Cook County Health (CCH) Board of Directors Meeting
November 22, 2024; 9 am   

Aaron Galeener, Chief Administrative Officer CountyCare, the County Health and Hospital System’s Medicaid managed care organization, responded to questions by Board Directors on how the incoming Trump  administration might affect the Hospital System.  Lots of concerns that the Hospital’s Medicaid block grants might be at risk noted Galeener.  CountyCare was founded utilizing a 1115 Medicaid waiver.  CFO Cassara added that CCH leadership would be conducting strategic discussions on possible impacts.  Governor Pritzker, Cook County Board President Preckwinkle and others will support CCH initiatives others commented.  Should CCH be concerned Director Robinson queried, with Galeener responding that they were hoping moderating influences would prevail.

Board Action: 

• Lyndon Taylor was re-elected unopposed as Chair of CCH Board by Directors.
• CC Commissioner William Lowry was elected unopposed as Vice Chair of CCH Board of Directors.
• Contract and Procurement items were all approved with: 

• Director Bhatt dissenting and voting “present” rather than “yes” on items 11 (Deloitte Consulting LLP: service-supply chain optimization consulting $598,095 extension of existing contract) and 20 (Deloitte Consulting LLP: service-human resources optimization, consulting and support services; $9,211,367 competitive bid RFP ).
• Likewise, Director Sorrell voted “present rather than yes for items 7 (Rush University Medical Center: service-clinical services agreement—no fiscal impact, extension of sole source contract) and 43 (Rush University Medical Center: service-renal biopsy studies, consults & conference moderation; $149,999, extension of contract--competitive bid RFP).  No discussion on reasons for dissent.
• Sept. 30, 2024 CCH Financials show $51,255,000 unfavorable variance to Budget for line item: supplies & pharmaceuticals.  This was attributed to increasing use of expensive biologic and genetic drugs, such as sickle-cell anemia gene treatment and others. 

Research and Grant Funding Discussion:

• Discussed the Life Science Department, newly established in 2024 to win research and other grants and contracts and manage them to increase a larger flow of extramural funds and expand the base of funders with the goal of supplementing revenue to CCH.

• Hektoen Institute has historically managed CCH’s grant solicitation and management.  Transition of Hektoen staff to permanent CCH positions is on-going with nearly 100 FTEs expected to transition by March 31,2025 at comparable salary & benefits.
• Directors posed numerous questions: 

• Institutional Review Board required to enroll human subjects— who will manage IRB, obtain informed consent, process research grant specimens? Answer: The program that sponsors the grant will manage IRB .  Clinical trial lab specimens will be processed at CCH.  
• Will participants recruited for clinical studies reflect CCH population? What about patients not eligible for study enrollment?  
• Grant funders have asked serious questions about the capability of CCH to manage their research grants. 
• Hektoen charges an 11% management fee—can CCH really provide services at this financial break point?  Will we generate more revenue than currently using Hektoen?
• How will we retain clinical investigators at CCH to be competitive?
• Director Reiter, Acting Board Chair in the absence of Lyndon Taylor, tabled the topic for further discussions at subsequent meetings.

Items to Watch for in the Future:

• Hektoen transition of grant management to new CCH Life Sciences Department status in 2025.
• Potential changes to Medicaid and healthcare provision impacting CCH in 2025 under new USA administration. 

Observer - Susan Kern, MD


Cook County Health Human Resources Committee Meeting
 November 14, 2024

Dr. Mikaitis introduced the newly hired Chief of Human Resources, Mr. Win Buren who joined the System just three days before on November 11.  The interim Chief, Carrie Pramuk-Volk was thanked for her leadership during the position search.

Metrics October 30, 2024:

• 1700 vacancies – 1200 of which are currently in the HR hiring/replacement process
•   113 days on average to fill positions and a 64% offer acceptance rate
• 1060 total filled positions of which 725 were external hires

December 1 – October 31 metrics:

• 290 Nurse hires and 173 separations:  117 net new nurse additions
•   107 days on average to fill positions
•   173 Retirements
•   216 Resignations
•     56 Discharges

September Agency Hires:  1,378                      October Agency Hires:  1,224

Recruitment Process Improvements: 40% reduction in positions not posted within 14 days of approval
Decision to Hire packets not completed within 14 days of submission also showed a 40% reduction.

Provident Scholarships:
2022    31 scholars $348,000 awarded           
2023    60 scholars $900,000 awarded
2024    91 scholars $1.3million awarded 

Observer - Diane Edmundson     

Cook County Health Board Meeting
June 28, 2024

Challenge of Monitoring 53 Separate Behavioral Health Grant Awardees

• Grants of either $500,000 or $1 Million of ARPA funds under the Stronger Together Behavioral Health initiative have been awarded to 53 different community-based organization  The purpose of the grants is to address behavioral health inequities across the region’s system of care through increased systems alignment, enhanced system quality, and the expansion of access to early intervention and prevention, treatment, support, recovery and crisis assessment and care.  Grant awards were made  to those communities in greatest need and will begin  September 2024. Commissioners were concerned with how the Department would accomplish gathering granular data, given the diversity of grantee organizations to be able to measure effectiveness. The Department recognizes  the challenge and is working on and dedicated to setting measurable and quantifiable goals and objectives. 
• The Commissioners also engaged in a discussion on the use of the term  “mental health” vs. “behavioral health” indicating that each may create stigma. The Department indicated that both terms are in use but are dependent on circumstances and level of comfort with who they are addressing at any time. Commissioners requested an update on goals and objectives in six months.

Report from Chairman of Board:  

• Chair Taylor asked for a moment of silence in recognition of the passing of Commissioner Dennis Deer and announced that there would be a formal recognition of his contributions with Commissioner Deer’s family present at the next scheduled Board meeting on July 26, 2024.  There were Commissioners who chose to reflect on their friendship with Commissioner Deer at this meeting as well.

Finance Committee Report: 

• A total of thirty-four contracts received approval from the Finance Committee on June 14th and subsequently received approval by the Board. Six had no fiscal impact, two were ARPA funded and two were grant funded. Of the remaining contracts, ten exceeded $1 million with the majority of those between $1 and $3.6 million except for a three-year contract for 3rd Party Administration of dental and vision benefits awarded to Avesis for $9.9 million; and a 2-1/2 year contract for telephone triage and referral services for mental health and substance abuse awarded to NAMI of Chicago for $7.9 million.   
• Questions were raised by Board regarding an amendment and increase to the contract with In His Hands Resource Center for $46,150 (ARPA funded) as to impact on homeless families with children and a request made to drill down to all levels of need - singles, families with children under 12, bi-lingual, etc. and further, how this service would be funded after ARPA funds are exhausted.

Quality and Patient Safety and Audit and Compliance Committees:  

• Due to a lack of a quorum, the Quality and Patient Safety meeting was cancelled. The Committee submitted reports for informational purposes and later consideration.
• Although the Audit and Compliance Committee had rescheduled its meeting to the hour before today’s Board Meeting, it went into a closed meeting and never reconvened into an open session. 

Report from Interim Chief Executive Officer:

• In addition to the Behavioral Health Grant awards, Dr. Mikaitis reported successful audits including a Joint Commission survey, and  an IDPH compliance audit for a sickle cell grant. Cermak developed a comprehensive resource guide for individuals leaving Cook County Jail. CCDPH continues to participate in the 100-day challenge to end homelessness in Suburban Cook County.

Informational Reports:  

1. Human Resources Committee Metrics: Second quarter vacancies at 1,821 with 1,435 at various stages of fulfillment from posting of position to offers made. Separations and retirements trending down, and one-third of  ARPA funded positions filled with permanent staff. The accelerated Nursing hire between August 2023 and May 31, 2024,  had 564 offers made with three hundred accepted and twenty-eight pending for a 57% acceptance rate. There were declines from applicants who had applied for multiple positions and could only accept one.
2. Managed Care Committee Metrics: County Care had 429,217 members as of June 5, 2024, and 33.7% of the managed Medicaid Market in Cook County. CountyCare’s enrollment increased 1.3% in March in part due to an 83.7% retention rate over projections. Retention through redeterminations has been helped by the presence of DHS staff at dedicated redetermination events hosted by County Care. 

​Observer - Peg Moster

CCH Quality and Patient Safety Committee 
April 19, 2024 

• The Operation Excellence (OpEx) workgroups from Stroger, Provident and Ambulatory and Community Health Network (ACHN) provided updates.  At Stroger, progress is being made on both lowering central line and catheter infections and decreasing Pulmonary Embolism and Deep Vein Thrombosis occurrences. Provident Hospital has also shown improvement in their goals. Sepsis occurrence has decreased and hand hygiene has improved. 
• The Stroger OpEx readmissions workgroup reported lowering the readmission rate for Congestive Heart Failure and Chronic Obstructive Pulmonary Disease patients. Since these diagnoses are common, they were chosen to start this goal. The work will also be extended to less common but high readmission rate diagnoses.
• The various factors identified as problematic were presented along with changes made to ameliorate them. The Ambulatory services (ACHN) have explored how to get patients’ blood pressure under control. It was found that there were inconsistencies in how blood pressure readings were determined. The standard for ACHN is to take the reading 3 times and average it. The procedure is to make sure the patient is comfortable and positioned properly. It was found that newer staff in the specialty clinics were not aware of the procedure and have now been trained. They also developed an algorithm that allows the nursing staff to change doses.
• ​Both hospitals are due for the Joint Commission on Accreditation of HealthCare Organizations (JCAHO) surveys later this year and are preparing. Mock surveys were done in January. There were very few comments from committee members and no closed session. Items to Watch for in the Future: JCAHO preparation.                                                                            

Observer: Lisa Slankard

​Managed Care Committee
April 19, 2024

• Metrics - 442,652 total members [well above budget projections].     13,849 ACHN Members [5.4%]  
•  It continues to be the leading Managed Medicare Plan in CC with 32.3%.  BC/SH is next with 27.6% market share. The CountyCare staff received kudos for its 80% Redetermination rate and its marketing and outreach efforts including billboards along the expressways.  
• ​CountyCare Access (health benefits for immigrant adults and seniors) - Effective January 1, 1013, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan.  To date, a total of 34,679 have been enrolled.  79% are in the adult category [vs seniors].
• Healthy Choice Illinois RFP  - The RFP by the State has been delayed for a year.  The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
• Quality and Equity Choice Campaign  - Primary care engagement strategies will focus on adults 18-24.  Equity efforts will start with smoking cessation via education and prevention.  Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants.  Clinical Services will focus on accomplishments particularly with behavioral health participants.

Observer:  Diane Edmundson

Cook County Health Board
Finance and Human Resources Committee Meetings
January 18, 2024

The fiscal year for Cook County Government runs from December 1 to November 30 of the following year.  On an accrual basis, interim financials show that CCH end November 2023 with a $362.1M favorable variance to budget.  On a cash basis, it showed a $252M favorable balance primarily due to the timing difference in CountyCare’s reimbursements.

2023 Financials                           Actual               Budget
Revenue                                                 $4,746 B           $3,844 B
Expense                                                    4,528 B             3,992 B

Stroger Hospital                              Actual             Budget
Average daily hospital census                      306                     267
Emergency room visits                              85,843                 95,006
Surgeries                                                        11,490                    11,436 

Provident Hospital
Average daily hospital census                        20                        26
Emergency room visits                              26,180                29,994
Surgeries                                                          3,442                  3,248

ACHN Patient Activity
Primary Care Visits                                 237,076               281,649
Specialty Care Visits                               378,305               274,000
                                                                                                                     
 COOK COUNTY HUMAN RESOURCES FISCAYEAR-END SNAPSHOT 
Positions Filled                                         1,359
External Hires                                              853
Retirements                                                  192
Resignations                                                 325
Discharges                                                      45

TOTAL                                             562  *
* 9.8% against a national benchmark of 2023

Observer - Diane Edmundson

Cook County Health Board of Directors
Quality & Patient Safety Steering Committee
​January 18, 2024 - No meeting this month - report based on dashboard slides

In 2023, data was reported in monthly increments.  In 2024 the committee will look at most of the data on rolling 12-months increments to better quantify improvements. Not all data will have this format to start with. 

In 2024 control charts have been added for performance monitoring data for many items. Control charts are visual depictions of quantitative data. They can be used for common variation monitoring or new process parameters (good/bad).  The new areas of focus are listed below:

Stroger Hospital 
Patient Experience
    Improve % Top Box for Communication with Nursing Domain
    Improve HCAHPS Survey Response Return percent
Clinical Outcomes
    Reduce CLABSI,( central line-associated bloodstream infection ) and 
   CAUTI (Catheter-Associated Urinary Tract Infection) & CDIF Volume of occurrences    
Reduce PSI - Patient Safety Indicator PSI12 Perioperative Pulmonary Embolism or Deep Vein Thrombosis volume of occurrences
Readmissions
     Reduce House wide Readmissions all Payors-including patients admitted elsewhere
Throughput
     Reduce timeline of Inpatient Ordered to physician verified (Diagnostic Radiology Orders)
      Improve GMLOS (geo-metric mean length of stay) variance
Clinical Documentation
     Increase Overall Medical & Surgical CMI 

Provident Hospital 
Patient Experience
     Improve % Top Box for Communication with Nursing Domain
     Improve HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems)      
     Survey Return percent 
Clinical Outcomes
     Improve SEP-1 (Severe Sepsis and Septic Shock Management Bundle) Compliance Rate
     Improve HH (hand hygiene) Compliance and coach clinicians where we are not meeting the  
     compliance.
Throughput 
     Improve LWBS ( left without being seen) Rate

Observer - Lisa Slankard

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