Cook County Health Board & Committee Reports
August 23, 2024

Board Meeting Discussion and Action:
Chairman Taylor and Dr. Erik Mikaitis, Interim CEO, began the meeting with the announcement that anchored by CCH’S Provident Hospital the Bronzeville Community Health Center will offer family medicine, behavioral health, and rehabilitation services including physical, occupational and speech therapy.  The 26,000 square foot center is projected to have 80-85,000 visits in its first year and will include 44 exam rooms and a gym space for therapy services providing care for patients of all ages and stages of life.    The family medicine and behavioral health practices are moving from Provident Hospital’s Sengstacke Health Center into Bronzeville which offers a larger, more modern environment to better serve patients.  The move will also free up more clinical space within Provident to allow for the expansion of hospital-based services.  Patients will continue to be able to receive comprehensive primary and specialty outpatient care at Sengstake.
 
CEO Position: The Commissioners adjourned following the Public Testimony to a Closed Session.  Upon return, Chairman Taylor made a motion to entertain and approve, subject to the approval of the Cook County Board of Commissioners, the appointment of Candidate “A” for the position of Chief Executive Officer of the Cook County Health and Hospital Systems pursuant to the compensation package discussed in closed session.  Motion to approve carried.  

Report from Interim CEO:   Dr. Mikaitis presented a high-level review of ARPA hire and spend. The current spend of ARPA funds is $137M with a remaining obligation of $97M which must be obligated by the end of 2024 with spend through 2026.  Next steps will be to determine sources to continue funding after ARPA funds are spent i.e. post 2026.  Initiatives include Food as Medicine at Belmont-Cragin and an opportunity at Provident Hospital.  Housing for Health which has received a boost to its effectiveness with ARPA funds. This was followed by updates on all the various programs which have received ARPA funding.  
Dr. Hasbrook was requested to in the future provide information about the overlap between Public Health outreach and the programs and to report on the collective impact of the investment in dollars and resources of the various programs. A report on Branding followed with a presentation of the new tagline – “Accountable, Exceptional for All.”  Updates have been made to web sites and staff will have access to new materials for use with patients after launch in September.   
 
Finance Committee:  Director Reiter briefly outlined the three Finance Committee meetings and public hearings in which the FY2025 preliminary budget was presented in detail and the August 15 Finance Committee Meeting where the preliminary budget was approved and requested a motion to approve without another presentation by Pam Cassara.  The CCH approved budget for 2025 is projected at $5.1B for both income and expenses.     Motion presented and approved.   This projected budget will require the  approval of the Cook County Board of Commissions in October.

Audit and Compliance Committee:  Director Harrington reviewed the minutes of the August 2, 2024, meeting indicating that Nicole Emerald, Chief Compliance and Privacy Officer reviewed 1st and 2nd Quarters including system compliance program and Cook County Medicaid Health Plan Compliance Program as well as recovery and the privacy update.  Motion made to approve and carried.  The next meeting will be on Friday, October 18 at 9:00 a.m.

Human Resources:  Reported metrics on vacancies, separations and status of hiring efforts.  1,080 vacancies reported as of the end of July.

Public Speaker Testimony:  There were four in-person, and one written testimonies provided.  The four speakers providing testimony were Dr. Ngozi Ezike, President and CEO of Sinai Chicago Hospital; Lena Hatchett, PhD, Co-founder and Executive Lead for Proviso Partners for Health (PP4H); Jackie Burgess Bishop, CEO National Kidney Foundation of Illinois; and Esther Cook, CEO Alevio FQHC serving Hispanic populations.  All four spoke in strong support of the preliminary Cook County Health and County Care budget for the coming fiscal year.  Each speaker provided an example of how their partnership with Cook County Health has had a positive impact on the goals and objectives of their organizations and a positive impact on the people they serve. 

Observer: Peg Moster

Quality and Patient Safety Committee: 
August 15
The Stroger Hospital and Ambulatory Clinics Joint Commission Triennial Accreditation and Primary Care Medical Home Certification survey was successfully completed in June 2024:

• The overall compliance was 97% for all standards and elements of performance. 
• Corrective actions were established for the findings identified and evidence of compliance will be submitted to the Joint Commission this month.
• Departments will report compliance data at the Hospital Quality and Patient Safety Committee meetings monthly August 2024 – December 2024, then quarterly thereafter thru 2025.
• A compliance dashboard has been developed for reporting and to track ongoing compliance.

Observer - Lisa Slankard

Managed Care Committee: 
August 2 
Metrics: 426,239 total members [well above budget projections].   32,928 ACHN Members [7.7%].  It continues to be the leading Managed Medicare Plan in CC with a 34.2%.  BC/SH is next with 27.2% market share. The CountyCare staff received kudos for its 88.9 Redetermination Rate and its marketing and outreach efforts including billboards along the expressways.  
CountyCare Access (health benefits for immigrant adults and seniors):  Effective January 1, 2023, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan.  Through April of 2024, a total of 35,000 HBI immigrants have come into the plan.  
Healthy Choice Illinois RFP: The RFP by the State has been delayed for a year.  The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
Quality and Equity Choice Campaign:  Primary care engagement strategies will focus on adults 18-24.  Equity efforts will start with smoking cessation via education and prevention.  Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants.  Clinical Services will focus on accomplishments particularly with behavioral health participants.
Other Successes, Goals, Strategies, and Metrics:

• Won three National Association of counties awards for Addressing food insecurity [Best in Category], engaging members during redetermination, and improving member demographics. It also won an Aster Award for healthcare marketing, advertising, and communications.
• HEDIS scores improved in all but one category [follow up after ED visit for mental illness in 7 days  dropped 3%]. Opportunities for improvement for 2024-25 include behavioral health, living with illness and chronic disease, and maternal and child health.
• CCH’s Illinois Healthcare Transformation 1115 Waiver [promotes the objectives of the children’s CHIP program] was approved as of 7-2-24 and ending 6-30-29.  However, within the request, 3 specific waivers were not approved, a leadership grant program, the redirection of DSH funding to create a pool of funding for strategies and intervention in underserved communities, and training community health workers.
• Food care strategies started in 2023 include emergency meals, general nutrition programs, and medically tailored food. A Total of 7,800 members have been engaged as of the August 2, 2024 report.
• A new non-emergency medical transportation vendor [ModivCare] will start on August 1. ModivCare maintains a network of providers providing multiple levels of transportation services, including public.
• In 2024, CCH and County-Care entered into a new value-based payment arrangement with the State including pay-for-performance incentives tied to key quality outcomes.

​Observer - Diane Edmundson

Cook County Health Finance Committee Meeting
August 15, 2024

​Attendance: Joseph Harrington, Sam Robinson, and Chair:  Robert Reiter. 

Proposed CCH FY2025 Preliminary Budget

• Proposed CCH FY25 Preliminary Budget: Pamela Cassara presented slides reviewing the preliminary FY25 Budget. The Finance Committee had no questions for the presenter. The vote was unanimous for approval by the Finance Committee of proposed preliminary FY25 Budget. The FY25 preliminary budget will now go to the full Health System Board. 

Contracts and Procurement Items 

• All 15 contracts were approved. 
• There was discussion regarding the amended and extended contract to 12/31/24 for agency staffing in radiology for both front line technicians and supervisory staffing for mammography PET and CT services. Response regarding actions by the Health System to reduce the amount of agency radiology staff focused on not being able to recruit staff due to shortages of qualified personnel. 
• Background: 
  • This contract for temporary staff agency in radiology has been in place for 2 years 
  • On 09/16/2022, the CCH Board of Directors were notified of an Emergency Purchase for contract in an amount not to exceed $1,550,000.00 for a twelve (12) month period from 09/26/2022 thru 09/25/2023. On 09/29/2023, the CCH Board of Directors approved a request to extend the contract thru 09/25/2024 and increase the contract by $6,976,613. 33

June 2024 Financials

• The report for financials noted in the payor mix a decrease in those covered by Medicaid and a increase in uncompensated care. This is attributed to loss of Medicaid coverage for persons due to the redetermination process.
• Noted also was a slight increase from FY23 in those covered by commercial insurance (7.4 to 7.8 %)

​Observer: Susan Avila

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 Board of Directors Meeting
January 27, 2023

Board Action:

• A $30M request was approved to increase existing contract with Vaya Workforce Solutions, LLC through 9/24/23 for agency nurse staffing to fill vacancies.  The Chief Nursing Executive stated the hourly wage for agency nurses has decreased from slightly over $200 to currently $150 to $175 depending on the specialty needed.  A dilemma was brought up by Board members regarding agency nurses vs employed staff nurses.  Agency nurses go for the increased hourly wages, more control over their lives and younger nurses may not have a long term career view.  Cook County Health (CCH) has advantages over agency nurses: CCH staff has good pension and other benefits for long term career plans.  There are work rules, free tuition and many resources available.  CEO Rocha added that closing the HR gap in hiring nursing staff is a major goal.  Other goals are empowering the employee experience, commitment to continuing education, building flexible staffing pool options, adding employee councils and addressing work and life balance.
• -Two contracts for a total of $32M were approved through 11/30/23 for temporary staffing. Positions include transporters, supervisors, Covid screeners, greeters, Lab personnel.  
• A 2M contract was approved to continue with Slalom Consulting through 7/19/23 for Human Resources.

New Cook County Health Board Members were approved by the Cook County Board of Commissioners at their meeting on 1/26/2023. The new members are Tanya Sorrell, PhD, PMHNP-BC and Mia Webster Cross, MSN, RN. These new board members have replaced Mike Koetting and Dr Heather Prendergast

Committee Reports:

• Finance Committee: On an accrual basis, interim financials show CCH ended November 30, 2022 with a $15.8M unfavorable variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $366.4M favorable variance.  This is due to the timing of how each records revenues and expenses.  These are preliminary numbers as the FY2022 financials will be audited April 2023.  CountyCare showed an operating gain of $11.5M.  CCH’s More Care, Medicare Advantage Plan, was discontinued as of December 31, 2022 because of low membership and revenue loss.
• Quality and Patient Safety Committee: Quality and Safety rating sites to check hospital and providers were mentioned that anyone can go to:   medicare.gov/care-compare/    (star ratings) hospitalsafetygrade.org     (Leapfrog hospital safety grade)
• CountyCare: CountyCare membership as of January 5, 2023 was 449,565 with 9.3% using CCH clinics.  This is an all time membership high, reflecting month over month growth since Medicaid redetermination has been paused.  Redetermination, an annual review of Medicaid eligibility, will begin in April 2023.  Renewal forms will be mailed to 1/12 of membership each month over the next year with CountyCare staff assisting members in this process.  Membership losses would start to show up end of June and July 2023.  The Board pointed out that continuation of care for those who will lose Medicaid is vital as conditions such as hypertension, diabetes and asthma can lead to major health costs down the road.  In 2022, CountyCare developed reserves of $100M and plan to increase this to $150M in 2023.  In 2022 CountyCare added over 100 urgent care sites providing an alternative to E.R. usage and housed 53 members in the Flexible Housing Pool Program and 14 members through the Community Transitions Initiative.  
• Human Resources: In FY2023 (Dec 1 to Dec 31, 2022), 119 positions were filled with 72 external hires.  Internal hires (some are promotions) help with employee retention.  16 offers were declined and the #1 reason was salary.  In FY2023 there were 90 separations, 73 were due to retirement.  HR is hosting monthly job fairs and can now offer recruitment and retention bonuses.

CEO Rocha reported that CCH with support from the CCH Foundation has selected local artists to lead mural projects at three health system sites.

Observer:  Michele Niccolai

Cook County Health (CCH) Board Meeting
August 26, 2022     

Cook County Health CFO Cassara presented the 3-year financial forecast which supports the 2023-2025 Strategic Plan approved earlier this year. It was developed in concert with the proposed FY2023 CCH budget which was also approved at today's meeting.
Accrual basis budgets show a deficit of $41M for 2023; $48M for 2024 and $47M for 2025.  CFO Cassara commented that closing these “deficits will require management interventions”.

Support to the Health System from Cook County totals $228M in 2023 including $80M CCH pension allocation and $148M Cook County tax allocation for health services, correctional and public health departments.

Cook County Health Heart Institute:

• Is a new CCH initiative to develop a comprehensive, academic, world-class, equitable, cardiac care program spanning from prevention to complex heart disease. 
• Radiology and Cardiology disciplines have been collaborating since 2021 on new interventional services including balloon valvuloplasty (of heart valve) and transcatheter aortic valve replacement
• Outpatient access to cardiology subspecialties (Cardiovascular genetics, heart failure, lipid disorders and electrophysiology among others) in suburban locations (Blue Island) Sengstacke at Provident Hospital with other locations being considered.

Monkeypox:

• CEO Rocha, Dr. Welbel, CCH Division Chair, Infection and Hospital Epidemiology, and Dr. Hasbrouck, Director of CC Department Public Health gave a data-intense update on the monkeypox cases in Cook County (800 cases in CC with 45 hospitalizations of which 77 cases and 7 hospitalizations were CCH cases)
• More information about Monkeypox can be found on the CCH website 

Observer - Susan Kern, MD

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