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 of Directors Meeting
May 28, 2001

Covid Vaccine Update:
Director Gugenheim was surprised at the Low 63% Employee COVID Vaccination Rate. Director Gugenheim further asked whether the Cook County Health System was working with their “Labor Partners” to increase employee vaccination.   Yes, but vaccination is voluntary and vaccine hesitancy has been an issue, staff replied.  

• Employee vaccination by race/ethnicity as of 4-30-21 reported as: Black/African-American 49.4%; Hispanic/Latino 67.6%; White 76.1%; Asian 81.7%.
• Vaccination by Job Category:  Nursing 63%; Doctors 85%; Administrative/Clerical, Non-clinical Leadership, Pharmacy and Public Health 100%
• Vaccination by Union & Non-Union:  Non-Union 76%; Union 61%

30 minutes of Public Comments addressed to the Board by employees and groups of employees largely centered on ongoing Labor Union negotiations.  Assertions included: lack of leadership by Administration & managers, unwillingness of Administration to negotiate on salaries and work rules, understaffing, and untrained Agency temporary nurses.  Strike threat was voiced by one speaker.

​Board Reports:

• CountyCare managed health plan: 20% increase in members over last 12 months-- total 398,534 exceeds budget and unexpected higher capitation rate awarded by State Medicaid yielded a small net operating profit.
• System wide financials, net loss of $21,802,000 is a result of increased claims cost but is less than budgeted loss of $32,551,000. 
• Compassionate Care initiative introduced in the Hospital System Ambulatory Clinics to address low (56% in hospital rankings) “Likelihood to Recommend” on Hospital System patient surveys. There are 3 Key Drivers impacting the ranking:  1) Courtesy of Registration Staff  2) Sensitivity to patient’s needs       3) Concern for Patient’s privacy
• Cook County Public Health Department’s Dr. Joshi reported on the Opioid epidemic: significant incremental increase in opioid-related deaths in Cook County 1,121 in 2018; 1,227 in 2019; 1,771 in 2020.   Chicago & CC Suburbs all showed increases.  Deaths due to Fentanyl far exceed those from heroin or prescription pain relievers.

Items to watch for in the future:

• Board attendance by new Board Directors, selection of Board Chair, selection of new Chief Financial Officer & new CEO of CountyCare.

Observed by: Susan Kern, MD                                               Meeting Length:  3 hours

Cook County Health (CCH) Board of Directors Meeting
April 30,2021

What did the Board decide:

• The Core Foundation property that was being leased by the County for The Ruth M. Rothstein Core Center for the treatment of infectious diseases will now be owned by the County as the lease has been terminated 6 years early..

Committee Reports:

• Human Resources - no meeting this month. Hiring continues. There is an increase in unfilled open positions. Even though more people have been hired than last year, more separations were reported and more positions were created due to grants received. Most of the openings are in nursing.
• Managed Care- CountyCare membership continues to increase. Up 1.4% over February for a total of 395,477 members. Plan Initiatives activity was presented. The Finance Initiative goal is to reduce cost by 50 million dollars.  Member Experience Initiative reported that over 5.1 million text messages were sent to members.
• Quality and Patient Safety- The 30 day readmission rate is up to 9.81% against a goal of 8.56%. 10% of readmissions were from Covid hospitalizations for a variety of reasons. The goal was met for surgical clinical documentation but not medical. Top Box score had a slight improvement and Communication with nurses and cleanliness had the highest percentile rank for Stroger.  The lead person on JCAHO left the organization.
• Finance- $5.5M  grants received for Covid vaccines. On an accrual basis CCH is ending February $12.1M ahead of budget. Net patient service revenue was better than expected  - lower than expected volumes, more than offset by better rate and payer mix. CountyCare capitation significantly higher than expected.

Board Chair Hammock Report

• A Foundation Gala will be held on October 28, 2021 in the old Post Office building to celebrate the 10th anniversary of the Foundation.

CEO Rocha Report

• The Daisy Award was given to Anu Thomas RN.
• Covid testing statistics were presented.
• There are 725 detainees awaiting transfer to IDOC. They must be fully vaccinated prior to transfer. This is the highest priority right now.
• 80% of CCH Staff  and 62% of CCH employees  have  been vaccinated.  Statistics on the breakdown of vaccinated employees by age, race, job category, union membership  and race/ethnicity were provided.
• A review of COVID vaccination activities was presented. In addition to marketing efforts, significant outreach and special events are planned for mass vaccination sites including: • Restaurant Worker Day Monday, May 3 • Mother’s Day Promotion at all sites Saturday, May 8 • Partnership with Chicago Medical Society physicians to refer patients • Efforts to encourage college students at schools where vaccines will be mandatory not to wait to get their vaccine until the Fall.  
• The My Shot outreach program is moving to phase 2 and targets 18-34 year olds. This is a change from a campaign for access to a campaign for advocacy and access.
• There has been a huge surge in CCH social media reach.
• The Leapfrog score (a hospital rating score) is up to a D. The CMS score is now 2 stars. This is from 2019 data. While this is still not good it is an improvement.

Items to Watch for in the Future:

• Covid rates and vaccination data.
• Financial situation of CCH

Observer - Lisa Slankard                                       Meeting Length:    2.5 hr                                                                     

Cook County Health (CCH) Board of Directors Meeting
​March 26, 2021

The 2020 five “ICARE” (Integrity, Collaboration, Accountability, Respect, Excellence) Employees of the Year were congratulated at the board meeting by Joseph Flanagan, Chairman of the Cook County Health Foundation. 

Committee Reports to the Board:
Human Resources:

• CCH labor union contracts are being negotiated with CC Bureau of Human Resources. 
• As of 2/28/2021, 290 Contract Tracers have been hired, 79% by CCH and 21% by Hektoen and 137 positions are in the CCH hiring process. 
• FY2021 Quarter 1 filled positions is greatly increased over FY2020 Q1 due to Contract Tracing hires.

Quality and Patient Safety:

• The Joint Commission, which accredits healthcare facilities after an inspection reviewing facilities, was recently at Provident Hospital.  The end of survey meeting was very positive and CCH is awaiting the official report.
• The 30-Day Stroger Readmission Rate (unplanned admission to Stroger within 30 days after being discharged from an earlier Stroger hospital stay) for Nov 2020 was 9.05% and was closer to the target of 8.56% as previous 2020 monthly readmission rates trended high. 
• he Medical and Surgical Case Mix Index for December 2020 was higher than target which is favorable for reimbursement.

Finance Committee:

• Two grants were received and filed for CC Board/CC Budget Director approval.  A grant from the Dept of Health & Human Services, Substance Abuse and Mental Health Services Admin, will support acupuncture use in the Emergency Dept as a pain reliever in order to reduce admissions.  A second grant from the IL Health & Hosp Assoc is for training/updating staff working with Covid-19 patients and preparing for future disease outbreaks. 
• The finance committee will hold a special future meeting to review all care management contracts. 
• On an accrual basis, CCH is ending January 2021 $3.35M ahead of budget.  The Net Patient Service Revenue was lower than expected due to lower volumes in Jan.  The Jan 2021 Medicare health plan membership is lower than budget, lowering revenue. 
• The Board approved purchase of “Syntellis Performance Solutions”- financial analysis software designed for the complexities of hospitals.  This software will help with future financial planning, the budget process, and decision making because the software will provide a more detailed financial look into CCH’s services and departments.

Managed Care:

• As of 3/4/21, CountyCare has 392,417 members (a 6,600 increase over 2/4/21) with 40,721 enrolled in CCH clinics. 
• CountyCare members increased their use of CCH health services. 
• CountyCare enrollment is expected to increase due to the temporary stopping of state Medicaid eligibility redetermination through 2021 and the 50% auto-assignment increase to CountyCare beginning Feb 2021.

Board Action:

• Mildred Williamson’s appointment to the CORE Foundation Board
• Provident Hospital Emergency Dept Triage & Triage Intervention Guidelines were approved

CEO Rocha Report:

• As of 3/22/21, from all tests conducted at CCH (119,237), the positive rate is 8%.  At Cermak (CC Jail Health Center) testing is done on site with rapid test, then confirmed at CCH.  There is robust testing at Cermak of all detainees to determine health care and housing.  At Cermak, the rolling 7 day positivity rate as of 3/24/21 is 0.4% with a jail census of 5,613.  Testing is important to respond to Covid-19 clusters.
• Monoclonal Antibody treatment is available in the ER when a patient is identified as Covid-19 pos in order to prevent hospitalization.  
• Vaccinations:  As of 3/19/21 Total Doses (1st & 2nd) given to Dept of Corrections & JTDC Employees & Contractors = 4,434 and given to Cermak Health Services Patients = 2,600.
• As of 2/28/21 CCH staff vaccinated = 74% and CCH employees vaccinated = 58%.  As of 2/28/21 there are 5,196 union employees-55% are vaccinated and 896 non-union employees-73% are vaccinated.  
• Vaccination sites:  On 3/22/21, Cook County moved into Phase 1b+. - CCH has five Mega PODs (points of distribution)- open to general public who meet current eligibility criteria. Sites continue to be added for varying populations.
• CCDPH Vaccine Equity Strategy prioritizes communities most disadvantaged and socially vulnerable.  32 suburban communities have been prioritized.
• Since Jan 25, 2021, CCH has administered more than 290,000 doses of Covid vaccine as of 3/26/21.
• Education: March 15 “My Shot” public awareness campaign launched.  Residents of CC share their reason to be vaccinated using billboards, bus shelters, transit, digital, social media and radio.  CCH is working with community based organizations to spread the word in areas most impacted by Covid.  Next phase will focus on 18-34 year olds.
• CCDPH Contact Tracing in suburban CC has more than 180 contact tracers and 60 case investigators.  In February 2021, there were 9,400 actionable Covid pos cases (92% called and 65.4% interviewed) and 91.2% close contacts called and 76% interviewed.  176 cases needed special resources from the Complex Care Coordination Team in order to quarantine or stay in isolation- 32% needed food, 28% needed income assistance, 11% needed medical assistance and 11% needed cleaning supplies.
• CEO Rocha stated Covid variants are in Illinois.  (Check the Illinois Dept of Public Health website for information on variants)

What to look for in the future: 

• The financial impact of the “American Rescue Plan Act of 2021” for CCH

Observed by:  Michele Niccolai                                                 Virtual Meeting length:  2 ½ hours

Cook County Health (CCH) Board of Directors Meeting  –
February 26, 2021

Public Testimony: 

• Regarding the SEIU Local 73, 12-hour strike on December 22, 2020 by CCH essential workers, union representatives gave testimony regarding President Preckwinkle's pushback and CCH's investigatory hearings of members.  The strike came after union members were unable to come to an agreement over pandemic pay and safe working conditions: short staffs and lack of PPE.
• A group of CCH employees from several departments was recognized. for their efforts to improve inpatient bill collections.   Discharged Not Final Billed (DNFB) collections: a delay in completing an inpatient's bill on discharge due to coding or documentation gaps that leads to a delay in payment.  Employee cooperation from IT, Health Information Management and Finance lead to completing patient bills within 4 to 6 days after discharge meeting the target in December 2020 for DNFB collections.

Human Resources (HR)

• Their 2023 Strategic Plan focus includes: an increase in hiring bilingual employees; reduction in the time to hire; developing the cultural competency of the workforce; and maximizing HR information systems. 
• The staff at CCH numbers 6,054 employees, based on the 12/4/2020 payroll. 
• The people leaving CCH through January 31, 2021 have been retirees at 65% and resignations at 29 %.  There is an Employee Exit Survey and the response rate is 26 % which falls within the Industry Wide Standard. By job category, nurses are the largest group to complete the Exit Survey.
• First Quarter FY 2021 filled positions is very high due to Contact Tracing hires.  The Average Time to Hire in FY20 and FY21 has met the goal of 90 days during the Covid pandemic. 
• Covid 19 Contact Tracing Hires:  As of 1/31/2021 285 positions have been filled, 71 case investigators, 203 contact tracers, 6 supervisors/managers, and 5 other. 228 positions are in the hiring process with CCH leading Hektoen Institute in the hiring process.
• CCH is developing an improved volunteer program.  304 National Guard are unpaid vaccination personnel: 143 at Tinley Park Convention Center; 36 at Triton College; 89 at Health Centers North Riverside/Morton College, Robbins & Cottage Grove, Arlington Heights, and Blue Island; 18 at Stroger/Provident/Core and 18 at McCormick Place (not a CCH site).  For the Covid-19 Hot Line launched 12/21/20, 34 volunteers are assigned to give out test results.

CountyCare Medicaid Managed Care Plan

• As of February 4, 2021 County Care has a total membership of 385,741, of which 39,751 are in CCH clinics.  This total member increase is 5,300 more over last month, due to increase plan choice and auto-assignment by the state.  There are 1,000 more members in CCH clinics over last month. 
• CountyCare's 31 % market share of all Cook County's Medicaid Managed Care Plans has held steady.  CountyCare's enrollment has increased 17.4% over the past 12 months following the trend of all Cook County Medicaid Managed Care Plans.

Financial Update

• The December 2020 Net Patient Service Revenue was better than expected due to slightly higher charges.  The December admissions were less than a year ago.  A one-time payment of $6M was received from BCBS Equity Program.  
• From the CARES ACT, approximately $6M is to be reimbursed for Covid-19 expenditures. 
• First Quarter FY2021 is on pace to save $5M from completed/near completed Vendor contract negotiations.  Uncompensated care decreased in December 2020 from Dec 2019 and Medicaid revenue increased in Dec 2020 over Dec 2019. 
• Payment denials/write offs met the Dec benchmark of 5%.  More than half of denials were related to prior authorization (focus is on infusion, radiology, outpatient surgery). 
• On an accrual basis, interim financials show that CCH is ending December 2020 $2.32M ahead of budget.  December 2020 Health Plans Financials showed a Loss of $1.6M consists of $0.4M from CountyCare and $1.2M from Medicare.  Membership in Medicare is lower than budget, driving lower than expected revenue and members have more serious health conditions.
• Contracts were approved for purchasing specialty surgery supplies, instrument & equipment repair, mammography equipment upgrades, an ultrasound system, neurological power tool accessories, medical/surgical acute care beds, aortic endo-grafts used by surgeons to repair the aorta, and job posting system maintenance/enhancements.  A software company contract was approved for the "CMS Interoperability and Patient Access Final Rule Integration".  Interoperability is the ability to share data between different computer systems.  Goal is to have data flow securely between CMS regulated payers, providers and to give patients access to their health information.
• Two grants were received and filed for approval by the Cook County Budget Director:  An IDPH grant for "Cities Readiness Initiative Program" which is designed to enhance the response to large public health emergencies needing medicine/medical supplies in large metropolitan centers.  A second CCH Foundation Grant is for mass vaccinations/ support patient recovery.

Cook County Dept. Public Health (CCDPH) serves CC suburbs: 

• The Public Health Accreditation Board has continued accreditation of the CCDPH for 5 years. 
• CCDPH in collaboration with Hektoen Institute has awarded nearly $5M to 42 community-based organizations (CBO) for a 6 month project Dec 2020 to May 2021 for Covid-19 Community Supports and Worker Protection Programs.  Investing in existing community assets, since they are credible and trusted places, will help to reach populations where hesitancy and distrust exist.  These programs are in communities/populations most disproportionately impacted by Covid-19.  The Community Supports program provides outreach, education, expansion existing programs/services, testing.
• The Worker Protection Program provides employers and workers information, resources and support to minimize the spread of disease to promote health and safety in workplaces.

Covid-19 Vaccination: 

• As of 2/16/20, 70% of CCH staff and 56% of CCH employees have been vaccinated. 
• As of 2/19/21 vaccine doses distributed at Chicago & Suburban CCH Points of Distribution (POD) to CCH patients and public who meet current eligibility = 43,636. 
• Vaccine doses distributed to general public who meet current eligibility at Mega PODs = 46,453 and vaccine doses distributed to specific eligible populations at Targeted PODs = 1,264. 
• Other community vaccination access is from CCDPH Mobile Units, CCH/CCDPH Strike Teams (homeless shelters, home-bound and hard to reach populations), Drive-Thru at CC Forest Preserve District sites,  Loyola and Advocate hospitals, Pharmacies, Federally Qualified Health Centers, and Oak Street Health. 
• CC is currently in Vaccine Allocation Phase 1b which includes individuals 65 and over and frontline essential workers. 
• Vaccination registration & appointment information is available at Website: vaccination.cookcountyil.gov     Call center: 1 833 308 1988, M-F  7am to 7 pm.
• Covid-19 Vaccination at CC Department of Corrections & Juvenile Temporary Detention Center; Staff: since 1/20/21 more than 3,500 doses have been administrated.  Detainees and prisoners are Phase 1b.  To date, nearly 1,300 detainees have received their first dose.

CCH Covid-19 testing: 

• As of 2/21/21, from all tests conducted at CCH (107,334) the positive rate of patients is 8%.
• Covid-19 testing at Cermak (CCH health center at CC jail) remains a high priority and plays a critical role in the containment of Covid-19 at CC jail.  The rolling 7 day positivity rate as of 2/23/21 = 0.8% even as the jail census as of 2/22/21 = 5,435.

Observer:  Michele Niccolai                                   Virtual Meeting length:  2+ hours

Cook County Health (CCH) Board of Directors Meeting - January 29, 2021 
All directors were present, and there were no public comments submitted.

Report of Israel Rocha, Chief Executive Officer:

• Annual I-C-A-R-E employee awards were announced. I-C-A-R-E includes Quality, Integrity, Collaboration, Accountability and Excellence.  CEO Rocha talked about the importance of these qualities for the System and its employees to thrive.
• He then turned to a status report on Covid-19 reporting numbers as of January 27, 2021.  Confirmed CC cases 448,546; deaths 8,756; and total tests 5,625,530.  The new Covid website is up and running: vaccine.cookcountyil.gov, and the phone number is 1-833-308-1988.  Cook County residents can sign up to receive the vaccine, but it was made very clear that the holdup to the vaccination program is not the operational aspects but the availability of the vaccine supply.  Residents who sign up will be notified and given a date only when the Department of Public Health can ensure the vaccine is available.  The Chicago and Suburban Cook County Health Departments are working together.  Chicago will give vaccinations to suburban CC residents working in the city, and CC Health will do likewise for city residents working in Suburban Cook County.
• CCH is involved in a suburban Cook County community support program that includes $5 million awarded to 42 community-based organizations and a “Mask-Up Campaign”.  Community organizations are providing masks and care packages.
• On January 27, Cermak (Cook County Jail health facility) reported a rolling 7-day positivity rate of 4.4% and a census count of 5,324.  2000 of the staff members have been vaccinated and detainee vaccinations are in progress.
• CEO Rocha reported that 2,825 or 49% of the 6,033 staff have been vaccinated -– job category percentages include Doctors 80%; Nurses 49%; non-union 62% and union 47%.  An effort to educate employees on vaccine safety is under way.

Committee Reports:

Human Resources:

• Year-end Report [11-30-20]:  325 total positions were filled [146 externally].  Average time to fill positions was 91 days against a goal of 90 days.  Separations totaled 546 of which 271 were resignations, 288 retirements, 36 discharges, 11 deceased, and 50 laid off.  Chair Hammock asked for a summary of exit interview reports listing the reasons given for leaving Cook County Health.
• Covid Hiring as of January 22, 2021:  154 tracers, 93 Case investigators, 6 Supervisors, 7 Leadership.  Another 33 are scheduled to come on board in the next two weeks.  

Managed Care as of January 4, 2021: 

• County Care Managed Care Organization (MCO) continues to have the highest enrollment in Cook County at 380,386 or 31% of which 38,695 or 10.2% actually use the CCH hospitals and ambulatory care centers.  Because it has received Illinois’ highest quality ranking among the Cook County MCOs, County Care’s share of the State’s auto assignment will rise to 50% on February 1.  
• The State has continued to pause its annual redetermination requirement.  This along with the newly reopened Federal ACA enrollment opportunity is expected to further the rise in CCH’s MCO enrollment.  It is also expected that until later this year the System will receive a fee for service reimbursement rather than the current Medicaid rate for undocumented Cook County residents aged 65 and older who meet the financial need requirement.

Quality & Patient Care: 

• Stroger’s readmission rate on November 20, was 8.69% against a target of 8.56%.  Heart failure continues to be the leading cause. 
• Unfortunately the rate of patients that would recommend Stroger dropped to 64.39 % from a 77.9% rating reported at the December 4 board meeting.  The target is 71.3%.    

Finance:  

• In December, the System approved an emergency purchase of $8.4 million with Dialysis Care Center Holdings to operate the renal dialysis center at Provident.
• The board approved a $2,069,820 contract with Specialty Consulting for environmental assessments at the Oak Forest Health Campus, the CCH Administration Building, the Department of Public Health’s Forest Park, and Provident Hospital.  The Cost for 2021 is $1.7 million and will be funded by Cook County’s capital improvement budget.
• On an accrual basis, the System ended the year $35 million ahead of budget due to emergency funds received from the Federal government.  Revenues were up due to emergency Medicaid payer mix improvement, a decrease of 16% in patient volumes, and the receipt of $153 million in CARES Act funding.  Expenses were over budget but most Covid expenses were reimbursed.  In addition uncompensated care, including Charity Care, was down due to Covid.  
• CountyCare had an operating loss of $51 million in FY2020.  The new Medicare plan is not expected to show a profit for the next year or possibly two.  As of January 2021, there is an intergovernmental agreement with the State to reduce the revenue payback.  It was noted that due to Covid there was significant drop in claims, but that was offset by the higher cost of inpatient claims.  Board member Curry asked for a separate Medicare financial report.
• Domestic spend was $225 million compared with the $173 million budgeted.  Mr. Rocha said that he and Mr. Galeener, Interim CEO of CountyCare, are working on a revenue generating strategy.   Board member Koetting asked to be included in discussions to improve profitability.  He commented that he would not support a “wholesale” adoption of the strategies used by other MCOs.
• Grants:  The System’s lawyer described the new grant review procedure due to a change in the County appropriation ordinance and resolution for FY 2021 that did not include grants.   The CC Board will no longer approve, but will receive and file them.  Going forward the County Board must approve grants over $150,000 and the County budget director will approve grants under $150,000.  The lawyer assured the directors that the new process was not intended to eliminate CCH’s control over grants.

Observed by:  Diane Edmundson                                    Meeting Length:  3 hours