Cook County Health & Hospitals System
CountyCare Managed Care Committee Meeting - October 18, 2018 

What was Discussed: 

• CountyCare holds largest share of Cook County Medicaid managed care market, ahead of Blue Cross Blue Shield, with 335,484 enrollees as of August 2018.
• CountyCare has launched a series of social media marketing strategies to promote enrollment for 2019, including two YouTube videos with over 400,000 views combined within the last month
• New campaign slogan designed to appeal to working enrollees: “You don’t have time for a sick day”
• CountyCare enrollment goal for 2019 is 345,000; CountyCare saw a small drop in their Affordable Care Act enrollment in 2018
• Primary care providers in Cook County agreed to send out a total of 130,000 letters to potential enrollees supporting CountyCare as the best managed care option for their patients
• Patients with CountyCare can now get LASIK eye surgery and qualify for a monthly package of diapers if children are fully vaccinated 

How is CountyCare doing?

• State of Illinois is behind on making payments to CountyCare. Because of this delay, CountyCare is paying only around 50% of their claims to medical providers within 30 days of submission
• CountyCare saw a decrease in completed patient care plans for members in July after absorbing Aetna plan patients. Care plans are vital for managing high-risk patients
• As of now, 30% of visits to primary care do not occur with assigned primary care provider within the Ambulatory and Community Health Network clinics (these numbers are similar to other provider groups within the CountyCare network). CountyCare plans to stop paying providers who treat patients who have a different primary care provider

What else did the Board discuss:

• The board discussed sending out a patient survey to determine why some patients seek care outside of their assigned primary care provider

Items to Watch For in the Future

• New member enrollment into CountyCare plan and how well the plan holds onto current members for 2019
• The impact of the new marketing campaign on 2019 enrollment
• An explanation for why 30% of primary care visits do not occur with assigned primary care provider within the Ambulatory and Community Health Network clinics

Observer: Sarah Edwards                                                     Meeting Length:    One Hour 

Cook County Health and Hospitals System (CCHHS) Annual Board Meeting
June 29, 2018

The CCHHS Board requested that Human Resources properly designate positions with a unique job code if the job requires bi-lingual skills. These positions would be more highly compensated due to the requirement for these skills. It is felt that filling these positions appropriately would increase the cultural competency of staff along with ensuring proper care for patients. It was indicated that a bi-lingual worker would be especially helpful in working with many Out Patients. The Board also requested that Human Resources review the process for exit interviews with Department heads’ as there is currently a lack of helpful information being received.

Other Committee Actions or Discussions:

• Managed Care Committee-Increase of membership from 331,000 to 338,326. Board wanted a breakdown of the membership and the number of people who would be aging out of Medicaid.
• Quality and Patient Safety Committee-Discussed the 2018 proposed plan. Board talked about their concern about maternal deaths and the reasons behind them along with how to increase the number of woman who chose to give birth within the system.
• Audit/Compliance Committee-Fraud/waste/abuse have maintained from last year. New contract requires there to be one investigator per 100,000 members so with our 338,000 plus members, we will need 4 investigators. The issue of revenue recovery will continue to be a major issue for the system and the results from the systems in place and those being put into place will be closely monitored. Board Chairman Hill Hammock and CEO Jay Shannon presented these revenue recovery strategies to Cook County Board at a hearing on June 5.

Other Data Presented to the Board:
As part of the Cook County Department of Public Health 3rd quarter report, an update was given on current TB Prevention efforts. It has been found that those most affected with the disease live in the suburbs and 70% are foreign born and have been living in the United States for 5 or more years. The city of Des Plaines in the Northwest suburbs is the most infected area. There has been no direct correlation between TB and Poverty Rates.The current treatment is provided by nurses as part of a program called Directly Observed Therapy (DOT}. This program provides for a new treatment that takes 12 weeks instead of the old method that averaged 6 months. Each patient is assigned to a nurse who assumes responsibility for ensuring each of their patients takes their medication. This means these nurses are driving around the county doing DOT on a daily basis. 

Observers - Bill Edmundson and Jackie Buttafuoco                     Meeting Length: 3 hours

Cook County Health and Hospitals System (CCHHS) Board Meeting - March 29, 2018        

What did the Board decide?

• The Board approved  a $189m 4-year contract with Evolent Health that commits Evolent to third party administrative services for the CountyCare program.  CCHHS retains the right to cancel the contract with little notice if Evolent does not perform.  There were 4 responses to the competitive bid.
• The CCHHS board also approved a 3-year, $5,945,000 contract with Cerner Corporation for software support and maintenance upgrades, a sole source contract, “an expensive part of what we do,” Deputy CEO Doug Elwell said.  The government allows Cerner to change requirements for hospital accreditation, and customers like CCHHS must pay for the changes. 

What else did the Board discuss or refer to committee?

• The finance committee reported a year-to-date $48,138,000 shortfall (vs. $39.7 anticipated shortfall), attributed to more external claims expenses and higher pharmaceutical costs than anticipated.   
• James Kiamos, ED of Managed Care, reported 328,870 CountyCare members as of 3/1/18; of these 220,500 are family health patients, with 48,000 of these served by CCHHS ambulatory care clinics.  The hope is that the clinics can put more pediatricians in these clinics and attract more patients.  CountyCare represents 75% of CCHHS revenue.

Unexpected Votes, Events, Testimony or Items to Watch for in the Future:

• After at least 4 years of monitoring and effort to improve outcomes, only 67% of Stroger Hospital patients would recommend the hospital to others, and only 68% of Stroger surgeries begin on time. 
• Do CCHHS staff experience themselves as stakeholders in the system’s survival?

Any Other Comments or Observations: 

• CEO Dr. Shannon spoke movingly of participating in the March for Our Lives in Washington DC with members of the HHS trauma and social work teams; they met with Robin Kelly at the rally, where they spoke not only of specific violent gun incidents, but of the crisis in neighborhoods plagued by ongoing gun violence, the trauma of repeated incidents over time.

Observer - Linda Christianson                                                         Meeting Length     2.5 hours

Cook County Health and Hospitals System Board Meeting - March 31, 2017

Significant Topics Discussed:

Cook County Health and Hospitals System (CCHHS), in response to a Request for Proposal (RFP) issued by the Illinois Department of Healthcare and Family Services, will submit a proposal to revamp its Medicaid Managed Care Program.  With goals of (1) improving healthcare quality, (2) ensuring access, and (3) controlling costs for Illinois Medicaid patients, applicants must commit to providing the full spectrum of Medicaid-covered services. 

• The RFP was issued Feb. 27 and is due May 15.  Oral presentations are scheduled for June 12-23; awards will be announced June 30; and successful plans must be able to go into effect Jan 1, 2018. 
• Proposals must address in detail the ways the managed care providers will meet the 3 goals. 
• Awards will go to one or two managed care providers serving only Cook County (but these must be government or minority-owned providers), and 4-7 providers serving the statewide Medicaid population over the state’s 102 counties. 
• An estimated 3.1m persons statewide receive Medicaid, of whom 1.6m live in Cook County; statewide they are currently served by a total of 11 managed care providers.
• Assuming CCHHS’ proposal will be successful, Steven Glass, Managed Care Executive Director, predicts that the reduced number of managed care providers might increase CountyCare enrollment, but that rates of reimbursement will decrease.  CCHHS will be contracting with “new players” who may be entering the state marketplace for the first time.

The Joint Commission on Accreditation of Healthcare Organizations awarded accreditation to Stroger Hospital March 30.
$4m in contracts were negotiated with 2 nursing home organizations to provide short- and long-term care.  Costs to care for patients in these facilities can be $5000-$6000 per month, and Deputy CEO Doug Elwell explained that these contracts won’t be renewed in the hope that these 400-500 patients can receive home care.  He said CCHHS is considering providing long term care for its CountyCare and indigent patients.

Current Data Presented: 

• CCHHS has experienced an 8% loss of operating revenue due to diminished patient fees. 
• Length of hospital stay has diminished; emergency room visits are up slightly.
• CountyCare enrollment lowered slightly, to 142,250;
• Pharmacy claims have been higher than budgeted. 
• 74% of Stroger Hospital patients would be willing to recommend the Hospital; 80% is considered the median percentage overall in other major institutions.
• CCHHS had 727 staff vacancies in February; 167 vacancies were filled in the first quarter of 2017; the average time to fill a vacancy is now 93 days.

Observer -  Linda Christianson                                                                         Meeting Length: 3 hours

Cook County Health and Hospitals System Board Meeting -  September 29, 2016

Key Board Member Resigns  
Cook County Health and Hospitals System (CCHHS) Board Member Dr. Wayne Lerner submitted his resignation, with many commendations for his service by board members and by CEO Dr. Jay Shannon.  As chair of the CCHHS Managed Care committee, Dr. Lerner stressed the importance of CountyCare’s focus on (1) quality care; (2) risk management; (3) improving health status: and (4) a distribution of membership between healthy and less healthy to even out cost of care.

Significant Topics Discussed:

• Public speakers complained of abruptly closing the Oak Forest Health Center cafeteria that served 500 staff and patients.
• CCHHS Director of Public Health Dr. Terry Mason described the Partnership to Improve Community Health (PICH), funded through  three annual grants of $2m each from the Centers for Disease Control. The funds have been used for community programs focused on better access to smoke-free environments, healthy food, and street and forest preserve signage improvements for better access to physical activity, with encouraging results.
• Despite efforts only 57% of surgeries at Stroger Hospital start on time, due in part to staff shortages. Family Medical Leave Act allows up to 12 weeks of unpaid leave for staff members.  Patient satisfaction level about 70% for both Stroger Hospital and the Ambulatory and Community Health Network (ACHN) experience.
• CountyCare membership below expectations, attributed to time-consuming redetermination process.  CountyCare seeks to grow membership in the coming months through marketing fairs and telephone contact.
• Dr. Shannon suggested CCHHS has more managers than needed, with an assessment due in coming months.  Time to hire averages 110 days, with 839 current vacancies.
• CCHHS is owed $20m in accrual from State of Illinois.  Loss of $22m in salaries/benefits due to 7.9% overtime. Explanation: expectations were that patient activity would lessen in 2016, so staff were accordingly reduced.
• The new plan to provide healthcare for uninsured Cook County residents earning up to twice the federal poverty level will be presented to the full county board in October.

​To Watch For:  With the resignations of Lewis Collens, Dr. Erika Marsh, and now Dr. Wayne Lerner, the CCHHS Board has lost expertise that has guided the board through the formative years of CountyCare and a challenging strategic planning process yielding a 3-year plan for the organization.  Can the new board members master the complicated workings of CCHHS and move the organization forward to achieve the aggressive goals laid out in the Strategic Plan?  Stay tuned. 

Observer - Linda Christianson                           Meeting Length - 3 hours