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

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