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

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

Cook County Health and Hospitals System Board - April 29, 2016

Significant Decisions Made:
Approval of $112,700,000 Contract for New Health Center which will adjoin John Stroger Hospital, replacing 3 aging structures: Fantus Clinic , the current administration building on Polk St.  and the Hektoen Building.

• Via RFP (request for proposal) Clayco, Inc was selected to lead the development, design and construction of this new nine-story Health Center housing expanded outpatient services and administrative space and adjacent future parking structure. 
• Completion is expected in 2018 at a cost less than estimated for deferred maintenance on the old buildings.
• CCHHS are gambling that a more attractive, efficient facility will serve to retain patients, who are now insured under Medicaid (under the Affordable Care Act) and are increasingly choosing to go to other hospitals.  
• Board members commented that great care was taken in the contract to mitigate cost over-runs and insure local hires.

Significant Topics Discussed:
Concern was expressed by Director Erica Marsh, MD, that the nearly 800 employed HHS physicians  are not being assessed for productivity.  The number of physicians per patient is high compared to other hospitals.

• Doctor generated RVU (Relative Value Units: standardized measure of value for physician reimbursement) are used by other health care organizations to hire or retain and in some cases a doctor must meet a 50% or higher threshold compared to peers to be retained.  This, or comparable data (number of patient visits/encounters per day) is critical to predicting the fiscal sustainability of the organization and should be included in the HHS Strategic Plan under discussion. 
• Dr.Claudia Fagan agreed that there have been complaints that some physicians may only be seeing a couple of patients a day and they are not required to time -in or out.  There is a history at CCHHS of paying lower salaries and not particularly being concerned about the amount of work, because this was a charity hospital.  Most of the physicians are employed and belong to the union. 
• Director Lerner stated that there needed to be a new medical staff structure for the Strategic Plan including labor partners. 
• Productivity monitoring and performance achievement are needed added CEO Shannon.  Dr. Fagen responded “you cannot change culture overnight; it has always been like this at County”. 
• Director Junge (labor attorney) countered that the doctors have employment contracts.

Unexpected Events:
CCHHS Board Member, Lewis Collens, has unexpectedly resigned. The resignation was announced by Chair Hammock who noted the dedicated service as Chair of the Finance Committee that Director Collens had given to CCHHS.  He mentioned that the resignation was for family reasons. 

In an unscheduled visit to the Board meeting, Senator Dick Durbin,  our Illinois US Senator, cautioned the Board on the heroin epidemic. He noted that opiate abuse was on the rise and HHS will be at the forefront. 

• He also noted that the Zika Virus was unlikely to be of much concern to our region this year
• Both of these are central to the mission of CC Dept of Public Health which is administratively a component of HHS.                               

Observer: Susan Kern                                Meeting Length: 3 hours 45 minutes 

CCHHS Board of Directors Meeting - February 26, 2016

Significant Decisions:
A new unit for women and children in remodeled space at Stroger is planned to be open by the end of the year that will consolidate pediatric and maternity inpatient and outpatient services. This is an urgent response to retain patients.The Peds ER has already merged with the Main ER. Physicians and other Stroger staff were present as public speakers to oppose this plan because of their concern that quality would suffer. Administration said that there would be no staffing cuts of physicians or support staff with pediatric expertise.
 
Two sole source contracts were approved:

• A contract for $1,312,049 with Community Counseling Center of Chicago to provide behavioral health services connected to the early release program with mental health support in the criminal justice system. The intent is to decrease prison population of non-violent inmates with cost-savings.
• A contract signed with Favorite Healthcare Staffing Inc. for $1,028,760 to provide temporary contract services of Operating Room nurses and technicians. The intent is to improve operating room utilization and efficiency and to enhance revenue by cost savings.

Significant Topics Discussed:
Director Collins reported that CountyCare (Medicaid managed care) is failing to capture the business of its members who continue to use other Hospitals & Clinics in the network resulting in a $10m shortfall from budgeted income in Dec. 2015.  Corrective action plans include:

1. Primary care physician outreach - encouraging them to refer patients to CCHHS, explaining that the perception of long waiting lines for services and appointments is no longer a fact
2. Addressing lack of patient parking by relocating employee parking to a remote lot & providing shuttle service
3. Lack of cleanliness has been addressed by contracting with a a new cleaning service 

Dr. Shannon, CEO presented an overview of the new Strategic Plan for CCHHS that   the Board will be developing over the next 5-6 months. Board meetings will be devoted to creating the Strategic Plan, and committee reports will be curtailed.
The 5 principal objectives of the Strategic Plan:

1. Improve healthcare equity
2. High quality,safe,reliable care
3. Demonstrate value, use benchmarking
4. Develop human capital
5. Leader in medical education and clinical investigation.

​Items to Watch For:

• Strategic Plan posted to CCHHS website
• More labor unrest due to “change” and market-place pressures CCHHS must adapt to

Observation: 
The CCHHS Board, are dedicated, represented by a diverse background of experiences and in Chair Hammock, CEO Shannon and Deputy-CEO Elwell have strong, focused and business-orientated leadership. Net operating margin loss of 199 million for 2015 is less of a loss than in 2014 by 9 million.  Challenges include labor unrest, 30% uninsured patients, and stiff competition from other Hospital Groups. CCHHS will continue to require subsidies from Cook County to survive and budgetary deficits at the State level will be aggravated in 2017 when 5% of the cost of new Medicaid patients will revert from federal to State payments.

Observer: Susan Kern              Meeting Length: 3 hours