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

Board Action and Reports:

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

Items to Watch for in the Future: 

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

Observed By: Susan Kern

Cook County Health Board of Directors Meeting
June 30, 2023
 
Dr Rami Doukky presented an overview of the interventional cardiac services. In January 2023, a new Cardiac Unit opened. There are 13 beds. Also in January, the Watchman procedure was added to procedures performed. In May, Mitraclip was added. There was discussion on obstacles to overcome regarding the continued expansion of the unit and services.

Committee Reports

• Human Resources – Metrics continue to slowly improve.  Turnover rate is well below the national benchmark. 
• Managed Care
  • CountyCare’s enrollment
    • increased 4% over the past 12 months, behind the Cook County increase of 5%
    • increased 0.3% in April 2023 compared to the prior month, behind the Cook County increase of 0.6%
  • There are 2 paths for redetermination. The first group are members who have information in the system and are auto renewed. The next group there is no information in the system and they must complete a form to confirm eligibility.  In June, 66% of members were redetermined. There is a 30 day grace period and efforts are being made to reach those who still need to submit forms.
• Finance –(from Committee meeting) - During the discussion of the information provided regarding the Health Plan Services Financial Results, the Committee discussed the subject of redetermination. Aaron Galeener, Chief Administrative Officer for Health Plan Services, provided information on current strategies being used to increase awareness and responsiveness for those who must go through the process to determine whether they qualify for Medicaid assistance. A question was raised regarding whether there is a mechanism available for outreach to families via students enrolled in the Chicago Public Schools (CPS). Mr. Galeener stated that he will look into the question to see if there are any opportunities available.

The chair recognized the service of Director Dr  Karen Kim who had resigned and moved to Pennsylvania.
There was no public testimony at any of the committee meetings or at the Board of Directors meeting.

Items to Watch for in the Future:

• Continue to monitor Medicaid redetermination and staffing levels.

Directors absent- Deer, Bhatt

​Observer:  Lisa Slankard

Cook County Health Board of Directors Meeting
Friday May 26, 2023

Attendance:  All Directors present except: Commissioner Dennis Deer, Karen Kim MD, and Robert Currie

Overview of COVID_In person public meetings: 

• Dr. Welbel, Chief of Epidemiology and Infection control opened meeting assuring that the room design and set up allowed for an in-person meeting where masks were optional. Health System Board meetings will continue be hybrid and can be watched at https://www.youtube.com/watch?v=zJH-3DqPVJc
• Public Testimony: The testimony was remote and hard to hear because of background noise. 

Board and Committee Reports:  Link to Board of Directors Meeting Minutes April 28, 2023 

• Human Resources Committee Meeting May 18, 2023
  • Human Resources Minutes May 18 Committee Meeting
    • Notes From Minutes: Ms. Amos stated that she is working on an analysis of staff who are or will be eligible for retirement based on a number of factors; once that is finalized, she will share that information. 
    • Slide 4 of report indicated that as of 4/30/23 there are 2,330 vacancies. 
• Managed Care Committee Report
  • Link to Manage Care Committee Report: Aaron Galeener, Chief Administrative Officer for County Care.  Mr. Galeener presentation indicated that the County Health System still cares for a small percentage of the County Care enrollees (See slide and definitions of Categories).  
    • Addressing this issue, was a later presentation to the Board by Alexandra Normington Marketing Officer on a marketing plan to increase awareness of County’s outpatient clinic system. 
  • Mr. Galeener reported that Medicaid redetermination started May 1st. The System estimates that only 30% of those facing redetermination will be automatically re enrolled with the rest having to go through the redetermination process.

FHP: Family health plan: This is the historical TANF (Temporary Assistance to Needy Families) Medicaid population – it is generally families – so children and parents.
ACA: This is the adult expansion population that was covered under the Affordable Care Act that increased Medicaid eligibility as a percent of federal poverty level up to 133%.  This is only adults. 
ICP: Integrated Care Program. This is individuals with high needs and/or disabilities.
MLTSS: These are individuals that are covered under Medicare for most services with the exception of Long Term Services and Supports which are covered under Medicaid.

• Quality and Patient Safety Committee Meeting May 18, 2023
  • Quality and Patient Safety Committee Minutes 
• Finance Committee Meeting May 18, 2023
  • Finance Committee Meeting Minutes
    

Report from Chair of the Board & Chief Executive Officer

• CEO Rocha reported on the Initiation of a program “Ideas for Change Campaign” which seeks input and ideas from front line workers ON how to make CCH better. Recognition and incentives are available for those ideas put into action. Mr. Rocha STATED there has been a positive response to program. 

​Observer - Susan Avila 

Cook County Health Board Meeting 
March 31, 2023              Virtual Meeting

Emergency Medicine at Cook County Health remains one of the most competitive physician residency programs nationwide drawing from the brightest graduating medical students.  Minority and underrepresented groups account for 16% of the internal medicine residency slots beginning with the 2023 class.
Strengthening the multicultural diversity of primary care physicians (internal medicine, Family Practice) training at Stroger, Provident Hospitals and affiliated clinics is a priority of CCH’s DEI plan (diversity, equity & inclusion) Dr. Claudia Fegan, Chief Medical Officer, expounded. 

• Employment Plan Compliance officer, Kimberly Craft noted that while the CCH push to improve and streamline hiring was a priority goal, compliance with Federal & State labor law as well as collective bargaining agreements require enhanced written documentation supporting the hiring/termination/discipline policies.
• Provident scholarship program: up to $20,000 for graduate level medical/dental & Advanced Practice Nurse students and up to $10,000 for undergraduate and Allied Health Professionals.   It is hoped that these students will remain at CCH for their career. 
• Directors poised questions on the status of the initiatives to accelerate the hiring process which Valarie Amos, Chief HR Officer, noted was down to 119 days from posting the job to filling a position versus 160 days in FY 2022.  8 job Fairs in FY23 were successful in garnering 401 interviews with 152 acceptances of the 166 offers.   Many acceptances were made the same day as the offer! Decreasing “temporary agency” cost for high use temporary staffing categories is anticipated.

Items to Watch for in the Future:
Redetermination for CountyCare managed Medicaid plan members is likely to eventuate in decreased plan membership in the June 2023 Managed Care data, noted Aaron Galeener, Chief Administrative Officer for CountyCare.

Observer - Susan Kern

Cook County Health (CCH) Board of Directors Meeting
February 24, 2023

CCH Human Resources’ goal toward maximizing efficiency and decreasing the time in recruitment and hiring receives continuing support from outside consultants.

• Slalom has taken the lead with HR by adding technology, department staff training and analyzing HR processes with a focus on efficiency.
• Deloitte has reviewed job descriptions, undertaken compensation analysis, added technology focused on employees and revised new hire orientation.  Deloitte’s job recruiters have reduced administrative burden.
• Cross Country has organized monthly job fairs, helped with recruiting and has created marketing strategies and campaigns using Tik Tok, videos, fliers, and social media.
• Brazen- has added virtual job fairs and a virtual hiring platform.

Human Resources Committee

• FY2023 Year to Date through 1/31/2023, filled positions is 253, with 156 positions external hires.  Most of the 127 separations were due to retirement.  The time to fill from the day the job is posted to the day the offer is accepted is 120 days, which is a significant decline from FY2021. 
  
• CEO Rocha added that CCH is a great academic training center and staff gain great skills in their first to fifth year of employment and become very marketable.  Once employees hit the 10 to 15 year employment, pensions and other benefits become important and they tend to stay at CCH.  The retention of the 5 to 10 year employee is CCH’s focus.

Finance Committee

• A contract extension and increase was approved for the The Chicago Lighthouse to be a backup for the patient support center to help with scheduling, registration and insurance verification assistance.  The Chicago Lighthouse was founded in 1906 and provides jobs for the blind and visually impaired, disabled and Veteran communities.
• Interim financials FY2023 ending Dec 31, 2023: On an accrual basis show that CCH ended December with a $37M favorable variance to budget.  On a cash basis, the county’s preliminary cash report on revenues and expenses show a $49.7M favorable variance.  CountyCare shows an operating gain of $6.1M.
• GPO Presentation: A GPO is an organization that through a group’s collective buying power obtains better pricing and value for its members.  Most of all health systems in America are GPO members contracting for medical/surgical supplies, drugs, food, purchased services, technologies, etc.  CCH begins at the start of FY2023 to solicit proposals from vendors and after analysis and attending presentations decides on a GPO by 3/20/2023.

Managed Care Committee

• As of February 7, 2023 CountyCare membership is 450,264 with 41,800 in CCH clinics.  Through December 2022, CountyCare has a 32.6% share of Cook County managed Medicaid market.  Membership is still high as Redetermination has not yet started.  Once it starts April 1st membership numbers are expected to drop. CEO Rocha said a CCH goal is to assist members in the redetermination process.

Items of Interest

• Cook County Dept Public Health Quarterly Report 2023 on the “Suburban Cook County Healthy Work Initiative”.  This report highlighted the plight of essential workers especially during the pandemic.  Another focus is precarious workers.  These are low wage workers with unpredictable/unstable work conditions, work with hazards and without regulatory safety standards.  The goal of this initiative is to improve worker safety and addressing these issues was highlighted.
• CEO Rocha introduced the “One Source Enterprise” project to transform patient access and patient experience.  After calling the Contact Center for non-emergency care needs, a caller can talk to a real person.  The caller can receive  virtual care through nurse triage, connection to  a provider or referral to urgent care sites.  A caller can also  schedule appointments, refill prescriptions, and ask other care questions.  A limited 1st phase urgent care rollout will be spring 2023.  Virtual RN positions at CCH are a competitive opportunity for nurses. 

Observer - Michele Niccolai

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