Category: Contracts

Cook County Health Continues to Have Funding Challenges

10/25/2019

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

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Cook County Hospital Board Approves $189M/ 4 Year Contract with Evolent Health

4/3/2018

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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

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Hospital System Contract for Tele-Psychiatry Tops $3M

3/12/2018

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Cook County Health & Hospital Systems (CCHHS) Board Meeting - March 2, 2018

What did the Board Decide?

A Sole Source contract for $3.12M with Regroup Therapy, Inc., a start up with deep Chicago roots, for Tele-Psychiatry services was approved by the Board last month. Services will be provided to the Hospital System, including Correctional Health at Cermak / Cook County Jail as well as to the City of Chicago via intergovernmental agreement. Doug Elwell, Deputy CEO, responded to the public speakers who complained that this was a private contract not including CCHHS mental health providers, lacking in transparency, evidence based data of the quality of care, racial/ethnic background of contracted providers, by noting that all providers would be credentialed through the Hospital’s Medical Staff and a licensed person would be present in the room for the Tele-psychiatry sessions. This contract fills a void in critically needed mental health services .

What did the Board Discuss?

Update on integration of 284,932 new CountyCare/Medicaid members from Aetna and FHN acquisition by newly appointed Director of Managed Care, James Kiamos, noted that total CountyCare member enrollment dropped from the original 425,000 in Dec. 2017 to 329,000, by end of Feb. 2018 with expected further drops during the open enrollment period ending 3-31-18. (Member attrition has not been as great as predicted yet and well within the budgeted minimum of 235,000 retained members).
Director Gugenheim questioned whether the CountyCare network of 53 hospitals, 26 Federally Qualified Health Centers, 4,690 primary care and 14,639 specialty providers shouldn’t be strategically narrowed to better control quality & cost.
2017 end of year financials still pending. Doug Elwell gave a verbal update, noting that 2017 was not a good year financially compared to the previous 3 years with a $31M deficit below budget due to both decreased revenues and increased costs. CFO Akpan said planned/ anticipated corrective actions were in place. Chair Hammock told Elwell and Akpan that finances must be on an accrual, not cash basis, and they needed to stay on top of it—No surprises for the Board!
PowerPoint report on Hospital System minority & women-owned business enterprise (MWBE) participation confirms that fewer than 10% of CCHHS contracts are with women or minority owned businesses. 1% Hispanic participation is very low noted Director Gonzales. Chair Hammock said he was not satisfied with the numbers and more work need to be done. CEO Shannon requested the % of potential/suitable MWBE available in our region compared to the % the Hospital System contracts with, by category, to better assess whether CCHHS’s % of MWBE doesn’t just reflect the lack of such available businesses in our area.

Items to Watch For in the Future

Director Estrada resigned due to work demands. Cook County Board President, Preckwinkle will be appointing a replacement

Observers - Susan Kern, MD & Michele Niccolai Meeting Length: 3 hours

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Concern Rising Over Likely Cuts in Federal Medicaid Funding

6/7/2017

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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

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CCHHS to Submit Proposal to Revamp Medicaid Managed Care Program

4/3/2017

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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

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CCHHS 3 Year Strategic Plan Approved Unanimously

8/2/2016

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

Significant Actions Taken:
The Proposed 3 Year Strategic Plan was approved unanimously with commendations from board members for its

attention to metrics
safety net for patients
best practices
staff involvement.

CEO Dr. Jay Shannon said the plan will allow HHS

to transform into a modern health care system,
to form partnerships with like-minded organizations
to retain its focus on patient needs.

Board Election/Changes: The Board re-elected Hill Hammock as HHS Board Chairman and Jerry Butler as Vice-Chairman. Dr. Shannon commended outgoing board members Carmen Velasquez and Dorene Wiese for their dedication and leadership.

Contract Awarded: Morrison Management Specialists were awarded a $13,900,000 contract to provide labor, supplies and software for food and nutritional services, replacing former contractor Sodexo.

Significant Topics Discussed:

Stroger Hospital now ranks in the 37th percentile nationally in willingness of patients to recommend the hospital; 60% report satisfaction in moving through their visit; 56% report satisfaction with the phone access.
Valence Health Systems, administrator for CountyCare, has been purchased and will be split into 2 businesses, selling the largest portion to Evelent for $145m. Valence’s existing leadership will transfer to Evelent and stay in Chicago with no change to services provided to HHS.
CountyCare membership 154,000 as of June, down from 160,000 in March. $84.8m = profit plus what HHS pays itself, close to the 2015 figure. Membership is down partly due to inefficiency/challenges of call center: Valence staff inexperienced, are calling from Texas. In-house call center at Oak Forest must try to conform to state Medicaid regulations and reach newly-insured Medicaid population who are confused about cards, may have no permanent address or phones that can only call out.
As of June HHS was $49,254,000 over budget, which, combined with its $128,638,000 pension obligation, totals $177,892,000 net loss. HHS has $5,069,215,000 in total liabilities. It has 48 days’ cash on hand. CountyCare’s revenue was budgeted at $26,284,000, but its actual revenue was $17,291,000 (revenue left in the system once other providers are paid.) The shortfall is attributable to (1) reduced headcount and (2) reduced capture of available revenue when other providers are chosen.
When Dr. Shannon was asked to comment on budget considerations for 2017, he cautioned that (1) there has been no significant pension reform by the state; (2) no significant growth in state revenue; (3) there will be union-negotiated 2.5% salary increase (resulting in increased pension obligation) and step increases; and (4) HHS will be on its own in generating revenue for capital improvements. “We will not be able to cut our way out of budget challenges; we have to GROW. We have to invest in things that allow us to grow.”

Observer - Linda Christianson Meeting Length: 2 hours, 40 minutes

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<<Previous

Cook County Health Continues to Have Funding Challenges

Cook County Hospital Board Approves $189M/ 4 Year Contract with Evolent Health

Hospital System Contract for Tele-Psychiatry Tops $3M

Concern Rising Over Likely Cuts in Federal Medicaid Funding

CCHHS to Submit Proposal to Revamp Medicaid Managed Care Program

CCHHS 3 Year Strategic Plan Approved Unanimously

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