Category: Public Health

Cook County Department of Public Health Receives $40.8 Million Grant for Contact Tracing

6/30/2020

Cook County Health (CCH) Board of Directors Meeting - June 26,2020
This meeting was held remotely with audio only available to observer.

Public Comments

An employee stated they did feel they received adequate pay during their course of coronavirus infection.
Other employees said they needed to have more PPE, better staffing and more testing.

Annual Business

Annually a Chair and Vice Chair of the CCH Board of Directors is elected. At this meeting, Hill Hammock was elected as Chair and David Munar was elected as Vice Chair.

Committee Reports

Human Resources reported that hiring has slowed down in 2020 and the time to hire has been slowly decreasing over the past several years and is very close to meeting this goal in 2020.
Managed Care reported that current membership as of June 3, 2020 is 342,196, of which 10.5% are enrolled in CCH clinics. The IL Dept of Health and Family Services' April 2020 data showed that CountyCare had a 31.9% market share of the Managed Medicaid Organizations in Cook County (CC). It was predicted the number of members will increase in July due to the economic downturn, loss of jobs, and CountyCare outreach. People are enrolling in Medicaid in increasing numbers. Medical claims payments have continued to improve with priority payments to safety net hospitals, Federally Qualified Health Centers, and nursing homes. A recently passed Illinois law offers Medicaid to noncitizen seniors (over 65) with income at or under federal poverty level beginning July 1, 2020 when the Illinois FY2021 begins.
With Coronavirus overshadowing healthcare systems over the previous months, routine healthcare visits, elective surgeries are slowly starting to increase. Telehealth visits have played an important role in patient care. The Board approved an extended contract to Res Publica Group, LLC for continued marketing and advertising for CountyCare. Priorities for CountyCare are retaining current membership, recruiting new members and increasing brand awareness for those applying for Medicaid because of job loss.
Quality and Patient Safety is aware of the need to improve patients' willingness to recommend CCH OP clinics, Provident and Stroger hospitals to family members and friends. As a result a Patient Experience Steering Committee was created to improve Patient Satisfaction Scores. It is known that staff communication with patients, frequent rounding/checking in with patients and quiet surroundings rate high.
Finance A grant from the IL Dept of Human Services was approved by the Board to purchase NARCAN, medication for emergency treatment of narcotic overdose, for CCH OP health centers.
Also approved by Board was the $40.8 million Grant given to Cook County Dept Public Health (CCDPH) for Contact Tracing from the IL Dept Public Health. CCDPH provides public health services for suburban Cook County (CC). There was Board discussion on the Contract for the Hektoen Institute for Medical Research as related to the $40.8 Contact Tracing Grant. The contract as presented stated Hektoen would provide services for the Contact Tracing Grant: management, financial duties, hire staff, fill contact tracer positions, and give work to community based organizations outreach efforts. Board discussion of the Hektoen Contract as presented centered on defining Hektoen's role as to the hiring plan, management/staffing, payroll and financial details. It was felt the hiring process needed to hire from communities and minority groups most impacted by Covid-19 and there was a need to have input from CCH and CC human resources and unions regarding hiring. The Board suggested that the Finance Committee call a special meeting to meet with pertinent parties without delay to iron out and finalize the Hektoen Contract and report back to the July Board meeting.

Debra Carey, Interim CEO Report

CCH has adjusted to living with the Coronavirus, "The New Normal".
There is an emphasis on health care at CCH's Cermak Hospital.
Employee guidelines for returning to work are in place for those who worked remotely during the pandemic.
CCDPH has contact tracing plans.
CCH has preparedness plans for a potential resurgence of Covid-19.
Patient income generating visits have dropped off and surgery volumes are down for 2020. Telehealth visits have increased in 2020.
Community in-person events since March have been canceled.

Board Chair Hammock Report

Chair Hammock proposed that the CCH Board of Directors work together to issue a Board Resolution affirming CCH's commitment and work for Health Equity. There was also a suggestion for a new position in the FY2021 budget for a Chief Equity Officer as the health equity gap needed to be closed.
Chair Hammock also felt now was the time for the Board to begin planning and forecasting for the FY2021 budget. Discussions regarding finances included decline in patient revenues and cost saving measures such as renegotiating/putting on hold vendor contracts, reducing overtime and expenses, and decreasing non-union positions.
The growth of CountyCare is a priority for CCH's FY2021 budget. As CountyCare members get rehired into jobs as the economy picks up, membership loss will follow.
Chair Hammock referred to the June 26, 2020 CC FY2021 Preliminary Budget Forecast. President Preckwinkle stated that the projected shortfall in health funds was projected to rise to approximately $187 million. The Board felt that this number did not include the cost saving efforts of CCH.

Items to Watch For in the Future

The Finance Committee's revised contract for Hektoen Institute for Medical Research.
The Board Resolution affirming CCH's work for Health Equity

Observed by: Michele Niccolai Meeting Length: 3 hours

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Will COVID-19 Transform the Cook County Hospital System?

6/5/2020

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Cook County Health (CCH) Board of Directors Meeting - May 29, 2020
Virtual Audio Meeting due to COVID-19 shut down

Public Comment:

Public comment by a series of Hospital employees struck a similar chord: complaints of inadequate supplies of PPE (personal protective equipment), canceling of paid vacation time , refusal to grant “hazard pay” and criticism of temporary health staff hiring to cover COVID care tasks during the ongoing pandemic.
Dr. Fegan responded that there were adequate supplies of PPE from federal stockpiles which were inventoried twice daily. CCH follows CDC and IDPH utilization guidelines for PPE, adding that shoe and hair-covers are not COVID protective and N 95 masks & disposable gowns were designated for use by staff in close patient contact and with aerosolizing procedures. Additional employee education on proper PPE use would be planned.
Director Reiter was assured that canceled vacation time was rescheduled or financially compensated as defined in the union-negotiated employment contracts, and there was daily communication with the union and invited front-line employees.

Board Discussion/Decisions:

Hospital’s CountyCare, Medicaid managed care plan: 326,631 members, largest in Cook County
COVID-19 testing: 7,704; 2,355 positive patients across all CCH locations; CountyCare received 115 claims for in- patient admissions (low number attributed to lag in submission of charges)
COVID financial impact projected through June is a $75-$100 million revenue loss due to 40% decline in charges since March 15, 2020; decreases across all service lines ; plus $10-$15 million of increased costs: supply/equipment/agency temp. staff; and overtime $8-$12 million
Offsetting COVID financial assistance income: $59 million federal distribution for number of COVID positive patients; $11.1 million received to help offset revenue loss (CARES Act); federal reimbursement for testing/treating uninsured COVID patients, $1 million grant pending for telehealth from FCC;
$40 million grant from IDPH for CC Dept. Public Health with plans for 400 contact tracing hires
Discussed: $429 million Cook County awarded from the CARES Act. Hospital system will pursue payment from this grant!
Board voted to transfer a total of $5,339,739 from various accounts to accounts exclusively for COVID expenses under guidance from the County government in anticipation of applying for this CARES Act grant.
COVID net negative impact: income is $36.6 million below budgeted.
Expected rebound in volume of patient charges for CountyCare once the COVID shut down has loosened restrictions, will require provider payments from capitated payments already received, further undermining the financial outlook
Charity care and self-pay volumes and costs are up $18 million over 2019, likely reflecting high unemployment rates due to COVID shut down
Telehealth success: 44,335 telephone visits via the clinic system since COVID March shut down
CCH preparing for post-COVID opening, ramped up drive thru virus testing, Stroger & Provident
COVID containment at Cook County Jail due to ongoing testing of symptomatic, asymptomatic, new admissions to the jail and surveillance testing.
Outreach to COVID high risk members, providing thermometers and pulse oximeters for home self-testing (telehealth); telemonitoring of diabetes, hypertension, via home use glucometers, blood pressure cuffs etc.

Items to Watch for in the Future:

Post-COVID-19 adaptation of the Hospital system to the “New Normal”

Observed by: Susan Kern, MD Meeting Length: 3 hours and 15 minutes

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Cook County Health Board Hears Update from Department of Public Health

2/4/2020

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Cook County Health (CCH) Board Meeting
January 31, 2020

Reports to the Board:
The Cook County Department of Public Health (CCDPH) - is at the command center for Chicago's coronavirus case, along with the Illinois State Department of Public Health and the Centers for Disease Control. The CCDPH website has links for coronavirus and flu information. Cook County Health has been screening for coronavirus. CCDPH also presented their 2019 Quality Improvement Projects. These projects result from Planning, Testing, Study, Implementation. The goal of planning is to understand and analyze a problem, potential solutions are pilot tested, afterward studied/evaluated, then the new process is implemented.
The 2019 CCDPH Quality Projects are:

Investigation of Food-borne Disease and Outbreaks
Promotion of Smoke-Free Multi-Unit Housing
Improving Tuberculosis Direct Observation Therapy- cost effective way of a video picture of patient taking their medication
Annual School Health Conference Check-Out Process
Improving Access to Services in the Illinois Breast and Cervical Cancer Program
Environmental Health Services Digitization: Forms
Improving Perinatal Hepatitis B Post Exposure Prophylaxis
Adverse Pregnancy Outcomes Reporting System Program face-to Face Contacts

Human Resources - starting out 2020 with approximately 526 vacant positions with 308 positions in the hiring process. They have a Position Control Committee that receives requests to hire. These requests must meet patient safety and quality standards, regulatory requirements, need to generate revenue and reduce expenses. If a position is approved by this committee, it goes for budget approval and then is posted on Taleo (the county's on line application site).

CountyCare - as of 1/2/2020 has 318,000 members, 10.6% of members using CCH clinics. Next Level Health, a Managed Care Organization (MCO) only available in Cook County, was recently purchased by Molina Healthcare. Molina is increasing its presence in the county. Over the past year, CountyCare membership has held steady with its 31.5% of total CC Medicaid members. In 2019 there has been an overall drop in total Medicaid members, and CountyCare membership has followed this trend. Auto-assignment of Medicaid enrollees into MCO health plans happens when a member does not choose a health plan/primary physician within the specified time. CountyCare auto-assignment has been increased from 35% to 50% starting April 1, 2020 and is open-ended. This increase is a result of CountyCare's innovations, quality and housing program. The 2020 projected enrollment is 326,000 members.

Quality and Patient Safety Committee - reports good results at the end of 2019 for decreased hospital acquired pressure injuries due to a focused nursing campaign. The aim is to sustain this decreased number with continuing preventive measures.

Other Business:

The CCH North Riverside Health Center, replacing the Cicero clinic, opened for patients January 27, 2020. CCH is installing posters, distributing flyers at all facilities to raise awareness of the 2020 Census.
The CC Board of Commissioners proposed changes to the 2008 Ordinance Establishing the Cook County Health and Hospitals System. The original ordinance can be found HERE. The proposed changes are in the Ordinance Amendment. (Cook County Board Agenda Item 20-1118) Members of the CCH Board discussed the proposed changes and decided to meet with the CC Board of Commissioners and present the CCH board's point of view on the proposed changes.

Observed by Michele Niccolai Meeting Length: 2 hours and 30 minutes

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CountyCare Enrollment Declines by 33,000 in 2019

4/28/2019

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Cook County Health (CCH) Board Meeting - April 26, 2019

CountyCare - Managed Care Organization Update

Medicaid enrollment in CountyCare, Cook County's managed care organization, has declined by 33,000 from January-March of 2019. And statewide, since its April 2018 peak at 2,298,000, membership in Illinois' managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence of this decline for CCH is that the number of uncompensated emergency and primary care visits will increase.
CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share.
CEO Shannon praised new healthcare leadership in Springfield, including former CCH Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program.
Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully to offset threatened funding cutbacks.

What did the Board discuss?

Personnel status - 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.

Items to Watch for in the Future

Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.

Other Comments or Observations

Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.

Observer - Linda Christianson Meeting Length: 3 hours

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Cook County Health to Host Housing Summit in May

3/18/2019

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Cook County Health Board Meeting - February 28, 2019

What did the Board Discuss:

The first Cook County Health (CCH) Research and Innovation Summit was held February 20, 2019 on the topic of opioids. More than 120 individuals attended. This summit was designed to share CCH's efforts and plans to address the opioid epidemic with other established interest groups and included action planning with health and community leaders.
County Care managed care members as of February 7, 2019: 320,994 of which 13.7% are using CCH services. These latest numbers are down 10% from the same time last year. The target for 2019 membership is 345,000. Annual redetermination of Medicaid members is a review of their eligibility for Medicaid and requires submission of redetermination forms in a timely manner. Now an automated system drops individuals from Medicaid rolls if the forms are not completed on time. If dropped, the individual looses continuity with their Primary Care Provider and case managers. In order to keep its members, County Care offers to help with the redetermination process. County Care has raised concerns about this process with Governor Pritzker.
FY 2019 CCH system wide uninsured numbers captured by visit is 44%. The FY 2018 uninsured numbers were 42%. There is a need to get details of these uninsured to see if some are eligible for Medicaid, then assist them in enrollment.
Governor Pritzker announced that Dr Ngozi Ezike was appointed Director of the Illinois Department of Public Health (requires state Senate approval). She served for more than 15 years at CCH and most recently served as a physician at the Juvenile Temporary Detention Center.
The Cook County Department of Public Health (CCDPH) has a tobacco prevention and control unit and its goal is to eliminate exposure to secondhand smoke, promote quitting, and prevention of youth smoking. In Suburban Cook County, 16.7% of adults are current smokers. E-cigarettes are currently the most used tobacco product among youths and its use in this group has increased last year. E-cigarette liquid contains chemicals and carcinogens and this liquid can poison children through ingestion or skin absorption.
It was announced that there would be no election of the CCH Board Vice-Chairman at this meeting.

Board Decision:

A contract with the Bobby E. Wright Comprehensive Behavioral Health for mobile crisis outreach team. This is a nonprofit on Chicago's Westside that provides mental healthcare, addiction treatment and developmental disability services.

Items to watch for:

The final audit of FY2018 in May 2019
The second CCH Research and Innovation Summit to be held May 22, 2019 on the topic of housing.

Observed by: Michele Niccolai Meeting Length: 2 hours 30 minutes

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New Director Appointed to Cook County Health Board

2/15/2019

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Cook County Health Board of Directors Meeting - January 25, 2019

Items of Note from Reports to Board

At the January 24, 2019 Cook County Board meeting, Commissioners approved the appointment of Michael Koetting to the Cook County Health Board of Directors. Mr. Koetting is a healthcare and strategic planning consultant as well as an adjunct member of UIC's faculty. From 2010-2015 he served as Deputy Director for Planning and Reform Implementation for the Illinois Department of Healthcare and Family Services.
Managed Care: Total CountyCare members as of January 7, 2019 is 326,026 of whom 45,446 are served by Cook County Health clinics (13.9%).
The Arlington Heights Health Center opened January 14, 2019. This new 35,000 sq ft center has 24 exam rooms, six dental suites, WIC nutritional services, mammography, behavioral health services and on-site lab. The comprehensive patient care team includes bilingual Spanish speaking staff members.
Through January 3, 2019, Cook County Health's (CCH) Fresh Truck partnership with the Greater Chicago Food Depository has resulted in 152 visits to 12 CCH health centers. Collectively, theFresh Truck distributions have totaled more than 420,000 pounds of fresh produce delivered to individuals, most of whom are food insecure. Access to better nutrition can lead to better health outcomes.
February is Heart Health Month and the American Heart Association's Go Red for Women. CCH and CountyCare sponsored several programs to increase women's heart health awareness.
Governor Pritzker named Theresa Eagleson as new Director of the IL Dept of Healthcare and Family Services. This agency oversees the state's Medicaid Managed Care programs and child support services.
Recently approved state rules lowered blood lead levels to 5 micrograms/deciliter. This rule change will allow children to be identified as having lead exposure when their blood lead levels are at or above 5 micrograms/deciliter. This earlier detection of lead exposure is important as it will result in more children receiving public health intervention.

Post Meeting Review Report submitted by Michele Niccolai

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Cook County Department of Public Health Receives $40.8 Million Grant for Contact Tracing

Will COVID-19 Transform the Cook County Hospital System?

Cook County Health Board Hears Update from Department of Public Health

CountyCare Enrollment Declines by 33,000 in 2019

Cook County Health to Host Housing Summit in May

New Director Appointed to Cook County Health Board

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