Cook County Health Board of Directors Meeting
January 27, 2023

Board Action:

• A $30M request was approved to increase existing contract with Vaya Workforce Solutions, LLC through 9/24/23 for agency nurse staffing to fill vacancies.  The Chief Nursing Executive stated the hourly wage for agency nurses has decreased from slightly over $200 to currently $150 to $175 depending on the specialty needed.  A dilemma was brought up by Board members regarding agency nurses vs employed staff nurses.  Agency nurses go for the increased hourly wages, more control over their lives and younger nurses may not have a long term career view.  Cook County Health (CCH) has advantages over agency nurses: CCH staff has good pension and other benefits for long term career plans.  There are work rules, free tuition and many resources available.  CEO Rocha added that closing the HR gap in hiring nursing staff is a major goal.  Other goals are empowering the employee experience, commitment to continuing education, building flexible staffing pool options, adding employee councils and addressing work and life balance.
• -Two contracts for a total of $32M were approved through 11/30/23 for temporary staffing. Positions include transporters, supervisors, Covid screeners, greeters, Lab personnel.  
• A 2M contract was approved to continue with Slalom Consulting through 7/19/23 for Human Resources.

New Cook County Health Board Members were approved by the Cook County Board of Commissioners at their meeting on 1/26/2023. The new members are Tanya Sorrell, PhD, PMHNP-BC and Mia Webster Cross, MSN, RN. These new board members have replaced Mike Koetting and Dr Heather Prendergast

Committee Reports:

• Finance Committee: On an accrual basis, interim financials show CCH ended November 30, 2022 with a $15.8M unfavorable variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $366.4M favorable variance.  This is due to the timing of how each records revenues and expenses.  These are preliminary numbers as the FY2022 financials will be audited April 2023.  CountyCare showed an operating gain of $11.5M.  CCH’s More Care, Medicare Advantage Plan, was discontinued as of December 31, 2022 because of low membership and revenue loss.
• Quality and Patient Safety Committee: Quality and Safety rating sites to check hospital and providers were mentioned that anyone can go to:   medicare.gov/care-compare/    (star ratings) hospitalsafetygrade.org     (Leapfrog hospital safety grade)
• CountyCare: CountyCare membership as of January 5, 2023 was 449,565 with 9.3% using CCH clinics.  This is an all time membership high, reflecting month over month growth since Medicaid redetermination has been paused.  Redetermination, an annual review of Medicaid eligibility, will begin in April 2023.  Renewal forms will be mailed to 1/12 of membership each month over the next year with CountyCare staff assisting members in this process.  Membership losses would start to show up end of June and July 2023.  The Board pointed out that continuation of care for those who will lose Medicaid is vital as conditions such as hypertension, diabetes and asthma can lead to major health costs down the road.  In 2022, CountyCare developed reserves of $100M and plan to increase this to $150M in 2023.  In 2022 CountyCare added over 100 urgent care sites providing an alternative to E.R. usage and housed 53 members in the Flexible Housing Pool Program and 14 members through the Community Transitions Initiative.  
• Human Resources: In FY2023 (Dec 1 to Dec 31, 2022), 119 positions were filled with 72 external hires.  Internal hires (some are promotions) help with employee retention.  16 offers were declined and the #1 reason was salary.  In FY2023 there were 90 separations, 73 were due to retirement.  HR is hosting monthly job fairs and can now offer recruitment and retention bonuses.

CEO Rocha reported that CCH with support from the CCH Foundation has selected local artists to lead mural projects at three health system sites.

Observer:  Michele Niccolai

Cook County Health Board Of Directors Meeting
December 9, 2022 

Cook County vaccination rates, particularly the 3rd booster is extremely low.  Board members stated that the system has an obligation to target communities most in need.  Dr. Hasbrouck, Public Health, said that he is building an outreach team to work with providers and to also go into homes.  He noted that people are “vaccine tired”.  Financial incentives and a mobile vaccine clinic have been initiated.  Directors noted that schools should also be targeted.  A $700,000 grant was received to raise the vaccination rates. 

Finance Committee [based on 9-30-22 reports].  CCH ended the 3rd quarter with a $15.8 M unfavorable balance to budget.  On a cash basis, the variance was favorable by $201,000 due to timing of reimbursement rates. Managed Care expenses are higher than budget due to higher membership rates.
During procurement coverage, board members were concerned that the System is paying premium dollars to outside agencies to fill such jobs as janitors from the same local market as CCH is recruiting.
Also under procurement was a new contract for a new service to provide medically tailored meals to patients outside of the hospitals.  The Greater Chicago Food Depository and local minority vendors will be used.  Director Story asked for an evaluation tool by 2023.

Charity Care reporting now expanded 
                                                                      2021 Actual        2022 Budget         2022 Actual/Projected
Traditional Charity Care                                $162,626           $152,827                       $134,772
Other Uncompensated Care                        100,894             109,162                          164,595
Cermak & JTDC Health Services                  104,465             106,405                         106,405
Public Health                                                       16,908               17,763                              17,763
Other Public Programs and Services           68,750              66,321                              66,321 
         TOTALS                                     $453,643      $452,478                 $489,856
        % of Costs                                    27.9%              36.3%                      34.5%
        % of Revenues                             38.6%             36.3%                       41.1%

Managed Care:   Membership is at 443,470 which is 32.5% of the total management care population in Cook County.  40,940 or 9.2% use CCH services at Stroger, Provident, or ambulatory clinics.  Vaccination rates among managed care members is in line with overall county rates.  Seniors lead the numbers at 52%; Adults 26-65 at 26%; Adults 19-25 at 17%; Adolescents 12-18 at 16%, Children 1-11 at 4% [23% for 2nd dose].  

Human Resources:  Filling nursing positions continues to be a huge challenge.  The use of temporary hires was discussed, and Director Koetting noted that over 20% of total employees are out on FMLA at any one time.

Observer:  Diane Edmundson                                             Absent Board Members:  Deer, Kim, Reiter 

Cook County Health (CCH) Board Of Directors Meeting
October 28, 2022 

Approximately 4,000 asylum seekers have arrived to date with the majority coming from Venezuela and the balance from other Central American countries.  They are residing at 23 locations across Cook County in 12 shelters and 11 hotels.  At the peak, there were 109 arriving per day but that is now trending down due to changes in policy at the border.  Most of the health screening is routine and outpatient with most common complaints a cough or headache. A telephone triage center staffed by nurses has been established for after hours.  A total of 183 Cook County Health staff have provided refugee health care to date.  The center is establishing medical homes for the refugees and tracking expenses.  A Resolution was introduced and approved to accept donations from individuals who have contacted CCH wishing to contribute a monetary amount in support of the services being rendered by Belmont Cragin to the migrant population.  
CEO Israel Rocha, announced a Cook County Health/U. S. Navy Training Partnership centered on the Resuscitative Surgical System (ERSS) which began in October. Navy personnel will train at Stroger Hospital with staff knowledgeable in ERSS.  When complete they will return to their assignments and possible deployment. 
Due to an outbreak of Ebola in the Sudan, County Health is closely monitoring the situation and clients.  Covid-related calls both inbound and outbound have declined as the numbers of Covid patients has decreased.  CountyCare is providing rewards to its patients who are getting their Covid shots and boosters.  
Provident Hospital is now providing hemodialysis services to serve the population in need of that service.  
Dr. Sam Robinson’s appointment to the Board which was deferred at the September meeting has since been approved.

Committee Reports
Human Resources:  Chief of Human Resources Valerie Amos provided metrics on recruiting indicating 647 positions filled year-to-date at an average of 65 per month.  The turnover rate is steady at 9.9%.  There have been month over month increases in new hires.  Resignations continue to outpace other types of separation i.e. retirements or discharges.  Multiple hiring fairs have been conducted and the on-line presence improved for internal and external use.  
Audit and Compliance Committee:  The schedule of meetings for 2023 was not firm yet.  The Committee’s focus is on CountyCare, Community Education and the metrics for CCH and CountyCare.  There were no action items.
Quality and Patient Safety Committee:  In an update on future directions for Stroger and Provident Hospitals the following initiatives are being pursued:  Building Stroger’s Neuro ICU to a Level 1 Neurosciences ICU; Establishing Stroger as a Thrombectomy Capable Stroke Center; and Provident as a Stroke ready or Primary Stroke Center.
Managed Care:  CountyCare continues at 32.7% of the Cook Market Share and has increased 7% over the past 12 months -– ahead of the Cook County increase of 4%.  Enrollment continues to exceed budget projections.  HEDIS rates remain stable.
Finance Committee:   On an accrual basis, interim financials show that CCH ended August with a $6.7M positive variance to budget.  On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $204.4M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses.  Year to date revenues better than Budget due to catch up payments from the State and higher than budgeted CountyCare membership. Other Non-operating Revenue negative variance due to fluctuations in County property tax collection.    CountyCare membership remains over 400,000 which is greater than the 381,000 budgeted.
 Contracts in excess of $1M were submitted and approved as follows:

• Konica-Minolta Business Solutions – One Year Extension - $1,500,000 (Print, scan and copy service for 1 year – RFP to follow); 
• Housing Forward – Two Year renewal -Sole source $3,769,450 (ARPA funded), (Temporary recuperative housing for homeless); 
• Atos Healthcare Services - One Year Extension - $33,000,000 (Information Technology management services – increased  because of additional resources pre and post-pandemic -RFP to be issued in January); 
• McKesson - $4,029,363 (Information Technology management services – Pharmacy Point of Service, Lab and Stores management – Original sole source contract extension through 2027); 
• CDW Government, LLC  - additional Microsoft Defender 365 - $1,314,953 (security licenses, retroactive to 6/2022 through 5/2024); 
• ADT Commercial Government LLC - $1,767,915 (equipment and installation of new nurse call and paging system at Provident Hospital to replace obsolete and ineffective system); 
• Professional Clinical Laboratories LLC dba PCL Alverno -  one year extension $1,814,577 (histology services); 
• Executive Building Maintenance dba EBM Inc. – 6 month extension $2,394,426 (Environmental cleaning and terminal cleaning services for Stroger – RFP in development to consolidate environmental services); 
• ABM Healthcare Support Services, Inc. – 6 month extension $1,315,770 (environmental management service for Stroger and other CCH locations – RFP in development to consolidate environmental services)

Recognitions:  Thanks and kudos to retiring Commissioner David Munar; Team award for ambulance runs at Provident - 70 in the first week; Cardiology team awards by the American Heart Association. Pinnacle awards on healthcare marketing for the My Shot Covid campaign for the CountyCare team.

Observer:  Peg Moster

Cook County Health Board of Directors Meeting 
September 30, 2022 

KImberly Craft gave the semiannual EPO (Employment Plan Officer) report. As with other departments she had staffing issues which made it difficult to monitor the plan. A new Program Manager and Information Coordinator have recently been hired. There were an unusually large number of vacancies during the reporting period. The hiring process was revised and a new plan was rolled out in July. There were a number of hiring problems found. Part of the problem was in coordinating plan rules with the outside vendors. The 22-page report is informative and detailed.

CountyCare's 10th anniversary was celebrated. Cook County Health’s emergency medicine and preventive medicine residency programs were recognized in Becker’s Hospital Review for being among the best clinical training programs, according to Doximity’s 2022-2023 Residency Navigator.

Cook County Public Health has sent out a survey to collect data from 34,000 adult (18 and older) suburban Cook County residents concerning their health-related risk behaviors, chronic health conditions, and access to health care.  Using startup funds from CDC’s Health Equity Grant, CCDPH’s Epidemiology Unit is collaborating with UIC’s PHAME Center and Metopio to design and deploy an online atlas for exploring and sharing health information concerning the suburban residents of Cook County. The atlas allows stakeholders to examine, visualize and download health data using maps, charts and tables. The site is at https://cookcountyhealthatlas.org/

Iliana Mora, Chief Administrative officer for Ambulatory Services reported on the Asylum seekers that were bussed to Cook County from Texas. All seekers were seen by medical staff promptly and screened for disease and vaccinated. Children received all vaccines needed to attend school. Ambulatory staff handled everything, but additional help is needed if this is to be a continuing need. Contracted staff will be onboard next month. Money was allocated for this but CCH is working with state and federal agencies for reimbursement. 

An overview of the Substance-Use Disorder program was presented by Dr. Juleigh Nowinski Konchak. It is a Multidisciplinary and Patient-centered plan. 

An overview on Monkeypox was presented by Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health).

Human Resources: While there is still a lot of work to be done to get staffing levels up, there has been a slight improvement and several vendor agencies have been contracted to help with the process. Slalom Program Management will ensure the vendor resources are allocated effectively to accelerate hiring. The other HR partners are:

• Cross Country – Onboarded March 2022 - Recruitment support for 500+ vacancies (Clinical), Talent sourcing support & marketing
• Incredible Health – Onboarded June 2022   Talent sourcing support in Nursing
• Brazen – Onboarded June 2022  Virtual hiring fair platform 
• Deloitte – Onboarded September 2022  HR Optimization - Compensation, performance management, workforce development, operations technology

Listening sessions have been scheduled to help with employee retention.

Managed Care: CountyCare’s enrollment has increased 7% over the past 12 months, ahead of the  Cook County increase of 4%. CountyCare’s enrollment decreased 0.1% in July 2022 compared to the prior month, ahead of the Cook County decrease of -0.2%. The vaccination rate of CountyCare members is still too low, especially among children. Only 21.78% of children 1-11 years are fully vaccinated. And only 45.2% of all members are fully vaccinated.

Quality and Patient Safety: Committee minutes were presented. Dr. Erik Mikaitis was hired as Chief Quality Officer.  The readmission rate was down to 7.49% in May, the lowest it has been in the last year and well below the goal of 9.93%. The case mix index for surgical patients, the top box score and the HbA1C goal were not achieved.

Finance: The finance committee met this month. On an accrual basis, interim financials show that CCH ended May with a $13.4M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $300.2M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses. 

Recognitions:

• CountyCare's 10th anniversary was celebrated.
• Cook County Health’s emergency medicine and preventive medicine residency programs were recognized in Becker’s Hospital Review for being among the best clinical training programs, according to Doximity’s 2022-2023 Residency Navigator.
• Dr. Michael Alebich, Co-Director of Medical Student Programs and Attending Physician in the Division of Hospital Medicine, has been named an “Emerging Leader” by the Health & Medicine Policy Research Group (HMPRG).
• Dr. Dhara Amin, Director of Quality Improvement and Patient Safety and Attending Physician in the Department of Emergency Medicine, has recently been named as a Fellow in two prestigious health care programs.  Dr. Amin was named a Fellow in Medical Justice in Advocacy by the American Medical Association and Satcher Health Leadership Institute. She was also named a Fellow in Diagnostic Excellence by the Society to Improve Diagnosis in Medicine (SIDM).

There was no public speaker testimony and no closed session this month.

​Observer: Lisa Slankard

Cook County Health (CCH) Board Of Directors Meeting ​
July 22, 2022 

Human Resources Report:
Currently Stroger Hospital is operating with a staff level of 65% of budget. This has led to adding $75 million to the outside staffing budget for the remainder of the fiscal year and has had some effect on Quality metrics. It also has led to increased resignations of existing staff. The Human Resource committee presented their statistics and the current hiring is barely keeping up with the staff losses and not helping make up for past separations. Before starting the new goal of hiring 400 new employees between 5/16 and 9/1, it has taken 36.8 days on average from the time an offer has been requested to the offer being made to the applicant. 450 offers were made and 317 were hired. The ultimate goal has been to cut the 36.8 days to THREE days. From May 16 to July 22, 220 candidates accepted offers. Since 94 were internal hires, the net result was 126 new employees.
The hiring initiatives are as follows:

• Offers made within 72 hours
• 20 nurses sourced per week
• Train 100% Hiring Managers
• 6 Hiring Events by Sept 1, 2022     200+ positions    
• Increase frequency of new employee orientation by 50% as needed
• To help with this a contract was made with a third recruiting company

Appointments/Recognitions:

• Arnold Turner has been named Chief Hospital Executive for Provident Hospital, Aaron Galeener has been named Chief Administrative office of Health Plan Services and Karolina Duszczak will be Interim chief operating officer of Health Plan Services.
• US News and World Report named Stroger as a high performing hospital in four categories: Chronic obstructive pulmonary disease • Pneumonia • Heart attack • Heart failure.
• Chicago Magazine recognized Dr. Elizabeth Marcus as a top doctor for breast oncology. Dr Mike Alebich was identified as an emerging leader by Health & Medicine Policy Research Group.  
• Becker’s Hospital Report recognized Andrea Gibson as Great Health System Chief Strategy Officer and Linh Dang as Outstanding Health System Chief Experience Officers.

Public Health Update:

• An overview on Monkeypox was presented along with the midyear budget review.
• Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health) presented the quarterly report from the Cook County Department of Public Health- Building Healthy Communities: Initiative and funding process overview.
• The CCH board signed on to the Cook County Board’s PROPOSED RESOLUTION REGARDING AN ASSAULT WEAPONS BAN.

Committee Reports:

• Managed Care: As of 7/5/2022 County Care has 32.6% of market share, up from 32.5% the previous month but the actual number of members is 433,248 compared to 434,021 last month. Initial target was set to develop $50M in reserves in FY 2022. To date, total reserves have been funded at $75M. The public health emergency has been set to end October 15, 2022. At that time redetermination is set to begin 60 days later and 1/12 of membership will be looked at each month.
  
• Audit and Compliance: A review of the CCH Compliance Program & Regulatory Environment was presented. It included a presentation on the Boards fiduciary and oversight obligations. 
  
• Quality and Patient Safety: Provident CAP (College of American Pathologists) Survey occurred May 12, 2022.  There were three low-level citations and actions were submitted and received acceptance of    those actions on June 30th.
  
• Finance: On an accrual basis, interim financials show that CCH ended May with a $36.1M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $225.5M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses. While there was a lot of discussion on the $75 million  request for Vaya Workforce Solutions, it was approved.

Observer: Lisa Slankard

Cook County Health (CCH) Board of Directors Meeting 
May 27, 2022

During Public Comments, eight nurses and nurse representatives reacted to the Cook County Commissioners 10% pay raise approved by the CC Board earlier in May.  The comments were pointed and the tone angry. For two months nurses have been asking for a $5.00 per hour increase as Retention Compensation for their work and their loyalty over the past two years of the COVID pandemic, noting that the System is hiring contract nurses at much higher pay. They are also unhappy that they must use personal sick pay for personal COVID absences.

Having been discussed at several previous meetings, the proposed 2023-25 Strategic Plan was approved by the board with little comment.  The Theme for the next three years is:  Impact, Change, Equity. Strategic Planning Officer, Andrea Gibson, noted that the data table will now include the years 2019-21 and also stated that Disability Access has been moved to a higher priority based upon public feedback.  With approval, the next steps include developing detailed work plans and integrating them into a three-year budget.  Chair Taylor commended the process and said it is a very good framework to deliver quality care over the next three years.

Committee Reports:

• Finance:  Through March,  the System reported a $1.2 million positive variance to budget partly due to lower than budgeted Surgical and OP volumes and lower than budgeted CountyCare claims expense.  CountyCare showed an operating gain of $10 million.   Chair Reiter reported that Deloitte Consulting has been hired to reduce reliance on sole-source contracts by looking at and recommending better time-line planning; and if needed, a restructure of the procurement department. 
• Managed Care:  As of May 6, CountyCare membership was at 434,021 of which 10.3% or 44,704 use Cook County Health services.  The Plan continues to have the largest membership in Cook County at 32.5%.  Second on the list of six is Blue Cross Blue Shield with 25.7% or 336,328.  Fifty percent of CountyCare members are fully vaccinated.  Recognizing the difficulty of increasing this metric, Director Koetting stressed the importance of continued efforts.  
• Quality & Patient Safety:  62.4% of patients recommend Stroger Hospital against a target rate of 71.1%. Readmission rates for the hospital were at 8.75% in January of 2022 against a 9.93% target.
• Human Resources:   The Department is now keeping metrics on its optimization strategy to improve and accelerate the hiring process.  Its monthly report stated that CCH must hire over 2,000 new employees – yet the current hiring process takes an average of 4-6 months per position.  HR has secured four consulting partners to streamline the HR processes and technology.  One of the partners, Incredible Health, has been hired for immediate nurse recruitment.
• Public Health:  HUD provided a grant for CC Public Health to begin work on 9 housing units in April; and the Epidemiology Unit will launch the CC Health Atlas Website for the public by the end of May.

 
Observer:  Diane Edmundson