Cook County Health (CCH) Board of Directors Meeting
November 22, 2024; 9 am   

Aaron Galeener, Chief Administrative Officer CountyCare, the County Health and Hospital System’s Medicaid managed care organization, responded to questions by Board Directors on how the incoming Trump  administration might affect the Hospital System.  Lots of concerns that the Hospital’s Medicaid block grants might be at risk noted Galeener.  CountyCare was founded utilizing a 1115 Medicaid waiver.  CFO Cassara added that CCH leadership would be conducting strategic discussions on possible impacts.  Governor Pritzker, Cook County Board President Preckwinkle and others will support CCH initiatives others commented.  Should CCH be concerned Director Robinson queried, with Galeener responding that they were hoping moderating influences would prevail.

Board Action: 

• Lyndon Taylor was re-elected unopposed as Chair of CCH Board by Directors.
• CC Commissioner William Lowry was elected unopposed as Vice Chair of CCH Board of Directors.
• Contract and Procurement items were all approved with: 

• Director Bhatt dissenting and voting “present” rather than “yes” on items 11 (Deloitte Consulting LLP: service-supply chain optimization consulting $598,095 extension of existing contract) and 20 (Deloitte Consulting LLP: service-human resources optimization, consulting and support services; $9,211,367 competitive bid RFP ).
• Likewise, Director Sorrell voted “present rather than yes for items 7 (Rush University Medical Center: service-clinical services agreement—no fiscal impact, extension of sole source contract) and 43 (Rush University Medical Center: service-renal biopsy studies, consults & conference moderation; $149,999, extension of contract--competitive bid RFP).  No discussion on reasons for dissent.
• Sept. 30, 2024 CCH Financials show $51,255,000 unfavorable variance to Budget for line item: supplies & pharmaceuticals.  This was attributed to increasing use of expensive biologic and genetic drugs, such as sickle-cell anemia gene treatment and others. 

Research and Grant Funding Discussion:

• Discussed the Life Science Department, newly established in 2024 to win research and other grants and contracts and manage them to increase a larger flow of extramural funds and expand the base of funders with the goal of supplementing revenue to CCH.

• Hektoen Institute has historically managed CCH’s grant solicitation and management.  Transition of Hektoen staff to permanent CCH positions is on-going with nearly 100 FTEs expected to transition by March 31,2025 at comparable salary & benefits.
• Directors posed numerous questions: 

• Institutional Review Board required to enroll human subjects— who will manage IRB, obtain informed consent, process research grant specimens? Answer: The program that sponsors the grant will manage IRB .  Clinical trial lab specimens will be processed at CCH.  
• Will participants recruited for clinical studies reflect CCH population? What about patients not eligible for study enrollment?  
• Grant funders have asked serious questions about the capability of CCH to manage their research grants. 
• Hektoen charges an 11% management fee—can CCH really provide services at this financial break point?  Will we generate more revenue than currently using Hektoen?
• How will we retain clinical investigators at CCH to be competitive?
• Director Reiter, Acting Board Chair in the absence of Lyndon Taylor, tabled the topic for further discussions at subsequent meetings.

Items to Watch for in the Future:

• Hektoen transition of grant management to new CCH Life Sciences Department status in 2025.
• Potential changes to Medicaid and healthcare provision impacting CCH in 2025 under new USA administration. 

Observer - Susan Kern, MD


Cook County Health Human Resources Committee Meeting
 November 14, 2024

Dr. Mikaitis introduced the newly hired Chief of Human Resources, Mr. Win Buren who joined the System just three days before on November 11.  The interim Chief, Carrie Pramuk-Volk was thanked for her leadership during the position search.

Metrics October 30, 2024:

• 1700 vacancies – 1200 of which are currently in the HR hiring/replacement process
•   113 days on average to fill positions and a 64% offer acceptance rate
• 1060 total filled positions of which 725 were external hires

December 1 – October 31 metrics:

• 290 Nurse hires and 173 separations:  117 net new nurse additions
•   107 days on average to fill positions
•   173 Retirements
•   216 Resignations
•     56 Discharges

September Agency Hires:  1,378                      October Agency Hires:  1,224

Recruitment Process Improvements: 40% reduction in positions not posted within 14 days of approval
Decision to Hire packets not completed within 14 days of submission also showed a 40% reduction.

Provident Scholarships:
2022    31 scholars $348,000 awarded           
2023    60 scholars $900,000 awarded
2024    91 scholars $1.3million awarded 

Observer - Diane Edmundson     

Cook County Health Board of Directors Meeting
October 25, 2024   

After securing approval of the AFSCME31 and SEIU 73 contracts, Acting Chair of this meeting, Robert Reiter, JR. (also the Chairperson of the Finance Cmte) revealed that the number of nursing staff vacancies has been frozen at the request of the County Board.  Although the number of budgeted positions is fixed, there is an increased need for staff due to increased patient load, new services, etc.  In turn, there is increased utilization of registry, which continues to negatively impact finances and employee morale.

The first public speaker, Dominica Flanagan, RN, SANE (Sexual Assault Nurse Examiner) in Pediatrics, 

• expressed her concern for two pediatric victims of sexual assault because she was not called in to interview the victims and assist due to the Executive Order to not call her on her day off.  

Before recessing to executive session, a second speaker, Mr. Blakemore, stated that

• “Health is Wealth.” and wants all CCH employees to use CCH for their health care.  And, US citizens to go to the front of the line.

Board members drilled down into the data in the just received 2022 Public Health report.

• 12-month delay on producing an annual report.  
• Faster results, like those for Covid are less accurate, have duplication and incorrect locations: address of report vs actual location.
• Items discussed were rates based on income and race for: 
  • pre-term birth, stroke mortality, equity and health equity, language preference, sexual orientation, lead abatement.
  • using opioid deaths to focus on specific communities for distribution of Naloxone/Narcan to specific organizations and businesses.  

Discussion of the late addition to the agenda: VI Action Items E. regarding the proposed resolution regarding agency usage and strategies promoted discussion and was referred to Finance Committee for more conversations with the labor partners. 

• CCH Board wants to maintain control and not have the Commissioners take over. 
• The turnover rate is at 18% which is less than the national average of 20%.
• 1264 vacancies; 
• 50% are in interview/offer stages.  
• 38% decrease in resignations over 2022/2023, but December sees higher rate of retirements.  
• 98 net new hires as of now, was 23 last year at this time.  
• 18% utilization of agency (averaged across all Depts & roles).

Other Items of Note:

• New device:  CCH has acquired and deployed a new robotic Lung Cancer Biopsy tool.
• Leader Rounds: 2-3 CCH Board members will make “rounds” to departments.
• New Leadership: Dr. Erik Mikaitis was introduced as the new CEO.
• New Board members: Maya Green, MD, MPH, FACHE and Dr. Inger Burnet-Ziegler
• Departing Leadership: Robert Currie

Observer -  Victoria L Cerinich

CCH Managed Care Committee Meeting –
October 18, 2024

Metrics Reported:
Members as of September 5:                    417,175
ACHN Members                                             31,621
% of CountyCare Members that use CC Health     7.60%

​Highlights from the meeting:

• CountyCare achieved a 90% redetermination rate to continue to lead the Managed Medicaid Market in Cook County with 34.2% of the total market share as of 6/24
• CountyCare received an award for its Food Insecurity Program
• In August 100,000 transportation requests were received.  Previously, LWVCC reported that CountyCare has switched to a new and broader transportation program including public and for-hire options.
• To Increase the 7.60% cited above, CountyCare staff is working with Cermak inmates to build relationships and trust before they are released.in order to retain them for CCH services.
• CountyCare led in the 2024 NCQA Health Plan ratings with prevention and equity, earning a 3.5 Star with the highest measurers for adolescent immunizations, BME percentile assessment, and prenatal immunizations.
• CountyCare working on a TeleHealth RFP which would have the potential for on-demand care for those that need it.  Implementation for selected vendors in early 2025.  To date.  CountyCare has contracted with 10 telehealth providers, adding at least 84 practitioners to the virtual care network.  Behavioral health is the domain more generally available.

Observer:  Diane Edmundson

Cook County Health Board & Committee Reports
August 23, 2024

Board Meeting Discussion and Action:
Chairman Taylor and Dr. Erik Mikaitis, Interim CEO, began the meeting with the announcement that anchored by CCH’S Provident Hospital the Bronzeville Community Health Center will offer family medicine, behavioral health, and rehabilitation services including physical, occupational and speech therapy.  The 26,000 square foot center is projected to have 80-85,000 visits in its first year and will include 44 exam rooms and a gym space for therapy services providing care for patients of all ages and stages of life.    The family medicine and behavioral health practices are moving from Provident Hospital’s Sengstacke Health Center into Bronzeville which offers a larger, more modern environment to better serve patients.  The move will also free up more clinical space within Provident to allow for the expansion of hospital-based services.  Patients will continue to be able to receive comprehensive primary and specialty outpatient care at Sengstake.
 
CEO Position: The Commissioners adjourned following the Public Testimony to a Closed Session.  Upon return, Chairman Taylor made a motion to entertain and approve, subject to the approval of the Cook County Board of Commissioners, the appointment of Candidate “A” for the position of Chief Executive Officer of the Cook County Health and Hospital Systems pursuant to the compensation package discussed in closed session.  Motion to approve carried.  

Report from Interim CEO:   Dr. Mikaitis presented a high-level review of ARPA hire and spend. The current spend of ARPA funds is $137M with a remaining obligation of $97M which must be obligated by the end of 2024 with spend through 2026.  Next steps will be to determine sources to continue funding after ARPA funds are spent i.e. post 2026.  Initiatives include Food as Medicine at Belmont-Cragin and an opportunity at Provident Hospital.  Housing for Health which has received a boost to its effectiveness with ARPA funds. This was followed by updates on all the various programs which have received ARPA funding.  
Dr. Hasbrook was requested to in the future provide information about the overlap between Public Health outreach and the programs and to report on the collective impact of the investment in dollars and resources of the various programs. A report on Branding followed with a presentation of the new tagline – “Accountable, Exceptional for All.”  Updates have been made to web sites and staff will have access to new materials for use with patients after launch in September.   
 
Finance Committee:  Director Reiter briefly outlined the three Finance Committee meetings and public hearings in which the FY2025 preliminary budget was presented in detail and the August 15 Finance Committee Meeting where the preliminary budget was approved and requested a motion to approve without another presentation by Pam Cassara.  The CCH approved budget for 2025 is projected at $5.1B for both income and expenses.     Motion presented and approved.   This projected budget will require the  approval of the Cook County Board of Commissions in October.

Audit and Compliance Committee:  Director Harrington reviewed the minutes of the August 2, 2024, meeting indicating that Nicole Emerald, Chief Compliance and Privacy Officer reviewed 1st and 2nd Quarters including system compliance program and Cook County Medicaid Health Plan Compliance Program as well as recovery and the privacy update.  Motion made to approve and carried.  The next meeting will be on Friday, October 18 at 9:00 a.m.

Human Resources:  Reported metrics on vacancies, separations and status of hiring efforts.  1,080 vacancies reported as of the end of July.

Public Speaker Testimony:  There were four in-person, and one written testimonies provided.  The four speakers providing testimony were Dr. Ngozi Ezike, President and CEO of Sinai Chicago Hospital; Lena Hatchett, PhD, Co-founder and Executive Lead for Proviso Partners for Health (PP4H); Jackie Burgess Bishop, CEO National Kidney Foundation of Illinois; and Esther Cook, CEO Alevio FQHC serving Hispanic populations.  All four spoke in strong support of the preliminary Cook County Health and County Care budget for the coming fiscal year.  Each speaker provided an example of how their partnership with Cook County Health has had a positive impact on the goals and objectives of their organizations and a positive impact on the people they serve. 

Observer: Peg Moster

Quality and Patient Safety Committee: 
August 15
The Stroger Hospital and Ambulatory Clinics Joint Commission Triennial Accreditation and Primary Care Medical Home Certification survey was successfully completed in June 2024:

• The overall compliance was 97% for all standards and elements of performance. 
• Corrective actions were established for the findings identified and evidence of compliance will be submitted to the Joint Commission this month.
• Departments will report compliance data at the Hospital Quality and Patient Safety Committee meetings monthly August 2024 – December 2024, then quarterly thereafter thru 2025.
• A compliance dashboard has been developed for reporting and to track ongoing compliance.

Observer - Lisa Slankard

Managed Care Committee: 
August 2 
Metrics: 426,239 total members [well above budget projections].   32,928 ACHN Members [7.7%].  It continues to be the leading Managed Medicare Plan in CC with a 34.2%.  BC/SH is next with 27.2% market share. The CountyCare staff received kudos for its 88.9 Redetermination Rate and its marketing and outreach efforts including billboards along the expressways.  
CountyCare Access (health benefits for immigrant adults and seniors):  Effective January 1, 2023, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan.  Through April of 2024, a total of 35,000 HBI immigrants have come into the plan.  
Healthy Choice Illinois RFP: The RFP by the State has been delayed for a year.  The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
Quality and Equity Choice Campaign:  Primary care engagement strategies will focus on adults 18-24.  Equity efforts will start with smoking cessation via education and prevention.  Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants.  Clinical Services will focus on accomplishments particularly with behavioral health participants.
Other Successes, Goals, Strategies, and Metrics:

• Won three National Association of counties awards for Addressing food insecurity [Best in Category], engaging members during redetermination, and improving member demographics. It also won an Aster Award for healthcare marketing, advertising, and communications.
• HEDIS scores improved in all but one category [follow up after ED visit for mental illness in 7 days  dropped 3%]. Opportunities for improvement for 2024-25 include behavioral health, living with illness and chronic disease, and maternal and child health.
• CCH’s Illinois Healthcare Transformation 1115 Waiver [promotes the objectives of the children’s CHIP program] was approved as of 7-2-24 and ending 6-30-29.  However, within the request, 3 specific waivers were not approved, a leadership grant program, the redirection of DSH funding to create a pool of funding for strategies and intervention in underserved communities, and training community health workers.
• Food care strategies started in 2023 include emergency meals, general nutrition programs, and medically tailored food. A Total of 7,800 members have been engaged as of the August 2, 2024 report.
• A new non-emergency medical transportation vendor [ModivCare] will start on August 1. ModivCare maintains a network of providers providing multiple levels of transportation services, including public.
• In 2024, CCH and County-Care entered into a new value-based payment arrangement with the State including pay-for-performance incentives tied to key quality outcomes.

​Observer - Diane Edmundson

Cook County Health Finance Committee Meeting
August 15, 2024

​Attendance: Joseph Harrington, Sam Robinson, and Chair:  Robert Reiter. 

Proposed CCH FY2025 Preliminary Budget

• Proposed CCH FY25 Preliminary Budget: Pamela Cassara presented slides reviewing the preliminary FY25 Budget. The Finance Committee had no questions for the presenter. The vote was unanimous for approval by the Finance Committee of proposed preliminary FY25 Budget. The FY25 preliminary budget will now go to the full Health System Board. 

Contracts and Procurement Items 

• All 15 contracts were approved. 
• There was discussion regarding the amended and extended contract to 12/31/24 for agency staffing in radiology for both front line technicians and supervisory staffing for mammography PET and CT services. Response regarding actions by the Health System to reduce the amount of agency radiology staff focused on not being able to recruit staff due to shortages of qualified personnel. 
• Background: 
  • This contract for temporary staff agency in radiology has been in place for 2 years 
  • On 09/16/2022, the CCH Board of Directors were notified of an Emergency Purchase for contract in an amount not to exceed $1,550,000.00 for a twelve (12) month period from 09/26/2022 thru 09/25/2023. On 09/29/2023, the CCH Board of Directors approved a request to extend the contract thru 09/25/2024 and increase the contract by $6,976,613. 33

June 2024 Financials

• The report for financials noted in the payor mix a decrease in those covered by Medicaid and a increase in uncompensated care. This is attributed to loss of Medicaid coverage for persons due to the redetermination process.
• Noted also was a slight increase from FY23 in those covered by commercial insurance (7.4 to 7.8 %)

​Observer: Susan Avila

Cook County Health Board Meeting
June 28, 2024

Challenge of Monitoring 53 Separate Behavioral Health Grant Awardees

• Grants of either $500,000 or $1 Million of ARPA funds under the Stronger Together Behavioral Health initiative have been awarded to 53 different community-based organization  The purpose of the grants is to address behavioral health inequities across the region’s system of care through increased systems alignment, enhanced system quality, and the expansion of access to early intervention and prevention, treatment, support, recovery and crisis assessment and care.  Grant awards were made  to those communities in greatest need and will begin  September 2024. Commissioners were concerned with how the Department would accomplish gathering granular data, given the diversity of grantee organizations to be able to measure effectiveness. The Department recognizes  the challenge and is working on and dedicated to setting measurable and quantifiable goals and objectives. 
• The Commissioners also engaged in a discussion on the use of the term  “mental health” vs. “behavioral health” indicating that each may create stigma. The Department indicated that both terms are in use but are dependent on circumstances and level of comfort with who they are addressing at any time. Commissioners requested an update on goals and objectives in six months.

Report from Chairman of Board:  

• Chair Taylor asked for a moment of silence in recognition of the passing of Commissioner Dennis Deer and announced that there would be a formal recognition of his contributions with Commissioner Deer’s family present at the next scheduled Board meeting on July 26, 2024.  There were Commissioners who chose to reflect on their friendship with Commissioner Deer at this meeting as well.

Finance Committee Report: 

• A total of thirty-four contracts received approval from the Finance Committee on June 14th and subsequently received approval by the Board. Six had no fiscal impact, two were ARPA funded and two were grant funded. Of the remaining contracts, ten exceeded $1 million with the majority of those between $1 and $3.6 million except for a three-year contract for 3rd Party Administration of dental and vision benefits awarded to Avesis for $9.9 million; and a 2-1/2 year contract for telephone triage and referral services for mental health and substance abuse awarded to NAMI of Chicago for $7.9 million.   
• Questions were raised by Board regarding an amendment and increase to the contract with In His Hands Resource Center for $46,150 (ARPA funded) as to impact on homeless families with children and a request made to drill down to all levels of need - singles, families with children under 12, bi-lingual, etc. and further, how this service would be funded after ARPA funds are exhausted.

Quality and Patient Safety and Audit and Compliance Committees:  

• Due to a lack of a quorum, the Quality and Patient Safety meeting was cancelled. The Committee submitted reports for informational purposes and later consideration.
• Although the Audit and Compliance Committee had rescheduled its meeting to the hour before today’s Board Meeting, it went into a closed meeting and never reconvened into an open session. 

Report from Interim Chief Executive Officer:

• In addition to the Behavioral Health Grant awards, Dr. Mikaitis reported successful audits including a Joint Commission survey, and  an IDPH compliance audit for a sickle cell grant. Cermak developed a comprehensive resource guide for individuals leaving Cook County Jail. CCDPH continues to participate in the 100-day challenge to end homelessness in Suburban Cook County.

Informational Reports:  

1. Human Resources Committee Metrics: Second quarter vacancies at 1,821 with 1,435 at various stages of fulfillment from posting of position to offers made. Separations and retirements trending down, and one-third of  ARPA funded positions filled with permanent staff. The accelerated Nursing hire between August 2023 and May 31, 2024,  had 564 offers made with three hundred accepted and twenty-eight pending for a 57% acceptance rate. There were declines from applicants who had applied for multiple positions and could only accept one.
2. Managed Care Committee Metrics: County Care had 429,217 members as of June 5, 2024, and 33.7% of the managed Medicaid Market in Cook County. CountyCare’s enrollment increased 1.3% in March in part due to an 83.7% retention rate over projections. Retention through redeterminations has been helped by the presence of DHS staff at dedicated redetermination events hosted by County Care. 

​Observer - Peg Moster

Cook County Health (CCH) Board of Directors Meeting
May 31, 2024

Stroger Hospital was awarded a “B” safety grade by The Leapfrog Group. This Grade is the only hospital rating focused exclusively on hospital safety and ranks nearly 3000 hospitals
CCH’s 2024 state legislative priorities:

• Secure annual appropriations to fund the Equity and Representation in Health Care Act (Public Act 102-0942)
• Protect and strengthen Medicaid. (Governor’s proposed FY2025 budget included $629M to continue Medicaid-like coverage for immigrant adults 42+ year but would not allow for a lift of the enrollment freeze in place since 2023.
• Support legislation that promotes harm reduction and prioritizes treatment instead of imposing criminal penalties (HB2/SB78 and SB1830) 
• Advocate for increased funding to local health departments (HB4823)

The new Neurocritical ICU at Stroger opened on May 28 which includes Board certified physicians and specialized APNs as well as state-of-the-art equipment to provide advanced care to patients with complex neurological conditions and injuries.
Additional report of interest:  Value-Based Care Strategy goals are to improve quality, enhance member 2024 Goals:

• Execute new value-based agreements
• Enhance core capabilities
• Align value to equity through appropriate measures and incentives

Observer:  Susan Gregory (reported from slides.  Virtual audio was not working]

CCH Finance Committee  – May 20, 2024 

• Execute contract for community triage and wellness center. This center was opened by the County Health System in Nov 2019 located in the former Roseland police station on 115th Street. The contract with Human Resource Development Institute (HRDI) lapsed in 11/30/23 but is now being reactivated for $500,000.00. The services provide a diversion from emergency departments for those experiencing a mental health crisis but who do not require psychiatric hospitalization. There is nationwide dearth of crisis care services, and the Roseland community has been identified as an area of need.
• Extend and Increase contract for $16,800,000.00 to Guidehouse Managed Services for the expansion of current operational teams and the creation of new support functions/teams. Additionally, this partnership is being leveraged to transition our professional coding, billing, collections and authorization operations in house. CCH is exercising the second one-year renewal option.

Observer:  Sue Avila

CCH Quality & Patient Safety Committee – May 20, 2024

• Provident Hospital underwent the radiation safety inspection survey with the Illinois Emergency Management Agency (IEMA) on 4/18/24. They were in compliance with all regulations. 
• Stroger Hospital and the Ambulatory services continue to prepare for the Joint Commission on Accreditation of HealthCare Organizations (JCAHO) survey. 
• Provident Hospital is actively working to improve the LWBS (left without being seen) goal. When ambulance service started at Provident the Emergency Department was overwhelmed with both ambulance patients and walk-ins who now realized the Emergency Department was open. There was also a nursing staff shortage. Many patients left without being seen. The staffing situation has eased. Some changes that were put in effect included a rapid evaluation by a provider in triage right after registration and a “pull to full” strategy which entailed keeping the patients in the care section instead of sending them back to the waiting room after triage. There are now daily and weekly reports on LWBS patients. 
• There has been an increase in mental health volume since most mental health patients arrive via ambulance.

Observer:  Lisa Slankard
​
CCH Human Resources Committee – May 20, 2024
Report from Interim Chief HR Officer C Pramuk-Volk on Strategic Plan Areas of Focus:

• Increased & Accelerated Talent Acquisition
  • 439 filled position YTD (68% offer acceptance ratio); 302 external filled positions (100 net gain)
  • 1400 vacancies in budgeted positions as of April 30, 2024, 815 are posted or in the interview process, 351 in the decision to hire process, and 138 have an offer accepted
  • Accelerated nursing hiring (8/23-4/24): of 459 offers, 251 (57%) accepted, 17 pending, 191 (41%) declined
  • 72% of nurses hired (8/23-8/24) came from agencies
• Increased Retention & Decreased Turnover
  • Exit surveys indicate that retirement is the number 1 reason for leaving; others include family/personal, my manager, and career progression
  • 77% of employees had a positive experience with their team and leaders
  • Implementing programs to improved team experiences, e.g. Building Workplace Relations and Harmonizing Guidance and Templates
  • Implementing Employee Recognition Programs

Observer:  Sue Gregory