Cook County Health Board of Commissioners  
​Managed Care Committee
​January 19, 2024

The MANAGED CARE COMMITTEE accepted an emphasis on the expansion of the telehealth service into urgent care by Quarters 3 and 4, 2024.  There was no discussion and no details were provided to the committee at the meeting. 

REPORTS
Report on CountyCare Health Plan Metrics (in power point slides) was presented and discussed:

• Total Enrollment as of 01/05/2024 is 432,589 which is a 32% market share.
• Medicaid managed care enrollment decreased 2.7% county-wide each month, since redetermination resumed in June 2023, with CountyCare enrollment decreasing at the same rate.
• 2023 metrics
  • Increase in call abandonment rate from .35% on 47,791 calls in Oct2023 to .82% on 41,586 calls.  Almost 1% of calls abandoned on 13% fewer calls.  Still meets State Goal of < 5%. 
  • 6.4% fewer calls answered < 30secs in Dec 2023 to 91.43%.
  • Acute admits decreased slightly from 2022-2023.
  • Covid vaccination rate for one dose = 49.9% & 44.97% for series. CDC benchmark = 94.45%.
  • Highest rating from National Committee for Quality Assurance (NCQA) across all MCO’s.
  • 53 of 230 new provider organizations added in 2023 were for Behavioral Health.
  • FY2024 focus includes 
    • Expansion of Telehealth in three phases
      • Q1&2 2024    Telepsychiatry, 
      • Q3&4 2024    Urgent Care, 
      • Q1&2 2025     Other specialties.
    • Reduce unpaid claims using population-based payment, in which CountyCare leads other MCO’s.

ITEMS TO WATCH:

• State of Illinois (SOI) is publishing RFP for Managed Care in Q2 2024.  First draft of response is completed. Consultant will be selected in the near future

ITEMS OF INTEREST:

• The actual enrollment for Dec 2023 and Jan 2024 were 25,000 and 40,000 higher than the budget projected.  
• More abandoned calls and longer delay before answered over three-month period Oct-Dec 2023.
• Less than 50% uptake on Covid vaccinations, less than 12% on Covid Booster.
• Unpaid claims over 60 days are decreasing.

ITEMS PROMPTING THE MOST DISCUSSION

• Flexible Housing Program – source of funding is ARPA and Illinois “Quality” $ from top ratings. 
• Workforce- Hired 231 positions, 80% team satisfaction.  Moving away from contracting labor.
• Housing Programs, Increased health benefits for immigrant (any status) adults and seniors.
• Health Benefits for Immigrant and Adults & Seniors (HBIA/S) (started by SOI 18-24 months ago) current enrollment is 9,217, projected at 40,000 between Jan-Apr2024.
• CountyCare is the only MCO that removed co-pays and cost-sharing for HBIA/S.  Committee was complimentary of assistance to this population, but wants report again in three months.

Observer - Victoria L Cerinich

Cook County Health Board of Director's Meeting
September 29, 2023             Virtual and In-person Meeting

CEO Israel Rocha, Chief Operating Officer, and staff presented departmental metrics and a third quarter update to Strategic Initiatives for the Cook County Department of Public Health.  The Strategic Plan for 2023-2025 was introduced in April 2023 and critical ones were included in each area’s Metrics Review.  

Highlighted in CEO Rocha’s presentation to the Board was an update by Dr. Urjeet Patel, Interim Medical Director of the CCH Cancer Center, on the Cancer Center Service Line.  The presentation reflected incorporation of the Strategic Initiatives introduced earlier in the year.   With a Mission to provide the highest quality, integrated care across the cancer care continuum for the community served; to create a comprehensive cancer institute through clinical and operational leadership alignment to serve as a fundamental pillar of the Change Institute of Cook County Health with health equity, state of the art care, patient safety, clinical excellence, and patient-centered experience.  The six areas identified to incorporate the Cancer Care Continuum were:

• Preventing/Risk Reduction
• Screening
• Diagnosis
• Treatment
• Survivorship
• End of Life/Palliative Care.

Dr. Patel outlined the 5-year plan begun in 2021 and the holistic approach being taken, including primary physicians, social work, genetic testing, affected families, and the modernization of mammography to be welcoming and informative with wrap-around services.  The target completion date for all elements of the transformation is 2025. 

Committee Reports:

• Human Resources reported improvements in all metrics including a reduction in the number of days to hire to 91, one above the goal of 90.  Valerie Amos attributed this to a successful trial to reduce the time to offer employment after receipt of a minimally qualified applicant (now implemented as standard operating procedure), along with an increase in the number of job fairs and recruiting efforts. Turnover has been reduced to 2.9% from 3.4% last year.   
• CountyCare continues to hold the lead in Cook County market share at 32.4% in a field of 6 other managed care organizations.  CountyCare exceeded its initial retention goal with 90% of members responding to their redetermination notice and had the highest response rate out of the HealthChoice MCOs.  Covid vaccination rates remain steady and claims over 60-90 days minimal.  Beginning January 1, 2024, Healthcare and Family Services will be transitioning the Health Benefits for Immigrant Adults(HBIA) and Health Benefits(HBIS) for Immigrant Seniors programs from fee for service into managed care.  Additionally, members in both programs residing in Cook County will be auto assigned to CountyCare.  As of August 2023, almost 45,000 HBIA/HBIS members were residing in Cok County
• Finance presented 23 contract and procurement items, all of which were approved.  Of interest are the following:
  • Contract for $831,079 (ARPA Funds) to the Kennedy Forum for the countywide behavioral health summit which will facilitate the development of a Cook County Behavior Health Authority Strategic Plan and Implementation Workplan. 
  • Contract for $16 million to LanguageLine Solutions 10/23 to 9/26 to provide telephone and video interpretation and document translation services for CCH, ACHN clinics, Cook County Dept of Public Health, and CountyCare. 
  • Six-month (10/1/23 to 3/24) contract extension for $9 million to Deloitte Consulting to continue initiative to transform CCH Human Resources. A lengthy discussion took place regarding this extension.  Currently there are a total of 3 consulting contracts, including Deloitte, working with CCH HR in their transformation.  The original contract with Deloitte was initiated in 8/2022. 
    • Questions from the members of Finance Committee focused on the HR organizational structure and where they were in the “rebuilding” as these contracts are ending. 

Ms. Amos, Director of Human Resources, stated that they are in the process of now looking at their organization structure and currently not sure of the positions needed. Their rebuilding is not done yet and not sure of the # for FTE needed for the HR Department. 
Director Reiter talked of a future plan for a master RFP process where all 3 contracts will be consolidated into one contract. Ms. Amos expressed concern that without this plan, CCH Human Resources will be unable to maintain the recruiting activity needed for the Health System. 

CEO Rocha also noted that CCH’s Stroger Hospital has been named the #1 most racially inclusive hospital in Illinois and #2 most racially inclusive hospital in the nation by the Lown Institute Hospitals Index. Cermak Health Services earned accreditation by the National Commission on Correctional Health Care (NCCHC).

What to Watch for in the Future:
A description of how the plan mentioned by Director Reiter for a master RFP process would work and whether it would address the issue of multiple contracts targeting one initiative.  

Observers: Peg Moster and Susan Avila – Finance Report

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