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

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 Special Board Meeting - September 11, 2020

After one hour of testimony and four hours of discussion, the Cook County Health Board approved a budget of $3.3 billion for 2021.  The budget for 2020 was $2.8 billion.  However, along with the approved budget, it also voted 6-4 to add an amendment asking for an additional $23 million which equates to the "indirect" costs of CC Correctional and Public Health Departments.  Interim CEO Carey and Interim Chief Business Officer Gibson were asked to ASAP identify what services, staff, etc. would be restored if the $23 million was granted.

Hours were spent in discussion with a majority of board members stating that they wanted to have more early involvement in setting budget priorities.   The Board’s Vice-Chair made the following points:

• The budget process is too reactive and needs to be more proactive.
• The System needs to explain what services cannot be performed because of revenue shortfalls.
• The System needs to articulate who is its targeted population.

Interim CEO Carey noted that there were over 100 public speakers during the two budget hearings and the Sept. 11, 2020 special board meeting to approve the budget.  Two programs eliminated in the 2021 budget generated a significant amount of testimony:

• Health Care service at the Morton East High School.  Carey indicated the System believes it can find a replacement provider, but Directors want more feedback on who or what would be the replacement.
• Children's Advocacy Center.  In 2020, the budget was $500,000 for mental and physical health services.  The Center offers many other services that will continue, and Carey said the System is looking into alternatives.  Director Deer who is both a Director on the CCH Board and an elected Cook County Commissioner expressed concern, and used this as an example of why the Directors should be involved earlier in the discussions of what will continue, be cut, or added when developing the annual budget.

As the meeting closed, several members of the board restated the following points:

•  More revenue is needed to fulfill the System’s mission and mandates.
•  The System needs to develop a robust Regional Planning process which must include a strategic discussion on charity care.

For those wishing to have more information about the budget categories and amounts, the 2021 proposed budget can be found HERE.

Diane Edmundson - Observer