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 

Cook County Health (CCH) Board of Directors Meeting
June 24, 2022

Board Report Highlights:

• Board Chair Rocha reported 15 confirmed cases of the viral disease monkeypox in Illinois. CCH and CCDPH are monitoring the situation. Dr. Wellbell is leading the operation. Historically monkeypox has not been fatal in the US and not expected to spread widely. CCH is prepared to diagnosis and immunize.  Priority will be given to those considered high-risk; the vaccine is limited. Director Harrington stressed the importance of messaging and the limitations of vaccines.
• COVID Mortality Rate is at a record low. CCH will provide vaccination for children under five next week. Chairman Reiter questioned whether CDC has guidance on second boosters for those under 50 years and 6 months out from first boost, with high risk for pre-exposure or post exposure, and rebound cases. Rebound cases have different isolation periods. To date, CDC has not provided additional information. The boosters need to be toward omicron variant.
• The Department participated in City of Chicago and Human Resources public safety training, including, Full-Scale Disaster Response Training and Stop the Bleed, a national prevention program.  STOP the Bleed offered Training to NPF organizations, individuals, first responders, and elected officials on how to stop a bleed from gun violence. In a separate event, CEO Rocha joined President Preckwinkle, and Senator Durbin, held a press conference to advocate for gun reform.

Human Resources Report:

• Metrics Review reported separations, 265 resignations, exceed new hires (43 monthly hires), and current vacancies of 263. The strategic plan is to use modernized technology, contemporary practices and external partners in recruitment and retention. Director Harrington commented that COVID impacted the dynamics of care and staffing. 
  
• The department plans to target staffing at Providence and Stroger first. Resources and outside partners are driving force for virtual job fairs and having timely information from a nursing data base. Dr. Hasbrouck asked if salary surveys had been conducted. Plans to review RFPs will address CCH competitiveness and salaries.
• Recruiting and staffing are streamed lined through Brazen Online Platform, Solum, and Incredible Health and launching a Key Hiring Metrics Dashboard improves real time decision making and information.

Managed Care Report:

• Membership increased to 436,000, Managed Medicaid Market is at 32.5, Trends versus CC Market overall up 5% and CC up 8%. Membership versus budget; CCH Continues to exceed budget by a significant margin; it is driven by PHE’s redetermination 50% auto assignment.
• Operations show steady performance and IP Acute Admits. Vaccination rates increased to 56-57%. Claims payment is less than 11 million for claims over 30 days.
• Director Story raised a discussion about the impact of re-determination on the budget and Domestic Spend. CCH is financially stable, due in part to the extended Public Health Emergency Period.  PHE is expected to continue through October (CMS will issue a 60-day notice).  Domestic spend, CCH has seen stable utilization of facilities and planning initiatives to increase utilization. More Care expected to end this December and planning the transition process.

Observer: Gwendolyn Maxie-Brown

Cook County Health (CCH) Board Meeting
​March 25, 2022     

Enrolled in the American College of Surgeons National Surgical Quality Improvement Program (NSQIP), since 2014, Stroger is now winning big for patients by decreasing surgical site infection rate from 1.5 times the national (NSQIP) average in 2016 to 0.77 of the rate in 2022!  Annual Stroger savings of $237,210 with avoidance of prolonged hospital & ICU stay and even death of patients who suffer from post-op wound infections is the bonus.  Accomplished by implementation of rigorous procedures for disinfection of skin prior to surgery, additional pre and post-op antibiotics, changes of gowns, gloves and instruments twice: for surgery and again for wound closure and patient education were key elements of this successful plan.  Surgeon Wille notes that this is an ongoing process, with direct comparisons of outcomes to other hospitals nationally on the numerous targets of enhanced quality with decreased cost that are being studied.  Initially there was skepticism of the program Dr. Fegan, Chief Medical Officer, at CCH commented but the successes are now making believers of surgeons from all CCH specialties.  CCH’s low rate of surgical morbidity/complications for its patients places it in the top 20% of all NSQIP hospitals for 2021. 

Highlights from Board Reports:

• CCH Financial Report: $5.156 million positive operating margin year to date, vs budget which predicted loss ($19,257) - Gain due to higher inpatient volumes and decreased County Care claims expenses.  Pension costs ($160 million/year) not included.
• CCH hospital and CountyCare (Medicaid plan) financials combined - not separate accounting 
• Human Resources: 4 new outside contracts to improve hiring/retention/technology
• Charity care cost: projected $464.5 million to exceed 2022 budget of $452 million 
• CountyCare: 429,256 members slightly increased YTD 2022, largest managed Medicaid organization in Cook County followed by BCBS 334,273
• Redetermination for CountyCare membership delayed by State- is expected September.  CCH outreach efforts to retain members described for the Board.
• Hospital volumes: Admissions, patient days, average daily census, Emergency Room Visits, surgeries and ambulatory visits All still lagging 2020. 

Items to Watch for in the Future:

• Aaron Galeener still listed as Interim Chief Executive Officer, Health Plan Services (CountyCare, Medicare).  When will a permanent CEO of CountyCare be appointed?

Observer - Susan Kern, MD

Cook County Health (CCH) Board Meeting
February 25, 2022

The timeline for the FY23-FY25 Strategic Plan introduced 

• In February/March an online survey asks for feedback from all employees/communities. 
• Promotion will occur through emails, community newsletters, and social media. 
• Town Hall meetings with employees, communities (one in Spanish), labor management, and Board of Commissioners are scheduled. 
• CCH provides significant amount of charity care as compared to other Cook County hospitals.  CCH includes eight Primary Care Centers, four Regional Outpatient Centers, a Child & Adolescent Service, two hospitals, Public health and two Correctional Health Services. CCH has administered more than 300,000 Covid tests, initiated Covid mitigation and prevention at Cook County Jail, and administered approx 1 million doses of Covid-19 vaccine. Cook County Dept of Public Health set up contact tracing program for Suburban Cook County.

Finance Committee

• On an accrual accounting basis, CCH ended Dec 2021 with a $15M positive variance to budget and Health Plan shows an operating gain of $8.7M as of December 31, 2021. 
• The nursing dept request to increase the existing contract with Vaya Workforce Solutions, LLC for Contract Management and Nursing Registry services (not to exceed FY$64M) as needed, for the remainder of the contract through 9/24/2023 was approved. 
• Dr B. Peters, Chief Nursing Officer stated in years past the hourly wages for agency nurses was around $20/hour and now the wages are around $200/hour.  She pointed out the need to continue to supplement the CCH staff, especially nursing, due to vacancies and retirements.

Managed Care Committee

• As of February 4, 2022 Total CountyCare membership is 425,981, of which 10.5% are using CCH clinics.  CountyCare’s enrollment has increased 11% over the past 12 months.  As of 2/4/2022 40.62% of vaccine eligible membership are fully vaccinated.  
• Dr Collins, Chief Medical Officer CountyCare, talked about Homelessness programs in her Health Equity Initiatives presentation.  Medical Respite care is acute and post-acute care for homeless who are not ill enough to remain in a hospital but are too ill to recover on the streets.  The Flexible Housing Pool addresses homelessness by connecting people to stable housing along with health services which decreases Emergency Room visits and hospitalizations.

Human Resources Committee

• FY2022 through 1/31/22: HR received 1,545 Requests to Hire:  1,238 positions in progress, and 82 vacancies filled. Also in this time period there were 149 separations due to retirements and resignations.  The big challenge is the retention of CCH’s nursing staff. 
• HR is actively recruiting by working with colleges and universities, marketing in communities and hosting job fairs. 
• Automation plans include adding Salesforce.  A key initiative is to partner with the new Chief Experience Officer.

Quality and Patient Safety Committee

• The new Chief Experience Officer and  the office’s Strategic Plan were introduced. 
• The Plan includes 4 top goals: Patient Satisfaction Goals, implement “C I Care” behaviors (connect, introduce, communicate, ask/anticipate, respond, excellence), workforce wellness programs, and goal orientation for new hires. 
• Some initiatives are wellness lounge, employee events, art murals for group participation, farmers market, hire chaplains, newsletter, Gemba walk (gemba means “actual”) where leaders actually step out of their offices and walk to work stations to connect with staff to gain knowledge of work processes. 
• All the new initiatives are designed to enhance both the patient and employee experience as positive experiences for both create a stronger organization.

Observed by:  Michele Niccolai

Cook County Health (CCH) Board Meeting
​January 28, 2022

Presentation - Stroger Hospital Stroke Program by Dr. L. Warrior

• On June 8, 2021 Stroger Hospital was certified as a Primary Stroke Center by the Joint commission.
• An ischemic stroke: a blood vessel is blocked preventing blood flow to the brain.  A hemorrhagic stroke: bleeding inside or around the brain.  Treatments for ischemic stroke are clot dissolving drugs, best given up to 3 hours of occurrence and removal of the clot (thrombectomy) best performed up to 6 hours of occurrence- “Time Is Brain”. 
• 51% of CCH’s stroke patients are black as compared to 30% in other Chicagoland hospitals and close to 20% in other IL hospitals.  30% of CCH’s patients identify as Hispanic as compared to approximately 15% in Chicago hospitals and less than 10% in IL hospitals.  CCH’s stroke patients are black, Hispanic and younger, most age 46-65, while in other IL hospitals the median age is 70 years. 
• For acute cases, goal is to get patient to CT scan under 15 minutes after entering emergency room.  CCH provides community stroke education events, stroke support group.

Public Testimony from Nursing Staff

• It was noted that CCH has a dedicated nursing staff, many with long years of service who have worked through the Covid-19 health crisis. 
• Nurses are working understaffed (shortage night shift), facing burnout which lowers defenses to disease,  working without hazard pay or hourly Covid differential pay, and some have contracted Covid-19.  There is concern with the need to use regular sick/vacation time for Covid-19 illness.  Nurses are quitting for agencies that pay higher wages over CCH wages. 
• Hiring agency nurses at times is a patient safety issue as some have to be supervised/trained by CCH staff making extra work.  ICU/trauma units need specially skilled agency nurses. 
• CEO Rocha stated that early in the pandemic, nurses moved to areas of the country with surges/flare ups with good intentions.  Over time this has become a bidding price war for agency nurses.  CEO Rocha said CCH is addressing these issues.

Finance Committee

• The FY2021 Preliminary Financial Report ending 11/30/2021 was presented. 
• CCH uses the Accrual Basis of accounting and interim financials show that CCH ended Nov 30, 2021 with a $5M positive variance. 
• CountyCare managed care program had a year to date operating gain of $10.0M.  Health plan spends 92.3% of revenue on medical claims and 4.7% on administrative cost FY2021.

Managed Care Committee

• CountyCare as of Jan 5, 2022 has 425,290 members, a 10% increase in FY2021- still the largest Medicaid managed care organization in Cook County.  10.4% of members are in CCH clinics.  Actual membership is still higher than the budgeted amount as redetermination is paused and will be extended to the end of March/April. 
• 34.6% of total membership is fully vaccinated as of 1/7/2022. 
• The 2021-2022 marketing campaign for open enrollment is “CountyCare is There” highlighting benefits that provide dependable health coverage.
• Dr Collins, Chief Medical Officer for CountyCare, gave a presentation on Health Equity Updates.  80% of CountyCare membership live in disproportionately-impacted zip codes (children in school lunch programs, receive SNAP benefits, below poverty line).  Data from April 2020 to March 2021 was presented on specific zip codes where emergency room visits and hospitalization rates were high and primary care visits low. This data allowed focus on members with gaps in care which resulted in a targeted outreach contacting those members to schedule primary care visits and mammograms.

Audit and Compliance Committee

• The formal CCH Research Compliance Program was introduced February 2021 and implemented during FY2021 to ensure research compliance with regulations/agency laws and enforcement bodies. 
• The number of total active research studies at CCH as of mid-Nov 2021 was 1,023, an under recognized aspect of CCH.

Human Resources Committee

• Dept is committed to meet the priority staffing needs of clinics, public health, CountyCare, Provident and Stroger hospitals by process improvements, technology improvements (on-line application Taleo), streamline recruitment and by adding consultants.  The number of recruiters has dropped over the years to 5 today. 
• 1,252 positions are in the recruitment process, with 29 hires for FY2022. 
• HR recognizes there is a national shortage of health care workers, especially nurses, and job fairs for Lab and Managed Care were held and fairs for Social Work, Nursing and Respiratory are planned. 
• With the Covid resurgence, 350 agency nursing jobs and 210 other agency staff added in FY2022.

Report from CEO Rocha

• CCH recently reopened three of its mass vaccination sites: Des Plaines, Forest Park and Matteson.  The large well-coordinated team of CCH employees involved with quickly setting up these sites was recognized at the board meeting.  To date at the mass and community vaccination sites/programs more than 965,000 vaccine doses have been administered. 
• KN95 masks are being distributed at mass sites, CCH clinics, and community organizations. 
• CCH provides Covid testing at six locations by appointment: cookcountyhealth.org/covid. 
• The American Rescue Plan Act’s (ARPA) funds will support the response to and recovery from the Covid-19 public health emergency.  Cook County will receive funds over several years for well-being community programs: Healthcare, Mental Health, Public Health, Food Security, Housing. 
• The FY23-FY25 strategic Plan timeline was introduced.

What to watch for in the future:

• ARPA funds for CCH
• FY23-FY25 Strategic Plan

Observer - Michele Niccolai