Cook County Health Board (CCH) of Directors Meeting
April 29, 2022

Israel Rocha, CEO and Andrea Gibson, Chief Strategy Officer presented a draft FY23-FY25 Strategic Plan   for Board consideration and input. 

• The timeline for approval is the May Board meeting followed by preparation of a 3 year financial outlook with FY23 budget to be presented at the August Board. 
• In September both the Strategic Plan-informed budget and the 3-year financial outlook will come before the CCH Board for final approval and submitted to the County Board in tandem with the 2023 budget in October.   
• In brief, the draft Strategic Plan was summarized by its shortened but direct Mission Statement, “Establish universal access to the world’s best care and health services for all Cook County residents, regardless of the ability to pay, so all may live their healthiest life;” Vision Statement, “To ensure healthcare as a human right;” and Values Statement “ICARE - Innovation, Compassion, Accountability, Respect, Excellence & Education.” 

The presentation evoked a great deal of input from the Board concerning its lofty goals given the ongoing shortage of staff as well as having heard the same goals in years past.  This was addressed by CEO Rocha who indicated that although it was currently necessary to continue using agency nurses while they continued their ongoing efforts on retention and recruitment outlined in the Strategic Plan.  Further, he referenced an announcement made on April 26 by himself, President Preckwinkle, Commissioners Deer and Lowry, and the County Health Foundation of a $1M Provident Scholarship Fund to support students who are from, and committed to caring for, underserved communities.  The Fund will administer 60 scholarships this summer as follows:

• 30 to Health Professionals including medical and dental students;
• 20 to High School senior students entering a health care program; and
• 10 to students in the Allied Health/Undergraduate Program. 

CEO Rocha announced that the 1 millionth dose of COVID vaccine was administered on April 28th.  It was also reported that the Report Contact Tracing effort was scaling down from 300 staff at its peak to a core of 50 trained tracers while the balance of staff have either left or are being absorbed into other duties.  Beyond the immediate goal of tracing, the team increased relationships within the communities through networking and education which is being sustained and expanded.

Committee Reports

• Human Resources Committee – Due to ongoing use of agency nurses and not keeping pace with hiring, Deloitte Consulting to assist with recruiting efforts.
• Audit and Compliance - The results of the financial audit will be presented at next month’s Board Meeting 
• Finance Committee – Three contracts in excess of $1M for software support, maintenance, enhancements and hardware; for shuttle bus service; and for testing, maintenance and repair of building automation, security and radio transmission.

Item to watch for in the Future:  During his presentation CEO Rocha referenced establishing a “Mental Health Authority” to build out the behavioral and mental health footprint throughout the county.  He was challenged by several of the Commissioners on the term “Authority” and ceded that it might be an office or department as the Board cannot create an authority which implies a taxing body.  

Observed By:  Peg Moster

Cook County Health (CCH) Board Meeting
​March 25, 2022     

Enrolled in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), since 2014, Stroger is now winning big for patients by decreasing surgical site infection rate from 1.5 times the national (NSQIP) average in 2016 to 0.77 of the rate in 2022!  Annual Stroger savings of $237,210 with avoidance of prolonged hospital & ICU stay and even death of patients who suffer from post-op wound infections is the bonus.  Accomplished by implementation of rigorous procedures for disinfection of skin prior to surgery, additional pre and post-op antibiotics, changes of gowns, gloves and instruments twice: for surgery and again for wound closure and patient education were key elements of this successful plan.  Surgeon Wille notes that this is an ongoing process, with direct comparisons of outcomes to other hospitals nationally on the numerous targets of enhanced quality with decreased cost that are being studied.  Initially there was skepticism of the program Dr. Fegan, Chief Medical Officer, at CCH commented but the successes are now making believers of surgeons from all CCH specialties.  CCH’s low rate of surgical morbidity/complications for its patients places it in the top 20% of all NSQIP hospitals for 2021. 

Highlights from Board Reports:

• CCH Financial Report: $5.156 million positive operating margin year to date, vs budget which predicted loss ($19,257) - Gain due to higher inpatient volumes and decreased County Care claims expenses.  Pension costs ($160 million/year) not included.
• CCH hospital and CountyCare (Medicaid plan) financials combined - not separate accounting 
• Human Resources: 4 new outside contracts to improve hiring/retention/technology
• Charity care cost: projected $464.5 million to exceed 2022 budget of $452 million 
• CountyCare: 429,256 members slightly increased YTD 2022, largest managed Medicaid organization in Cook County followed by BCBS 334,273
• Redetermination for CountyCare membership delayed by State- is expected September.  CCH outreach efforts to retain members described for the Board.
• Hospital volumes: Admissions, patient days, average daily census, Emergency Room Visits, surgeries and ambulatory visits All still lagging 2020. 

Items to Watch for in the Future:

• Aaron Galeener still listed as Interim Chief Executive Officer, Health Plan Services (CountyCare, Medicare).  When will a permanent CEO of CountyCare be appointed?

Observer - Susan Kern, MD

Cook County Health Strategic Plan Town Hall Meeting #2
March 2, 2022

The meeting opened with a welcome and thanks from Israel Rocha.  He then turned it over to Andrea Gibson. She gave an overview of CCH’s scope and accomplishments. She next explained the SWOT process to be  used to obtain feedback from employees, community, labor,  and the CC Board of Commissioners.  S=strengths W=weaknesses O=opportunities T=threats.

• The first speaker was MCS from PASO, a west suburban action group.  She said the people she dealt with were helpful. Weaknesses noted were waiting time, navigating services, motivating patients to have conversations with healthcare providers and mental health access. She said that the COVID vaccination sites are an opportunity to bring more patients into the system.
• The next speaker BT said that climate change is a serious threat and cited heat issues, blackouts and flooding.
• Next was SK who said that the buildings, structures and advanced technology is a strength but labor discord is a weakness. The increase is charity care and lack of reimbursement is a threat.
• SA said that turning over patients to collection agencies is a weakness and not in line with the County goal of abolishing medical debt. Mr. Rocha explained that an attempt to collect copays must be made for claims covered by insurance and that there is now no copay for Carelink.
• HP asked about community health workers being able to go into the hospital again. Mentioned were the NICU club and lactation experts. Dr Fagan said they have hired a lactation specialist.
• Also mentioned was simplifying the process to enroll in Medicaid.

Observer: Lisa Slankard

Cook County Health Strategic Plan Town Hall Meeting #3
March 3, 2022

The Thursday morning virtual meeting began with an introduction by CEO Israel Rocha followed by Chief Strategy Officer, Andrea Gibson, presenting the initial process for the 2023-25 Strategic Plan which included three town halls (one in Spanish) the week of March 1.  A survey was sent to Stakeholders using the SWOT process of Strengths, Weaknesses, Opportunities, and Threats.  Ms. Gibson stated that no ideas would be presented by CCH at the town hall meetings as the purpose is to gather opinions and suggestions from the Stakeholders and the Public.

General feedback regarding CCH and the Public Health Department included:

• The COVID pandemic has expanded trust in the System and this is the moment to take advantage.
• The greatest emphasis from multiple speakers is the request to expand the CCH's Public Health Department.  I.E., ramp up the comprehensive development of services including maternal and child health.
• Consistent requests also centered on expanded mental health and addiction services.
• Ms. Gibson said that the CCH leadership has gotten the message that it needs to leverage what services have been offered throughout COVID.

Strengths:

1. The System's extraordinary team and its commitment to provide access to all individuals regardless of ability to pay.

      2)  CCH's Public Health Department but it needs more budget and staff.

Opportunities:  

1. Better communication across the System and within every department to make them aware of the resources available.                   

    2)  More collaboration with community based organizations. 
    3)  Create sustainable programs.
    4)  Increase birthing opportunities - for example "free standing birth centers."
    5)  Can long term care be made available?
    6)  Need more health services in the South Suburbs - population not dense but covers a  
          wide area – therefore, it is not easy to get to CCH health care sites.
    7)  Increased emphasis on the fact that "housing is health care".
    8)  Role out a #988 phone number for crisis calls.
    9)  Incorporate "peer support groups" into county services particularly for addition and 
         Mental health.

Weakness/Potential Threats:

1. Social Worker turnover at Stroger - Suggestions:  Hire more workers to lighten workloads and provide more defined career path[s].

    2)  Stroger being a learning institution often leads to a constant change in providers.
    3)  Medicaid application process for immigrants.
    4)  Turnover of nursing staff.   It was stated by a speaker that 50% of the current nursing     
          staff is from outside contractors.
     5)  Length of time needed to fill positions - particularly nursing.  

Observer:  Diane Edmundson

Cook County Health (CCH) Board Meeting
February 25, 2022

The timeline for the FY23-FY25 Strategic Plan introduced 

• In February/March an online survey asks for feedback from all employees/communities. 
• Promotion will occur through emails, community newsletters, and social media. 
• Town Hall meetings with employees, communities (one in Spanish), labor management, and Board of Commissioners are scheduled. 
• CCH provides significant amount of charity care as compared to other Cook County hospitals.  CCH includes eight Primary Care Centers, four Regional Outpatient Centers, a Child & Adolescent Service, two hospitals, Public health and two Correctional Health Services. CCH has administered more than 300,000 Covid tests, initiated Covid mitigation and prevention at Cook County Jail, and administered approx 1 million doses of Covid-19 vaccine. Cook County Dept of Public Health set up contact tracing program for Suburban Cook County.

Finance Committee

• On an accrual accounting basis, CCH ended Dec 2021 with a $15M positive variance to budget and Health Plan shows an operating gain of $8.7M as of December 31, 2021. 
• The nursing dept request to increase the existing contract with Vaya Workforce Solutions, LLC for Contract Management and Nursing Registry services (not to exceed FY$64M) as needed, for the remainder of the contract through 9/24/2023 was approved. 
• Dr B. Peters, Chief Nursing Officer stated in years past the hourly wages for agency nurses was around $20/hour and now the wages are around $200/hour.  She pointed out the need to continue to supplement the CCH staff, especially nursing, due to vacancies and retirements.

Managed Care Committee

• As of February 4, 2022 Total CountyCare membership is 425,981, of which 10.5% are using CCH clinics.  CountyCare’s enrollment has increased 11% over the past 12 months.  As of 2/4/2022 40.62% of vaccine eligible membership are fully vaccinated.  
• Dr Collins, Chief Medical Officer CountyCare, talked about Homelessness programs in her Health Equity Initiatives presentation.  Medical Respite care is acute and post-acute care for homeless who are not ill enough to remain in a hospital but are too ill to recover on the streets.  The Flexible Housing Pool addresses homelessness by connecting people to stable housing along with health services which decreases Emergency Room visits and hospitalizations.

Human Resources Committee

• FY2022 through 1/31/22: HR received 1,545 Requests to Hire:  1,238 positions in progress, and 82 vacancies filled. Also in this time period there were 149 separations due to retirements and resignations.  The big challenge is the retention of CCH’s nursing staff. 
• HR is actively recruiting by working with colleges and universities, marketing in communities and hosting job fairs. 
• Automation plans include adding Salesforce.  A key initiative is to partner with the new Chief Experience Officer.

Quality and Patient Safety Committee

• The new Chief Experience Officer and  the office’s Strategic Plan were introduced. 
• The Plan includes 4 top goals: Patient Satisfaction Goals, implement “C I Care” behaviors (connect, introduce, communicate, ask/anticipate, respond, excellence), workforce wellness programs, and goal orientation for new hires. 
• Some initiatives are wellness lounge, employee events, art murals for group participation, farmers market, hire chaplains, newsletter, Gemba walk (gemba means “actual”) where leaders actually step out of their offices and walk to work stations to connect with staff to gain knowledge of work processes. 
• All the new initiatives are designed to enhance both the patient and employee experience as positive experiences for both create a stronger organization.

Observed by:  Michele Niccolai

Cook County Health (CCH) Board Meeting
​January 28, 2022

Presentation - Stroger Hospital Stroke Program by Dr. L. Warrior

• On June 8, 2021 Stroger Hospital was certified as a Primary Stroke Center by the Joint commission.
• An ischemic stroke: a blood vessel is blocked preventing blood flow to the brain.  A hemorrhagic stroke: bleeding inside or around the brain.  Treatments for ischemic stroke are clot dissolving drugs, best given up to 3 hours of occurrence and removal of the clot (thrombectomy) best performed up to 6 hours of occurrence- “Time Is Brain”. 
• 51% of CCH’s stroke patients are black as compared to 30% in other Chicagoland hospitals and close to 20% in other IL hospitals.  30% of CCH’s patients identify as Hispanic as compared to approximately 15% in Chicago hospitals and less than 10% in IL hospitals.  CCH’s stroke patients are black, Hispanic and younger, most age 46-65, while in other IL hospitals the median age is 70 years. 
• For acute cases, goal is to get patient to CT scan under 15 minutes after entering emergency room.  CCH provides community stroke education events, stroke support group.

Public Testimony from Nursing Staff

• It was noted that CCH has a dedicated nursing staff, many with long years of service who have worked through the Covid-19 health crisis. 
• Nurses are working understaffed (shortage night shift), facing burnout which lowers defenses to disease,  working without hazard pay or hourly Covid differential pay, and some have contracted Covid-19.  There is concern with the need to use regular sick/vacation time for Covid-19 illness.  Nurses are quitting for agencies that pay higher wages over CCH wages. 
• Hiring agency nurses at times is a patient safety issue as some have to be supervised/trained by CCH staff making extra work.  ICU/trauma units need specially skilled agency nurses. 
• CEO Rocha stated that early in the pandemic, nurses moved to areas of the country with surges/flare ups with good intentions.  Over time this has become a bidding price war for agency nurses.  CEO Rocha said CCH is addressing these issues.

Finance Committee

• The FY2021 Preliminary Financial Report ending 11/30/2021 was presented. 
• CCH uses the Accrual Basis of accounting and interim financials show that CCH ended Nov 30, 2021 with a $5M positive variance. 
• CountyCare managed care program had a year to date operating gain of $10.0M.  Health plan spends 92.3% of revenue on medical claims and 4.7% on administrative cost FY2021.

Managed Care Committee

• CountyCare as of Jan 5, 2022 has 425,290 members, a 10% increase in FY2021- still the largest Medicaid managed care organization in Cook County.  10.4% of members are in CCH clinics.  Actual membership is still higher than the budgeted amount as redetermination is paused and will be extended to the end of March/April. 
• 34.6% of total membership is fully vaccinated as of 1/7/2022. 
• The 2021-2022 marketing campaign for open enrollment is “CountyCare is There” highlighting benefits that provide dependable health coverage.
• Dr Collins, Chief Medical Officer for CountyCare, gave a presentation on Health Equity Updates.  80% of CountyCare membership live in disproportionately-impacted zip codes (children in school lunch programs, receive SNAP benefits, below poverty line).  Data from April 2020 to March 2021 was presented on specific zip codes where emergency room visits and hospitalization rates were high and primary care visits low. This data allowed focus on members with gaps in care which resulted in a targeted outreach contacting those members to schedule primary care visits and mammograms.

Audit and Compliance Committee

• The formal CCH Research Compliance Program was introduced February 2021 and implemented during FY2021 to ensure research compliance with regulations/agency laws and enforcement bodies. 
• The number of total active research studies at CCH as of mid-Nov 2021 was 1,023, an under recognized aspect of CCH.

Human Resources Committee

• Dept is committed to meet the priority staffing needs of clinics, public health, CountyCare, Provident and Stroger hospitals by process improvements, technology improvements (on-line application Taleo), streamline recruitment and by adding consultants.  The number of recruiters has dropped over the years to 5 today. 
• 1,252 positions are in the recruitment process, with 29 hires for FY2022. 
• HR recognizes there is a national shortage of health care workers, especially nurses, and job fairs for Lab and Managed Care were held and fairs for Social Work, Nursing and Respiratory are planned. 
• With the Covid resurgence, 350 agency nursing jobs and 210 other agency staff added in FY2022.

Report from CEO Rocha

• CCH recently reopened three of its mass vaccination sites: Des Plaines, Forest Park and Matteson.  The large well-coordinated team of CCH employees involved with quickly setting up these sites was recognized at the board meeting.  To date at the mass and community vaccination sites/programs more than 965,000 vaccine doses have been administered. 
• KN95 masks are being distributed at mass sites, CCH clinics, and community organizations. 
• CCH provides Covid testing at six locations by appointment: cookcountyhealth.org/covid. 
• The American Rescue Plan Act’s (ARPA) funds will support the response to and recovery from the Covid-19 public health emergency.  Cook County will receive funds over several years for well-being community programs: Healthcare, Mental Health, Public Health, Food Security, Housing. 
• The FY23-FY25 strategic Plan timeline was introduced.

What to watch for in the future:

• ARPA funds for CCH
• FY23-FY25 Strategic Plan

Observer - Michele Niccolai

Cook County Health Board of Directors Meeting –
December 17, 2021

Human Resources:

• The Human Resources (HR) department is down to four recruiters from nine in 2020.  To help with the backlog, it hired contracted recruiters.  In January 2022, four agency recruiters will start and four former recruiters will come on board in a part-time capacity.  
• Strategic plans for 2022 include hiring a consultant to help overhaul the entire hiring process and also to help answer the question:  “how do we rebrand ourselves” to be more competitive in a very competitive health hiring market.

Human Resources Metrics

• Turnover of 10% to date is higher than normal, particularly in nursing.  Covid a factor
• To date, 614 positions filled:  453 external hires, 76 promotions, and 85 transfers.
• Avg time to fill a vacancy continues at 105 days.
• Separations to date total 653:  215 Retirements, 396 Resignations, Discharges 42.  

Managed Care

• Membership is now at 422,266 - 10% of which are Ambulatory Care Center members. Number expected to drop mid-2022 due to state reactivating the assignment process which was halted during 2020-21 Covid. 
• 42% of the Plan’s membership have had at least 1 dose of the Covid vaccine. This number includes 5 year olds and up.  36% are fully vaccinated as of 12/3/21.
• A 2022 Strategic Price Increase will focus on room & board which is approximately 55% below market and the surgery rate which is approximately 78% below market.
• Medicare membership revenue of $13,044 continues to lag well behind budget of $30,974.  

Quality & Patient Care

• The 30-day readmission rate is to up 10.78% against a goal of 9.93%.
• There was a significant drop in the “Recommend the Hospital” index from 87.91% in May to 63.16% driven by scores for cleanliness, nurses treating patients with respect, and buzzer response.
• The committee is reviewing its dashboard process for metrics and said it may present a new format in 2022.

Finance Committee

• On an accrual basis as of October 31, CCH shows a $12 M positive variance.  On a cash basis,$40 M.  This is partially due to a slowdown in CountyCare utilization of CCH facilities.
• County Care membership 414,000 as of October 31, 2021 with an operational gain of $10 M.  Both revenues and expenses are higher due to membership growth.
• The quality and quantity of patient TV use was discussed - particularly education and/or training programs.  This could be an area for savings.
• Primary Care and ER revenues are below budgeted expectations.
• The $10 cash payment required for charity care services was eliminated in 2021.

CEO Report:
Last month, CEO Rocha reported that moving forward, divisional updates will be provided to ensure that the CCH Board of Directors “has a deeper understanding of operational successes, opportunities and challenges”.   Areas to be covered include: Stroger Hospital, Correctional Health, Provident Hospital, Public Health, Ambulatory Care, Cook County Health Plan Services, Administrative [regulatory, legislative, strategic initiatives, etc.]

Highlights for this month include:
Provident Hospital:  

• Completed ICU monitor installation.  ICU beds delivered and nursing station construction is completed.
• Funding identified for new phlebotomy chairs, lab chairs, and updated refrigeration.
• Phase 2 Ambulatory Bay renovation work to begin in December.
• Installation of MRI scanner has begun in the new and enhanced diagnostic imaging center.
• Developing a plan to increase dialysis volumes.

Ambulatory

• YTD primary care volume is tracking with budget. Specialty care continues to lag.
• Working on year-end push to increase mammograms, eye, and colorectal screenings among managed care patients.
• Increasing scrutiny of the specialty schedules to understand which are underutilized and re-appropriate them to needed areas.

Note:  All of these reports can be found HERE.

Observer:  Diane Edmundson