunities available.

The chair recognized the service of Director Dr  Karen Kim who had resigned and moved to Pennsylvania.
There was no public testimony at any of the committee meetings or at the Board of Directors meeting.

Items to Watch for in the Future:

• Continue to monitor Medicaid redetermination and staffing levels.

Directors absent- Deer, Bhatt

​Observer:  Lisa Slankard

Cook County Health Board of Directors Meeting
Friday May 26, 2023

Attendance:  All Directors present except: Commissioner Dennis Deer, Karen Kim MD, and Robert Currie

Overview of COVID_In person public meetings: 

• Dr. Welbel, Chief of Epidemiology and Infection control opened meeting assuring that the room design and set up allowed for an in-person meeting where masks were optional. Health System Board meetings will continue be hybrid and can be watched at https://www.youtube.com/watch?v=zJH-3DqPVJc
• Public Testimony: The testimony was remote and hard to hear because of background noise. 

Board and Committee Reports:  Link to Board of Directors Meeting Minutes April 28, 2023 

• Human Resources Committee Meeting May 18, 2023
  • Human Resources Minutes May 18 Committee Meeting
    • Notes From Minutes: Ms. Amos stated that she is working on an analysis of staff who are or will be eligible for retirement based on a number of factors; once that is finalized, she will share that information. 
    • Slide 4 of report indicated that as of 4/30/23 there are 2,330 vacancies. 
• Managed Care Committee Report
  • Link to Manage Care Committee Report: Aaron Galeener, Chief Administrative Officer for County Care.  Mr. Galeener presentation indicated that the County Health System still cares for a small percentage of the County Care enrollees (See slide and definitions of Categories).  
    • Addressing this issue, was a later presentation to the Board by Alexandra Normington Marketing Officer on a marketing plan to increase awareness of County’s outpatient clinic system. 
  • Mr. Galeener reported that Medicaid redetermination started May 1st. The System estimates that only 30% of those facing redetermination will be automatically re enrolled with the rest having to go through the redetermination process.

FHP: Family health plan: This is the historical TANF (Temporary Assistance to Needy Families) Medicaid population – it is generally families – so children and parents.
ACA: This is the adult expansion population that was covered under the Affordable Care Act that increased Medicaid eligibility as a percent of federal poverty level up to 133%.  This is only adults. 
ICP: Integrated Care Program. This is individuals with high needs and/or disabilities.
MLTSS: These are individuals that are covered under Medicare for most services with the exception of Long Term Services and Supports which are covered under Medicaid.

• Quality and Patient Safety Committee Meeting May 18, 2023
  • Quality and Patient Safety Committee Minutes 
• Finance Committee Meeting May 18, 2023
  • Finance Committee Meeting Minutes
    

Report from Chair of the Board & Chief Executive Officer

• CEO Rocha reported on the Initiation of a program “Ideas for Change Campaign” which seeks input and ideas from front line workers ON how to make CCH better. Recognition and incentives are available for those ideas put into action. Mr. Rocha STATED there has been a positive response to program. 

​Observer - Susan Avila 

Cook County Health (CCH) Board of Directors Meeting
April 28, 2023     

CEO Rocha, Chief Operating Officer, Dr. LaMar Hasbrouck and staff presented the Cook County Department of Public Health’s (CCDPH) product from a collaborative and participatory strategic planning effort begun in 2022.  The resulting 2023-2025 strategic plan for CCDPH, “Putting the Public in Public Health,” defines CCDPH’s vision, mission, and values.    Based on feedback from across a variety of assessments and many facilitated planning sessions and conversations with staff, community partners, and the Strategic Planning Advisory Group, CCDPH identified five strategic pillars where CCDPH must focus its attention to be successful at advancing its vision and mission over the next three years.  The foundational pillars are:

• Pillar 1:  Strategic Communications.
• Pillar 2:  Community Partnerships and Collaboration.
• Pillar 3:  Workforce and Workplace 
• Pillar 4:  Infrastructure and Operations.
• Pillar 5:  Integration and Systems Alignment.

In brief, Putting the Public in Public Health is the guide that CCDPH has chosen for transformation during 2023-2025.  The strategy within the plan is dynamic and intended to evolve over time.  Metrics that matter will be developed for all major services, programs and initiatives including the strategic plan.  The plan will also serve as a blueprint for accountability as it strives to optimize community health and advance health equity for the residents of suburban Cook County.  A letter from Cook County President, Toni Preckwinkle praising the plan was included stating that “The Covid-19 pandemic illuminated not only the importance of having a strong public health system and infrastructure in times of crisis, but also the ongoing need for investment in proactive approaches to promoting community health and wellbeing.”    

CEO Rocha noted that effective Monday, May 15th masks will be strongly recommended but optional for many patients, visitors and staff.  Masks will remain a requirement for staff providing direct patient care, entering an occupied patient room or in high-risk areas.  Tests and vaccines for COVID will continue to be available at primary care medical homes.

The Community Murals Project unveiled three new murals at Provident Hospital, Blue Island Health Center and the Professional Building on central campus.  Paint parties were held where patients, staff and visitors came together to paint sections of the murals.

Committee Reports:
Human Resources –

• Remains up to 95 days to fill positions but trending down.  Maintaining 4% turnover compared to nationwide average in double digits.   Still catching up from COVID losses.  
• A letter sent by and read into the record by Mr. Lenny D. Asaro, attorney at Faegre, Drinker, Biddle & Reath, LLP seeking “. . . clarification regarding Cook County Health and Hospitals System’s policy in reference to offshoring jobs to India.”  Mr. Asaro referenced RFP #H21-0026, Addendum No.1. requesting 250 full-time equivalents to support the end-to-end revenue cycle. Mr. Asora claimed the RFP was service-based v. technology and does not require technical support for any type of technology.

Finance –

• Eight contracts exceeded $1M including for Nurse Registry services ($70M); two contracts for recruitment (totaling $8.6M); and two contracts for computer software and hardware (totaling $12.9M)

What to Watch for in the Future:

• Although it was indicated that great efforts were being made to reach out to Medicaid patients in their communities and in the health centers to encourage cooperation with renewal, it may still have an impact on enrollment.

Observer - Peg Moster

Cook County Health Board Meeting 
March 31, 2023              Virtual Meeting

Emergency Medicine at Cook County Health remains one of the most competitive physician residency programs nationwide drawing from the brightest graduating medical students.  Minority and underrepresented groups account for 16% of the internal medicine residency slots beginning with the 2023 class.
Strengthening the multicultural diversity of primary care physicians (internal medicine, Family Practice) training at Stroger, Provident Hospitals and affiliated clinics is a priority of CCH’s DEI plan (diversity, equity & inclusion) Dr. Claudia Fegan, Chief Medical Officer, expounded. 

• Employment Plan Compliance officer, Kimberly Craft noted that while the CCH push to improve and streamline hiring was a priority goal, compliance with Federal & State labor law as well as collective bargaining agreements require enhanced written documentation supporting the hiring/termination/discipline policies.
• Provident scholarship program: up to $20,000 for graduate level medical/dental & Advanced Practice Nurse students and up to $10,000 for undergraduate and Allied Health Professionals.   It is hoped that these students will remain at CCH for their career. 
• Directors poised questions on the status of the initiatives to accelerate the hiring process which Valarie Amos, Chief HR Officer, noted was down to 119 days from posting the job to filling a position versus 160 days in FY 2022.  8 job Fairs in FY23 were successful in garnering 401 interviews with 152 acceptances of the 166 offers.   Many acceptances were made the same day as the offer! Decreasing “temporary agency” cost for high use temporary staffing categories is anticipated.

Items to Watch for in the Future:
Redetermination for CountyCare managed Medicaid plan members is likely to eventuate in decreased plan membership in the June 2023 Managed Care data, noted Aaron Galeener, Chief Administrative Officer for CountyCare.

Observer - Susan Kern