Cook County Health (CCH) Board of Directors Meeting - December 21, 2018

What did the Board Discuss?:

• Commissioner Deer, 2nd District, has a background in health care.  After being appointed to replace retired Commission Jerry Butler as Chair of the Cook County Board Health Care Committee, he was then appointed to the Cook County Health Board and assumes the role of Vice-Chair.  Newly elected Cook County Commissioner Donna Miller (6th District), also in attendance at the meeting was introduced to the Board by Chairman Hammock.  She expressed her long-held interest in the health care services provided in and by Cook County.   Commissioner Deer noted that he will be advocating for more minority contract opportunities.
• CountyCare, the county's managed care health plan, is aggressively marketing its benefits to current and potentially new customers during this year’s Medicaid open enrollment period due to close the end of January 2019.   Current membership stands at 333,704 against a 2019 target of 345,000.    Of particular note - two out of every three CountyCare members do not use Stroger, Provident, or Cook County ambulatory clinics as their primary provider. CCH is aggressively working to change this metric.
• The interim Human Resources (HR) Director implemented a new technology and outreach plan in an effort to achieve its goal of a 90 day hiring cycle (current average is 96.4 days).   In 2018, 15 new bilingual hires were added to the work force with another 10 in the pipeline, and 30 more job titles with bilingual ability as a minimum requirement are under review to establish new job codes.  In addition to adding bilingual staff and working to improve cleanliness perceptions, CCH is focusing on decreasing waiting times and improving phone access.  A revised performance management policy [employee evaluation] is to be rolled out early in 2019 with on-line performance management to follow.
• The Finance report through the first eleven months showed no new surprises.  The CFO noted that CountyCare has contributed $184.5 million to date to the Revenues.  He also noted that while Cermac Health Services, the correctional system health operation, has seen fewer patients, those seen require more resources.  The top three referrals are oral care, ear, nose, and throat, and visits to the hand clinic.
• The Quality and Patient Care Committee noted that the willingness to recommend Stroger to others has increased but statistics were not cited.  Each Tuesday the in-charge coordinator for cultural improvement is going on rounds throughout the hospital and asking two questions:  1) What are your concerns?  and 2) How can we help?  One other item pulled from committee metrics is that at any given time, about 80 surgical residents are working in the County hospitals.
• Board member Gonzalez asked Dr. Mason, CC Public Health Director, for a geographic mapping for HIV, Hepatitis C, and all sexually transmitted disease cases.  This request followed a slide presentation mapping the “suburbanization of poverty” areas in Cook County.  Dr. Mason added that the mortality rate for African American mothers is 3 times that of Caucasian mothers, and he said that the number of African Americans living in Chicago has dropped by 15% while the number of Hispanics in Cook County has risen by 20%.
• Dr. Shannon recognized the retirement of the highly esteemed IT Director, and she gave a brief presentation to the board including what the future in IT holds for the System:  artificial intelligence, predictive analysis, and prescription analytics.    Dr. Shannon also noted that the newly implemented Kiosk check-in is being well received.

Items to Watch For in the Future
Ongoing:

• Director Lowery asked for a comparison of the System’s nursing openings to other like institutions across the country.
• Board Chair,  Hill Hammock, asked for feedback on what percentage of claims are never collected because of coding, timeliness, and/or processing issues.  
• Chair, Hill Hammock asked for a detailed dive into pension costs, projections, and percentage of takeover from the County by the Cook Health System.
• A Board decision on CountyCare’s proposal to stop paying providers who treat CountyCare patients when the patients’ visit is outside their assigned network of providers.

New

• The Fiscal Year ended on November 30.  Watch for final revenue/expense variances, and metric results vs targets (e.g., hiring cycle and higher revenue specialties such as surgeries and maternal deliveries).  
• The new Vista Clinic in Arlington Heights with preventive and specialty care services such as dental and behavioral health delayed its opening to January 14, 2019 with the grand opening to follow sometime soon.  A similar model clinic in Riverside is scheduled to open by mid-year.  Look for details on the openings as tours will also be scheduled for those interested.
• 2020-2022 Strategic Plan presentations and discussions will likely get under way in earnest at the January Board Meeting and go on through the May meeting.

Observer - Diane Edmundson                                   Meeting Length:  2 ½ Hours 

Cook County Health and Hospitals System Board Meeting - December 16, 2016  
  
Significant Topics Discussed:

​Invited to provide a Federal Update, Wash. DC, Legislative Consultants, Susan White and Jonathan Sheiner, predicted the following to a somber Cook County Health and Hospitals System (CCHHS) Board: 

• Jan. 3, 2017, Congress back in session will move to immediately modify the Affordable Care Act (ACA), commonly known as Obamacare.  Using the “budget reconciliation mechanism” the Senate measure can be passed with a simple majority and cannot be filibustered.  Expect passage, signed by the President, Jan/Feb 2017.
• Reconciliation bills are limited to changing laws that affect taxes and spending which covers key elements of Obamacare.
• Predict roll back of federal tax revenue subsidies for ACA plans.
• Expect Medicaid capitation or capped dollar block grant to States, 50/50% federal match for traditional Medicaid is vulnerable including Medicaid long term care.
• Medicaid expansion under Obamacare, federal support will probably be cut from 90% to 60-70-%. 
• CHIP program covering health care for children under the age of 19 will probably be reauthorized.
• Senate will likely confirm Dr. Tom Price (vehemently anti-ACA) as Secretary of HHS. 
• Governors, including Republican ones, are concerned about the financial impact on their States.

CCHHS Board Chair Hammock concluded that if the ACA insurance mandate is eliminated and Medicaid curtailed, many would not purchase/afford insurance and CCHHS would see a massive increase in use of charity programs: CareLink, the newly introduced Direct Access and unreimbursed care.  Director Richardson-Lowry called for an economic impact statement to be available as soon as possible for Board response to various potential fiscal outcomes.

Observations: 
CCHHS metrics reported for Dec. 2016: 

• Year to date income $3,675,000 but (-$212,020,000) with $212,020,000 pension expense included,
• Overtime as % of gross salary 7.9% (goal is 5%),
• CareLink enrollment at 100% assistance 25,714 vs 20,704 in 2015;
• CountyCare (Medicaid) contributing 64.7% to the CCHHS budget. 

These are perilous times for an organization that depends on Federal and State Medicaid/other indigent care payments to stay afloat. 

Chair Hammock commented that Cook County government is not interested in reinstating the tax generated subsidies of the past to bail CCHHS out!

Observer - Susan Kern, MD                                                            Meeting Length: 3 ½ hours

Cook County Health and Hospitals System Board Meeting -  July 29, 2016

Significant Actions Taken:
The Proposed 3 Year Strategic Plan was approved unanimously with commendations from board members for its

• attention to metrics
• safety net for patients
• best practices
• staff involvement. 

CEO Dr. Jay Shannon said the plan will allow HHS

• to transform into a modern health care system,
• to form partnerships with like-minded organizations
• to retain its focus on patient needs. 

Board Election/Changes:  The Board re-elected Hill Hammock as HHS Board Chairman and Jerry Butler as Vice-Chairman. Dr. Shannon commended outgoing board members Carmen Velasquez and Dorene Wiese for their dedication and leadership. 

Contract Awarded: Morrison Management Specialists were awarded a $13,900,000 contract to provide labor, supplies and software for food and nutritional services, replacing former contractor Sodexo.

Significant Topics Discussed:

• Stroger Hospital now ranks in the 37th percentile nationally in willingness of patients to recommend the hospital; 60% report satisfaction in moving through their visit; 56% report satisfaction with the phone access.
• Valence Health Systems, administrator for CountyCare, has been purchased and will be split into 2 businesses, selling the largest portion to Evelent for $145m.  Valence’s existing leadership will transfer to Evelent and stay in Chicago with no change to services provided to HHS.
• CountyCare membership 154,000 as of June, down from 160,000 in March.  $84.8m = profit plus what HHS pays itself, close to the 2015 figure. Membership is down partly due to inefficiency/challenges of call center: Valence staff inexperienced, are calling from Texas.  In-house call center at Oak Forest must try to conform to state Medicaid regulations and reach newly-insured Medicaid population who are confused about cards, may have no permanent address or phones that can only call out.
• As of June HHS was $49,254,000 over budget, which, combined with its $128,638,000 pension obligation, totals $177,892,000 net loss.  HHS has $5,069,215,000 in total liabilities.  It has 48 days’ cash on hand.  CountyCare’s revenue was budgeted at $26,284,000, but its actual revenue was $17,291,000 (revenue left in the system once other providers are paid.)  The shortfall is attributable to (1) reduced headcount and (2) reduced capture of available revenue when other providers are chosen.
• When Dr. Shannon was asked to comment on budget considerations for 2017, he cautioned that (1) there has been no significant pension reform by the state; (2) no significant growth in state revenue; (3) there will be union-negotiated 2.5% salary increase (resulting in increased pension obligation) and step increases; and (4) HHS will be on its own in generating revenue for capital improvements.  “We will not be able to cut our way out of budget challenges; we have to GROW.  We have to invest in things that allow us to grow.” 

Observer - Linda Christianson                                   Meeting Length: 2 hours, 40 minutes

CCHHS Board of Directors meeting, 12/18/15

Observer: Linda Christianson

Contracts approved:

• $21 million “lease” (line of credit) approved (with 3 voting “present” and 1 disapproving) to provide funds for renovation costs providing leeway for needed expenditures, defined as operational rather than capital and thus falling to CCHHS rather than County board for approval, identified by Chair Hill Hammock as “an unusual transaction.”
• Contract extensions for ventilator services to nursing home patients not on Medicaid.
• $12.5 million contract to provide laboratory automation equipment;
• CountyCare contracts: United Healthcare contract for $10 million to manage pharmacy benefits; First Transit contract for $5.3 million for transportation management, and DentaQuest contract for $4.1 million to manage dental and vision benefits.

Discussed: 
Penalties for readmission of patients within 30 days of discharge.  Even if the patient has a different diagnosis the second time, the penalty still applies.

Rates of readmission higher in inner cities, and higher for Medicaid patients than for Medicare patients.

Human Resources Director Gladys Lopez reported filling 1,267 vacancies in 2015, with 808 remaining vacancies.  Average hiring time has been reduced from 181 days to 121 days.

Items to Watch for:
A public speaker representing the nurses’ union said 98 nurses are scheduled to be displaced or laid off.

Deputy CEO Doug Elwell reported that the Government Accounting Standards Board will probably require CCHHS to recognize its pension funding, currently $60 million, now reflected in the County budget but not in the CCHHS budget.  If/when this change occurs CCHHS pension liability will total $280 million including unfunded pension interest for prior years. Most pension costs are associated with staff in “Tier One”, with defined benefit, rather than “Tier Two”, with defined contribution. Chairman Hammock responded, “These are expenses any hospital would have to deal with. Historically the County has borne the burden of this.”