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 (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 Board of Directors Meeting
September 24, 2021​

Meeting Highlights:

Human Resources Committee
Separations are outpacing hires.  There was a net of 91 fewer employees this past quarter. Resignations lead the separations. There is an 8% turnover rate, up 7% over the 3rd quarter last year.  Unfortunately HR is understaffed so hiring has slowed and average time to fill positions is up.  The market is very competitive right now.

Managed Care Committee
Membership numbers continue to increase and are up 10% over prior year. September 18, 2020 there were 371,248 members and September 9, 2021 there were 411,664 members. County Care’s market share increased to 10.7%, a slight increase from 10.5% a year earlier.  The membership numbers are over budget in part due to paused redetermination.  The call center and encounter rates have worsened. Claim’s payments have improved.

Quality and Patient Services Committee
Quality metrics are mostly unchanged except HbA1C indicator which is down to 66.7% (lower is better) toward a goal of 24% in outpatients.  At the start of the year it hovered near 90%.

Finance Committee
The agenda item receiving the most engagement from the board involved the 32 million dollar contract request for MHN ACO LLC. There is a contract already in place but an extra 32 million dollars is needed to be paid to finish off the contract which expires at the end of December 2021. This provider covers care coordination for County Care subscribers. The increase is primarily due to the increase in subscribers.  There was a lot of discussion on getting bids for this contract.  County Care has not started the bid process even though the contract only has 3 months left.  The board was concerned that the time left was inadequate and they offered help in getting this done. CEO Rocha will work with the managed care committee on a timeline for a request for proposal for next year's contract.  It was pointed out that the current company is a high performance vendor.
There was a transfer of 14 million dollars from salaries to Registry help and Human Resources.

CEO Report
All employees must be vaccinated by October 1. So far 83% are fully vaccinated with 92% having started the vaccine series. The hospital is making vaccinations available around the clock and are holding town halls to answer questions. Also, they are working with the unions. The gap on vaccination rates by race has decreased

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues 
• Managed Care costs and contracts

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