Cook County Health (CCH) Board of Directors - December 4, 2020
  
Acting CEO Debra Carey was thanked for the outstanding job she did this year in guiding Cook County Health (CCH) through the pandemic and the fiscal challenges. CEO-Elect Israel Rocha begins on Dec 7, 2020. He observed the meeting. All directors were present.

The Center on Health Equity and Innovation will go live with their new CMIS software on 1/1/2021.   $12 million was brought in from outside sources to fund this in 2020 and a $47 million grant was received covering a 4 year period.

Dr Lakshmi Warrior, a co-leader for the Cook County Racial and Health initiative was congratulated for being named one of the 40-Under-40 by Crain’s Chicago.

Committee Reports:

• Human Resources - The results of the biennial Employee Engagement survey were presented. The response rate was 56% up from 52% in 2018. The engagement indicator rose from 3.8% to 3.83%. They will use the data to develop action plans. The hiring of contact tracers has hit a snag in that several of the people hired are in quarantine and can’t come in to complete the hiring process (i.e. the employee physical). COVID has made hiring nurses difficult and agency nurses are still being used, but some have left for other states where they can earn as much as $200 an hour.
• Managed Care - CountyCare wants to renegotiate the PMPM with the state, and the state has expressed a willingness to consider.  Currently, CCH is required to give 10% of PMPM revenues back to the state.  Monthly enrollment reached 374,000 in October.
• Quality and Patient Care - The readmission rate is still too high primarily due to heart failure patients. There is a gap in care coordination. The Stroger recommendation rating is now up to 77.97%. The target is 71.3%
• Finance - 2020 financial numbers look good.  Could end the year with a small surplus based on resolution of Cares Act reverting back to the June requirements.  The January report should have final 2020 results.

COVID-19 Update:

• Testing has substantially increased but so have cases. The jail has become a problem again after getting it under control during the summer. The number of detainees is increasing. 
• Vaccine update- CCH is prepared for the vaccine's arrival. Extra cold storage units are in place and a plan for vaccinating employees is ready. At this point it will be available on a volunteer basis. Due to the side effect profile - sore arm, fatigue, headache for 24 hours - the roll out will not be by department. This will allow for affected employees to call out sick without putting undue strain on departments.

New Business:

• Chair Hammock requested a summary of the CCH and County Care Finance Reports for the board – and in particular, the new directors.
• The Racial Health Equity and Innovation Report will host a Webinar in February 2021 

Observed by:  Lisa Slankard                            Meeting Length: 3.25 hr

Cook County Health (CCH) Board Meeting
October 30, 2020

From Public Health to Finances to Human Resources to the Managed Care Program, Cook County Health officials reported that COVID-19 impacted most sectors of the System's operations.  

Public comments:   The League of Women Voters of Cook County and Civic Federation's comments urging the continuation of live streaming and archival recording of board and committee meetings post pandemic was the first to be read - followed by a number of nurses’ statements that Covid-19 testing in the new Blue Island community facility isn't safe due to space limitations and staff shortages. 

Committee/Department Reports:

• Human Resources: The new chair is Mary Driscoll.  312 contract tracing positions are in the recruitment phase with 255 in the interview process and 1 person hired.  Position approval related to Covid and revenue shortfalls has slowed down the hiring activity for non-Covid openings.  Of the 520 positions in H.R., 54% have been approved for active recruitment.  Currently, the average time to fill a position is 91 days against a target of 90 days.  Through September, 622 separations have occurred vs 480 in 2019 - over 100 due to layoffs.
• Managed Care:  The new chair is Vice President, David Menar.  Membership in County Care has consistently increased since the start of COVID and the loss of employer health insurance.  Through October 5, total membership was 373,645 which is 2,000 higher than September and within 500 of the 2020 budget projection.  10.4% or 38,815 of these members use Stroger services.  Illinois Medicaid gives County Care its highest ratings among the Cook County Managed Care Providers.  County Care’s market share in Cook County is 31.4% which is the highest percentage followed by Meridian and Blue Cross Blue Shield at 26% and 25% respectively.
• Quality & Patient Care: The average re-admission rate is 10% which is partly due to COVID.  Patient experience ratings inched up under the “communication with doctors category” and slightly down for “communication with nurses”.  Stroger’s hospital patient recommendation rating is at 70.8%.  Several directors commended the staff for their efforts to get the ratings headed in the right direction.
• Finance:  The board approved the acceptance of four grants totaling over $1.6 million.  Almost $1.5 million is from the city of Chicago for mobile units, Stroger, and Provident contact tracing services.  Directors discussed in detail the one year contract with the Hektoen Institute for Medical Research amounting to almost $2.75 million for temporary staffing services.  The contract would allow for up to 60 new hires including one manager, 8 case investigators, 2 case investigator supervisors, and 50 contact tracers. This number is added to the number hired by Hekteon under a 7-23-20 contract and by the System’s Human Resources Department.  Concerns centered on ensuring appropriate discussions and agreement with the AFSME union.  Assurance of contact and discussion was given, and the board approved the contract but requested follow up. As of August 31:   financial results are ahead of budget by $80 million  Negative variances are expense overages, partly due to COVID-19 costs and the loss of revenue due to reduced volumes.  Patient activity revenues have improved to just 22% lower than normal.  Surgery revenue is even closer to normal.   Recent guidelines of how to calculate revenue loss have changed which may negatively affect the amount of the $153.4 million CARES Act monies that can be kept.  DSH monies may also be in jeopardy as Illinois ran out of money in September.
• Public Health:  The System wants to increase the 2020 flu vaccine uptake, particularly for people at higher risk for serious flu and COVID-19.  It is in a collaborative partnership with 23 health providers.  Regarding its COVID-19 response to date, the Cook County Department of Public Health (CCDPH) has investigated over 5,500 cases including over 150 schools with a case or close contact; responded to over 10,000 inquiries; and provided 1,700 individualized recommendations. Compliance efforts in workplaces is ongoing and soon the Department will implement the Worker Protection Program as part of the COVID-19 contact tracing initiative.  This will include conducting pro-active education and outreach to workplaces and workers in Suburban Cook County. In addition, Public Health is planning for COVID-19 vaccinations when the vaccine is available.  Two doses will be needed between 3-4 weeks apart, and it must be the same kind of vaccine for both shots.

Other Items of Interest: 

• Interim CEO, Debra Carey stated that Stroger is one of only two sites in Illinois and one of 24 hospitals in the United States to lead a landmark trial to recruit adults who recently tested positive for COVID-19 to participate in a clinical trial of monoclonal antibodies for the Prevention of Covid-19.  The System is also participating in a Phase III controlled trial for a COVID-19 vaccine known as AZD1222 plus another six trials and studies including being the first hospital in Illinois to participate in a study to understand the effects of COVID-19 on acute myocardial infarction patients.
• In attendance were the three new CCH Board members Robert Currie, Raul Garcia, and Joseph Harrington.
• Moved to the November board meeting is the report from the Audit and Compliance Committee’s special meeting on October 14, 2020 and the report from the Center on Health Equity and Innovation. In addition, Director Guggenheim asked for a report on the COVID-19 mortality numbers of CCH staff.

Observer:  Diane Edmundson                         All 12 board members were present at the 3 hour meeting

Cook County Health (CCH) Board of Directors Meeting
August 28, 2020                                                                                                                                                     

Proposed Budget Discussion:

• Public speakers representing CCH employees and the SEIU labor union  objected to the proposed closing of the Woodlawn and Near South Clinics, conversion of the Provident Emergency Room to standby status and shuttering of the Oak Forest facility to help close a $187 million  deficit in the budget. 
• Despite cuts of 123 employees at Stroger, Provident and the clinics, there is a net increase of 134 FTEs System wide (from 2020)  due to the need for increased COVID-19 associated staffing at Cermak Health (provider of health services for Cook County Jail) and the transfer of CountyCare Managed Care employees to Stroger.
• The projected expense reductions of $55 million leave the remaining $133 million hole in the budget to be filled by increased revenues including Cook County Tax allocation increase of $30 million to $112.7 million.
• State IL , increased Medicaid payments to CCH :are paying the Fee For Service rate rather than lower  CountyCare Managed care rate
• Undocumented patients over 65 are now eligible for Medicaid reimbursement
• Planned improvements in bill collecting/ decrease in bill denials

 FY 2021 Budget Calendar: 

• Public hearings on budget Sept. 1 & 9, 2020
• CCH Board vote on proposed budget, Sept. 11,2020
• Cook County Board Meeting discuss/approve CCH Budget, Sept.24,2020

What else did the Board discuss or decide?

• Interim Chief Business Officer, Gibson reported the System showed  $94,065 million net income June 30,2020 but this was a result of Federal CARES act funding in excess of $122 million.  Revenues from charges are still 20% below 2019 due to COVID-19 shut-down and slow recovery of patient visits.
• Director Reiter made a plea for the Cook County Board to relook at the CCH tax subsidy which does not cover the 41% of patients who require uncompensated care.
• Dr. Joshi,  presented the quarterly report from the Cook County Dept. of Public Health, with an excellent COVID-19 PowerPoint update. He noted that there is a current resurgence of COVID positive testing (6.8%) primarily a younger population attributed to socialization without distancing/masking.

Items to Watch for in the Future: 

• Cook County Health, 2021 Budget hearings!

Virtual Meeting Observed by: Susan Kern, MD                  Meeting Length:  3 hours, 30 minutes

Cook County Health (CCH) Board of Directors Meeting
July 31, 2020                  
Meeting was held remotely with audio only available for observer

Public Comments

• Dr M. Fujara talked about CCH being the recipient of a three year Department of Justice Grant for the Child Safety Forward Initiative, aimed at reducing child fatalities and recurring injuries due to abuse and neglect.  CCH is one of five national sites chosen for this grant.  She said the legacy of child abuse persists into adulthood with the risk of serious medical issues, substance abuse, mental illness, involvement in the juvenile justice system and abusive romantic relationships, all creating community challenges.  The grant aims to develop strategies to address child fatalities and injuries to help families.
• Other comments from staff RNs were about the need for nurses to receive extra non-nursing duty pay for the extra work nurses now perform for their Covid-19 patients. Nurses now deliver food tray and clean patient room, perform dietary duties,  clerk duties and patient transport.

Committee Reports

Human Resources Committee reported that it took 90 days on average to hire, from the time of initial job posting to hiring.  CCH's Employment Plan brought CCH into compliance with the Shakman decrees, Federal court orders, which prohibit political influence into the employment process, but adds steps to the hiring process.  It was suggested that hiring steps be broken down to see if there could be improvement in hiring time and to compare the hiring time of CCH to other Chicago hospital systems.  A request for the diversity breakdown of nurses was requested. Almost half of  nurses are African American; Asian and White each make up about 
one-fifth of nurses.  HR actively recruits bilingual staff and reaches out to local groups and universities.

Managed Care Committee reported that as of July 2, 2020 CountyCare membership was 364,973 with 10.5% of these members using CCH clinics.  July 2, 2020 numbers are an increase over June 3, 2020 numbers.   August membership numbers are projected to be around 369,000 due to increased Medicaid members and IL Healthcare and Family Services (HFS) temporarily stopping the redetermination process during the Covid-19 crisis.  HFS's May data showed CountyCare had a 31.9%  share of the Cook County Medicaid market.  At some future point HFS will startup the redetermination process again and Medicaid numbers will decline.  During Covid-19 pandemic, CountyCare patients are getting care along with food, transportation, specialty care.  James Kiamos, CEO Health Plan Services, is leaving CCH and this is his last report.

Quality and Patient Safety Committee presented a new Quality Dashboard, specific graphs with reference targets for data collection and monitoring.  This dashboard now contains categories at CCH that need to be improved in the CMS Star Rating reports.  These CMS reports let consumers compare hospitals based on quality ratings.  An important area for CCH is clinical documentation to accurately record a patient's problems such as homelessness and other insecurities/illness/case complexity so as to get properly reimbursed for that patient's care.  In the LOWN Institute Hospital Index, Stroger Hospital rated very high in Civic Leadership, Value of Care, and Patient Safety.    

Finance Committee

• Presented the revision of the Illinois Dept. of Public Health (IDPH) Covid-19 Contact Tracing Grant               1. Hektoen Institute for Medical Research will receive a one year funding of $6 million for the administration of contracts with those Community Based Organizations that provide services in communities most impacted by Covid-19.  Hektoen will monitor progress, have oversight of funding and issue payments.  2. Hektoen will receive approximately $3.5 million to hire a startup contact tracing team of sixty positions so the initial launch phase of contact tracing will not be delayed.  After this, CCH will work to bring on a larger contact tracing workforce taking over hiring.  For the next year, monthly hiring reports will be provided to the Finance Committee. 
• A grant was received that provides wellness kits for patients with chronic illnesses. 
• A grant for Chicago Cook County Breast Cancer Risk Identification screening and Prevention will provide services for underserved CC patient populations.
• CCH Financial Update for the six months ended May 31, 2020: financial results are ahead of budget by $52 million.  Net patient service revenue is below budget due to Covid-19 pandemic.  $77.6 million received from CARES Act received through May to help compensate for the decline in patient activity.  The FY2020 projected year end deficit is $61 million. 
• ​Current financial planning is for FY2021 budget, seek Federal and State revenue for Covid-19 pandemic, and looking at areas where expenses can be reduced.  At the end of this report is the Guiding Principles and Timeline for the FY2021 budget.*

    
Report from Debra Carey, Interim CEO:

• Cermak hospital expanded testing to all inmates and with social distancing and mitigation strategies, the virus is contained in CC jail.

Items to Watch For in the Future:

• FY2021 Budget Request for Approval at August 28 CCH Board of Directors Meeting

Observed by:  Michele Niccolai                                        Meeting Length:  3 hour

*Link to the CCH Statement on Health Equity approved by the Board of Directors

Cook County Health (CCH) Board of Directors Meeting - May 29, 2020       
Virtual Audio Meeting due to COVID-19 shut down

Public Comment:            

• Public comment by a series of Hospital employees struck a similar chord: complaints of inadequate supplies of PPE (personal protective equipment), canceling of paid vacation time , refusal  to grant “hazard pay” and criticism of temporary health staff hiring to cover COVID care tasks during the ongoing pandemic.  
  
• Dr. Fegan responded that there were adequate supplies of PPE from federal stockpiles which were inventoried twice daily.  CCH follows CDC and IDPH utilization guidelines for PPE, adding that shoe and hair-covers are not COVID protective and N 95 masks & disposable gowns were designated for use by staff in close patient contact and with aerosolizing procedures.  Additional employee education on proper PPE use would be planned.  
  
• Director Reiter was assured that canceled vacation time was rescheduled or financially compensated as defined in the union-negotiated employment contracts, and there was daily communication with the union and invited front-line employees.

Board Discussion/Decisions:

• Hospital’s CountyCare, Medicaid managed care plan: 326,631 members, largest in Cook County
• COVID-19 testing: 7,704; 2,355 positive patients across all CCH locations; CountyCare received 115 claims for in- patient admissions (low number attributed to lag in submission of charges)
• COVID financial impact projected through June is a  $75-$100 million revenue loss due to 40% decline in charges since March 15, 2020; decreases across all service lines ; plus $10-$15 million of increased costs:  supply/equipment/agency temp. staff; and overtime $8-$12 million
• Offsetting COVID financial assistance income: $59 million federal distribution for number of COVID positive patients; $11.1 million received to help offset revenue loss (CARES Act); federal reimbursement for testing/treating uninsured COVID patients, $1 million grant pending for telehealth from FCC;
• $40 million grant from IDPH for CC Dept. Public Health with plans for 400 contact tracing hires
• Discussed: $429 million Cook County awarded from the CARES Act. Hospital system will pursue payment from this grant!
• Board voted to transfer a total of $5,339,739 from various accounts to accounts exclusively for   COVID expenses under guidance from the County government in anticipation of applying for this CARES Act grant. 
• COVID net negative impact:  income is $36.6 million below budgeted.
• Expected rebound in volume of patient charges for CountyCare once the COVID shut down has loosened restrictions, will require provider payments from capitated payments already received, further undermining the financial outlook
• Charity care and self-pay volumes and costs are up $18 million over 2019, likely reflecting high unemployment rates due to COVID shut down
• Telehealth success: 44,335 telephone visits via the clinic system since COVID March shut down
• CCH preparing for post-COVID opening, ramped up drive thru virus testing, Stroger & Provident
• COVID containment at Cook County Jail due to ongoing testing of symptomatic, asymptomatic, new admissions to the jail and surveillance testing.
• Outreach to COVID high risk members, providing thermometers and pulse oximeters for home self-testing (telehealth); telemonitoring of diabetes, hypertension, via home use glucometers, blood pressure cuffs etc.

Items to Watch for in the Future:

• Post-COVID-19 adaptation of the Hospital system to the “New Normal”

Observed by:  Susan Kern, MD                           Meeting Length:  3 hours and 15 minutes