Cook County Health (CCH) Board of Directors Meeting
August 25, 2023  -  9AM

Board Action and Reports:

• Unanimously approved with minimal discussion, by the CCH Board (who were all present in person or virtually or excused) the budget now heads for final approval to the Cook County Board.  Increase of $265 million from the 2023 budget of $3.992 billion is attributed to a ramp up of new service line investments in cardiology, neurology and cancer center and by rising costs and utilization rates for lab, registry temporary services, medical and pharmacy supplies.  Defraying these expenditures are projected enhanced revenues from federal programs $196 million (DSH/BIPA/GME/Direct Payments), increased CCH net patient revenues $62 million and additional Cook County tax allocation of $10 million (total tax allocation $157.7 million).
• Aaron Galeener, Chief Admin. Officer of CountyCare managed health plan reported on the redetermination of Medicaid benefits for plan members which was on pause during COVID.  Rolling numbers of members each month will be required to submit information to confirm eligibility starting June 2023 through May 2024.  Favorable retention rate to CountyCare of 85% vs 69% Statewide is recorded for the early months.
• Asylum Seekers program at Belmont Cragin ACHN (Ambulatory & Community Health Network clinic of Cook County Health) celebrated their 1st year anniversary providing healthcare including mental/behavioral health and transportation to appointments for immigrants.  Craig Williams, Chief Admin. Officer, Operations & Development detailed the services and noted that the cost of $1.8 million a month was funded by charitable support from the City of Chicago, CareLink, and other organizations. 
• Emergency increase of $36 million to the 5-year $400 million pharmaceutical contract generated the most animated discussion by Board Directors who were concerned that the contract amendment had not gone through the Finance Committee scrutiny on August 17, 2023 as is standard contract compliance governance.  Directors Currie, Robinson, Harrington, and Garza voiced disquiet that the “add on contract” was not in the Board packet. Director Reiter, Finance Committee Chair and CEO Rocha defended their decision as necessary to prevent an over-draft of the contract which was imminent due to a significant increment in the cost of pharmaceuticals which had not been anticipated.    

Items to Watch for in the Future: 

• Many of the Health System’s Board are newly appointed.  Will there be changes in governance philosophy?

Observed By: Susan Kern

Cook County Health (CCH) Board of Directors Meeting    
June 25, 2021
All board members were in attendance.  It was Director Mary Driscoll’s last meeting and she was lauded.

Highlight of the Meeting:

• Cook County Health has received a $25,214,437 federal grant. It will be a two-year project  (June 1, 2021 – May 31, 2023) The focus will be on priority communities and populations, with an expectation that this funding will impact 100% of jurisdiction through systems change.

There was no public testimony received at this meeting.

What did the Board decide?

• Approved 12 month purchase of reinsurance for CountyCare Health plan not to exceed $1,559,000.00. Since the inception of CountyCare, Cook County Health (CCH) has purchased reinsurance to offset the risk of its high-cost members. Claims costs incurred in excess of a per member threshold amount within a calendar year are reimbursed to CCH. Coverage is priced on a PMPM basis for Medicaid and Medicare by population type (e.g. FHP, SPD, ACA Adults, MA, SNP).
• The CCH policy is issued under a County-wide insurance brokerage contract with Alliant Insurance Services, managed by the County’s Office of Risk Management. CCH recommends entering a stop-loss policy coverage for twelve months, through December 31, 2021. Based on the bids submitted, and pricing and risk analysis, the recommended policy would establish a threshold for reinsurance at $2,750,000 for Medicaid and $300,000 for Medicare.
• Approved transfer of funds from salaries to contract position.  This was not connected to the strikes but due to delay in FEMA funds.

Committee Reports:
Human Resources Committee:

• Very little change in vaccination rates from last month. The union is working to encourage members to get vaccinated and VP Kamala Harris visited the CFL. 
• There have been 2 strikes this past month.  Both nursing and SEIU struck because of overdue contracts and staffing shortages.  There has been a significant increase in resignations this year
• New Chief Human Resources officer is Valerie Amos
• New Chief Revenue Officer is Curtis Haley

Finance Committee:

• Discussion on y-t-d financials, accrual vs cash methods.  Positive variance using accrual but negative variance using cash method

Quality and Patient Safety Committee:

• Elevated 30 day readmission rate with sepsis overtaking Congestive Heart Failure (CHF) as top diagnoses.

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues regarding strikes and open positions due to increase in resignations

Observed by:     Lisa Slankard                               Meeting Length:     2 ¾ hrs  

Cook County Health Board Meeting - September 25, 2020

The only action items were related to procurement but the board went into a closed session. 

• The public speaker testimony was all from Stroger employees and dealt with the handling of COVID-19. SEIU employees were laid off in the spring and many of their duties were transferred to the nurses. Neither group feels this is fair. The service employees want their hours back, sufficient PPE and additional training to do their jobs. The nurses want to do only nursing work. They all want hazard pay and PPE needed to do their jobs. 
• The board thanked the departing board members and welcomed Directors Garza and Curry. The new directors introduced themselves and spoke about their professional backgrounds. Director Richardson-Lowry stayed on for this meeting.

Committee Reports:

• Most of the committee reports addressed the changes made by the pandemic, including rule changes that were made to accommodate telemedicine and the financial effects.
• The quality committee spoke about changing the HgA1C indicator to include only patients that were seen twice in the last year.  (The HgA1C is a measure of how well blood glucose is controlled. Instead of a snapshot like a glucose level it takes into account 3 months of levels.)
• The contract metrics on women and minority owned businesses were not good this summer, possibly COVID related. YTD shows a surplus of revenue of $119 million but that includes $153 million received from the CARES act. 

​Interim CEO, Debra Carey reported: 

• that the hospital is encouraging patients to complete their census forms;
• and In the ER, they are helping people register to vote using the TurboVote platform via the patient’s phones.
  
• The Cook County jail after having a rough time with COVID is now down to a 0.5% positivity rate. 
• All employees are being encouraged to receive flu shots in advance of an expected difficult winter.
• The ER will be using a combined flu/COVID swab test. 
• he big concern is the possibility of the ACA being struck down in the Supreme Court. This will have an approximately $600 million dollar negative impact on the bottom line.

 
Items to Watch for in the Future:

• The future of the ACA or a replacement.
• Shortage and cost of PPE.
• Women and minority owned business contracts. 

Observer:  Lisa Slankard                                       Length of Meeting:  2 and 3/4 hours

Cook County Health Board Meeting -  February 28, 2019 

What did the Board Discuss:

• The first Cook County Health (CCH) Research and Innovation Summit was held February 20, 2019 on the topic of opioids. More than 120 individuals attended. This summit was designed to share CCH's efforts and plans to address the opioid epidemic with other established interest groups and included action planning with health and community leaders.
• County Care managed care members as of February 7, 2019: 320,994 of which 13.7% are using CCH services. These latest numbers are down 10% from the same time last year. The target for 2019 membership is 345,000. Annual redetermination of Medicaid members is a review of their eligibility for Medicaid and requires submission of redetermination forms in a timely manner. Now an automated system drops individuals from Medicaid rolls if the forms are not completed on time. If dropped, the individual looses continuity with their Primary Care Provider and case managers. In order to keep its members, County Care offers to help with the redetermination process. County Care has raised concerns about this process with Governor Pritzker.
• FY 2019 CCH system wide uninsured numbers captured by visit is 44%. The FY 2018 uninsured numbers were 42%. There is a need to get details of these uninsured to see if some are eligible for Medicaid, then assist them in enrollment.
• Governor Pritzker announced that Dr Ngozi Ezike was appointed Director of the Illinois Department of Public Health (requires state Senate approval). She served for more than 15 years at CCH and most recently served as a physician at the Juvenile Temporary Detention Center.
• The Cook County Department of Public Health (CCDPH) has a tobacco prevention and control unit and its goal is to eliminate exposure to secondhand smoke, promote quitting, and prevention of youth smoking. In Suburban Cook County, 16.7% of adults are current smokers. E-cigarettes are currently the most used tobacco product among youths and its use in this group has increased last year. E-cigarette liquid contains chemicals and carcinogens and this liquid can poison children through ingestion or skin absorption.
• It was announced that there would be no election of the CCH Board Vice-Chairman at this meeting.

Board Decision:

• A contract with the Bobby E. Wright Comprehensive Behavioral Health for mobile crisis outreach team. This is a nonprofit on Chicago's Westside that provides mental healthcare, addiction treatment and developmental disability services.

​Items to watch for:

• The final audit of FY2018 in May 2019
• The second CCH Research and Innovation Summit to be held May 22, 2019 on the topic of housing.

 Observed by: Michele Niccolai                                                     Meeting Length: 2 hours 30 minutes

CCHHS Board Meeting - January 29, 2016

Topics Discussed:
Patient Satisfaction at Stroger Hospital:  After one year of data keeping there has been no improvement as indicated in the latest metrics.  Chief Quality Officer Dr. Krishna Das attributed the problem to perceived wait times and cleanliness as key issues. Dr. Das and CEO Dr. Jay Shannon stressed the importance of educating managers to understand the critical link between service quality and patient retention.

Emergency Room Visits: CountyCare 2015 data reveal only a minimal decline in Emergency Room visits from the same period in 2014. County Care was intended to provide a "medical home" for patients to receive care so as to decrease the need for Emergency Room care. Reasons for the minimal decline identified in board discussion included:

1. Complexity of patient problems that require multiple specialists. 
2. Wait times in the ER can be shorter to get speciality care than having to wait to make an appointment at a speciality clinic.
3. Patients are used to getting their care in the ER and patients are reluctant to change their way of accessing care.

Contracts Approved:

• A sole source contract to Community Health Solutions for $4,982,040 to provide contracted staff, including nurses.  Public speakers including CCHHS staff nurses spoke strongly against the contract, citing CCHHS oversight challenges of nonstaff workers and promising strong union opposition.  Deputy CEO Doug Elwell said the contracted positions will come in house within the year. 
• Approval of contract for $1,920,011,725.00, as a pass-through to Valence Health, OptumRx, DentaQuest, and First Transit allowing them to pay service claim reimbursements to CountyCare service providers.

Items To Watch For: 

• Schematic designs for the central campus redevelopment are due to be complete by the end of March.
• A 3-year CCHHS strategic plan is due to be unveiled by June or July, with significant board input.

Observation:
​CCHHS has a professional, effective board of directors. The 11 board members have carefully developed metrics to measure quality and patient safety, human resources, managed care, and finances; managers now provide these data on a monthly basis.  The board will begin benchmarking their data against Kaiser and other major national health care providers. Check out the latest metrics presented to the board.

Observer: Linda Christianson   Meeting Length: 3 hours