Cook County Health (CCH) Board Of Directors Meeting
October 28, 2022 

Approximately 4,000 asylum seekers have arrived to date with the majority coming from Venezuela and the balance from other Central American countries.  They are residing at 23 locations across Cook County in 12 shelters and 11 hotels.  At the peak, there were 109 arriving per day but that is now trending down due to changes in policy at the border.  Most of the health screening is routine and outpatient with most common complaints a cough or headache. A telephone triage center staffed by nurses has been established for after hours.  A total of 183 Cook County Health staff have provided refugee health care to date.  The center is establishing medical homes for the refugees and tracking expenses.  A Resolution was introduced and approved to accept donations from individuals who have contacted CCH wishing to contribute a monetary amount in support of the services being rendered by Belmont Cragin to the migrant population.  
CEO Israel Rocha, announced a Cook County Health/U. S. Navy Training Partnership centered on the Resuscitative Surgical System (ERSS) which began in October. Navy personnel will train at Stroger Hospital with staff knowledgeable in ERSS.  When complete they will return to their assignments and possible deployment. 
Due to an outbreak of Ebola in the Sudan, County Health is closely monitoring the situation and clients.  Covid-related calls both inbound and outbound have declined as the numbers of Covid patients has decreased.  CountyCare is providing rewards to its patients who are getting their Covid shots and boosters.  
Provident Hospital is now providing hemodialysis services to serve the population in need of that service.  
Dr. Sam Robinson’s appointment to the Board which was deferred at the September meeting has since been approved.

Committee Reports
Human Resources:  Chief of Human Resources Valerie Amos provided metrics on recruiting indicating 647 positions filled year-to-date at an average of 65 per month.  The turnover rate is steady at 9.9%.  There have been month over month increases in new hires.  Resignations continue to outpace other types of separation i.e. retirements or discharges.  Multiple hiring fairs have been conducted and the on-line presence improved for internal and external use.  
Audit and Compliance Committee:  The schedule of meetings for 2023 was not firm yet.  The Committee’s focus is on CountyCare, Community Education and the metrics for CCH and CountyCare.  There were no action items.
Quality and Patient Safety Committee:  In an update on future directions for Stroger and Provident Hospitals the following initiatives are being pursued:  Building Stroger’s Neuro ICU to a Level 1 Neurosciences ICU; Establishing Stroger as a Thrombectomy Capable Stroke Center; and Provident as a Stroke ready or Primary Stroke Center.
Managed Care:  CountyCare continues at 32.7% of the Cook Market Share and has increased 7% over the past 12 months -– ahead of the Cook County increase of 4%.  Enrollment continues to exceed budget projections.  HEDIS rates remain stable.
Finance Committee:   On an accrual basis, interim financials show that CCH ended August with a $6.7M positive variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $204.4M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses.  Year to date revenues better than Budget due to catch up payments from the State and higher than budgeted CountyCare membership. Other Non-operating Revenue negative variance due to fluctuations in County property tax collection.    CountyCare membership remains over 400,000 which is greater than the 381,000 budgeted.
 Contracts in excess of $1M were submitted and approved as follows:

• Konica-Minolta Business Solutions – One Year Extension - $1,500,000 (Print, scan and copy service for 1 year – RFP to follow); 
• Housing Forward – Two Year renewal -Sole source $3,769,450 (ARPA funded), (Temporary recuperative housing for homeless); 
• Atos Healthcare Services - One Year Extension - $33,000,000 (Information Technology management services – increased  because of additional resources pre and post-pandemic -RFP to be issued in January); 
• McKesson - $4,029,363 (Information Technology management services – Pharmacy Point of Service, Lab and Stores management – Original sole source contract extension through 2027); 
• CDW Government, LLC  - additional Microsoft Defender 365 - $1,314,953 (security licenses, retroactive to 6/2022 through 5/2024); 
• ADT Commercial Government LLC - $1,767,915 (equipment and installation of new nurse call and paging system at Provident Hospital to replace obsolete and ineffective system); 
• Professional Clinical Laboratories LLC dba PCL Alverno -  one year extension $1,814,577 (histology services); 
• Executive Building Maintenance dba EBM Inc. – 6 month extension $2,394,426 (Environmental cleaning and terminal cleaning services for Stroger – RFP in development to consolidate environmental services); 
• ABM Healthcare Support Services, Inc. – 6 month extension $1,315,770 (environmental management service for Stroger and other CCH locations – RFP in development to consolidate environmental services)

Recognitions:  Thanks and kudos to retiring Commissioner David Munar; Team award for ambulance runs at Provident - 70 in the first week; Cardiology team awards by the American Heart Association. Pinnacle awards on healthcare marketing for the My Shot Covid campaign for the CountyCare team.

Observer:  Peg Moster

Cook County Health Board of Directors Meeting
September 24, 2021​

Meeting Highlights:

Human Resources Committee
Separations are outpacing hires.  There was a net of 91 fewer employees this past quarter. Resignations lead the separations. There is an 8% turnover rate, up 7% over the 3rd quarter last year.  Unfortunately HR is understaffed so hiring has slowed and average time to fill positions is up.  The market is very competitive right now.

Managed Care Committee
Membership numbers continue to increase and are up 10% over prior year. September 18, 2020 there were 371,248 members and September 9, 2021 there were 411,664 members. County Care’s market share increased to 10.7%, a slight increase from 10.5% a year earlier.  The membership numbers are over budget in part due to paused redetermination.  The call center and encounter rates have worsened. Claim’s payments have improved.

Quality and Patient Services Committee
Quality metrics are mostly unchanged except HbA1C indicator which is down to 66.7% (lower is better) toward a goal of 24% in outpatients.  At the start of the year it hovered near 90%.

Finance Committee
The agenda item receiving the most engagement from the board involved the 32 million dollar contract request for MHN ACO LLC. There is a contract already in place but an extra 32 million dollars is needed to be paid to finish off the contract which expires at the end of December 2021. This provider covers care coordination for County Care subscribers. The increase is primarily due to the increase in subscribers.  There was a lot of discussion on getting bids for this contract.  County Care has not started the bid process even though the contract only has 3 months left.  The board was concerned that the time left was inadequate and they offered help in getting this done. CEO Rocha will work with the managed care committee on a timeline for a request for proposal for next year's contract.  It was pointed out that the current company is a high performance vendor.
There was a transfer of 14 million dollars from salaries to Registry help and Human Resources.

CEO Report
All employees must be vaccinated by October 1. So far 83% are fully vaccinated with 92% having started the vaccine series. The hospital is making vaccinations available around the clock and are holding town halls to answer questions. Also, they are working with the unions. The gap on vaccination rates by race has decreased

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues 
• Managed Care costs and contracts

Observed by:     Lisa Slankard                          Meeting Length:     2 ¾ hrs

 Cook County Health (CCH) Board of Directors Meeting
October 25, 2019    

Board Discussion:
CEO Dr. Jay Shannon summarized recent Cook County Health (CCH) positive developments:

• The IL Health Facilities Board has approved the application for a new Provident Hospital;
• The National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings;
• The US Congress passed a continuing resolution through November 21, to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.

But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year.  In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations.  The demand for charity care has grown by $100m since 2017.  CCH is now providing about 60% of all charity care in Cook County.  Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured.  The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.

Committee Reports: 

• Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire. 
• Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL.  83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000.  An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications.  96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days.
• Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital.  The hospital’s readmission rate is currently 9.7%, vs. a 15% national average. 
• Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments.  Primary care visits are up by 10%, specialty care up 6%, Emergency Room visits down 2%, deliveries up 5%.

Significant contract awards: 

• Cerner Corporation for software support - $191m for 5 years, $38.2m per year
• Medline Industries for medical and surgical supplies - $70m for 36 months;
• Paschen Ashlaur Joint Venture  to construct Belmont-Cragin Health Center - $12m. 

Observed by:  Linda Christianson                         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 & Hospital Systems (CCHHS) Board Meeting - May 26, 2017

Significant Decisions Made:

• As concern rises over likely federal cuts and the 2018 changes in the State Medicaid reimbursement caps, the Board asked for a “dive” into CCHHS finances at both the June Board and Finance Committee meetings. President Hammock wants this done before the start of 2018 Budget preparation.
• A contract with Superior Air-Ground Ambulance Services, Inc. to provide sole use services to CCHHS to transport County Care, Medicaid, and other patients needing transport to the hospital and clinics was approved.  Pick up guaranteed!  The Board requested quarterly reports on the metrics to be used to evaluate these services. 

Significant Topics Discussed:
Finance:

• Unexpectedly high pension expense numbers were received from the County. HHS budgeted $220,000 against the new number of $321,000. 
• Overall, HHS is currently 20% off target for income.
• Overtime continues to be a big driver of actual v budgeted expenses.

County Care: 

• Not meeting client targets for primary and surgical care as well as deliveries.                            
• Enrollment stabilized at 141,776 vs budget number of 142,500 clients
• Market Share is 3rd place for managed care in Cook County.
• Call center meeting all targets

Application for the State Medicaid RFP 

• Cook County submitted their application early and there are 2 other applicants.
• Director Glass believes CCHHS much more responsive to the RFP.
• Concern expressed that care metrics must be increased.

Quality & Patient Safety:

• Metrics developed for cleanliness.
• Operating Room Improvement noted.
• Two new managers hired and will go floor by floor for intensive cleaning. 
• Patient satisfaction re communication with nurses and cleanliness continues to be an issue.  New protocols developed.  Nurses are being asked to make hourly rounds and the managers are to increase their rounds. 
  
• More training is scheduled for:  coaching, monitoring of/by supervisors, cleaning, and use of Family Medical Leave Act (FMLA).

Items to Watch in the Future:  

• Immigration and Customs Enforcement (ICE) activity [none reported to date].  
• CCHHS ability to accurately determine cost to treat patient vs state reimbursement.  Will become more important with expected cuts in federal and state Medicaid reimbursements and state managed care reimbursements. 

Observers:  Diane Edmundson, Bill Edmundson                    Meeting Length - 2 1/2 hours