Cook County Health (CCH) Board of Directors Meeting
April 26, 2024
Attendance: Lyndon Taylor, Dennis Deer, Jay Bhatt, Robert Currie, Raul Garza, Joseph Harrington, Robert Reiter, Sam Robinson, and Tanya Sorrell. Absent: Mia Webster Cross

​Public Testimony: There were 6 written statements submitted that focused on inequity in pay scale for RN’s working in public health and concern that recruiting and hiring of RN’s has not been effective and increased work loads of Health System staff nurses. One nurse spoke at the meeting focusing on these related concerns. 
Finance Committee: Approved a new contract funded by the Cook County Equity Fund at $1,050,000 00 for CCDPH to advance policy and systems changes that support the work of the Suburban Cook County Worker Protection Program.  Several other large contracts were approved to provide staffing services.

Action items:

• Report from Interim Chief Executive Officer
  • HR Report: Continue with 3 vendors working with Human Resources:
    • Slalom contract ends July 24 main focus was creating dashboards, modernized on line presences and access to real time recruitment and digital job description library. 
      • Director asked question what was the cost total cost per hire over 2023. Interim Director will get back with the answer.  
      • Discussion focused by Commissioners that the vacancy of 1700 is almost the same as FY22 and questions around what progress we have made in light of the dollars spent on consultants.  
    • Deloitte contract ends April 24 (pending) helped modernize orientation plan for new employees, pipeline learning development and benchmarked jobs identified as not competitive. A transition plan has been created. 
      • Discussion: HR now creating an RFP for building on work Deloitte started over this last year and half. Still don’t have HR staffing to follow up with work done by Deloitte. 
    • Cross Country contract ends Jan 2025. Helped hire fair support, modernized recruiting and piloting accelerated hiring process. 
• Report on Robotic Surgery Launch: March 8th first robotic surgery done at Stroger and now total 48 cases completed. 
• The Audit and Compliance Committee minutes were approved which included the approval of the 2024 CountyCare Compliance Plan, the CountyCare Fraud, Waste, and Abuse Plan, and the Internal Audit Charter
• Report from Cook County Department of Public Health on their tobacco prevention program and associated social media outreach.  This program is funded through State dollars and has established a tobacco free coalition. 

Observer: Susan Avila

Cook County Health (CCH) Board of Directors Meeting
January 18, 2024

Tom Nutter MD, CCH Chief Behavioral Health Officer, talked about the newly formed CCH Office of Behavioral Health (BH) and the upcoming Cook County (CC) Behavioral Health Summit on February 15, 2024.  Invitations have been extended county-wide to mental health and addiction disorder colleagues to convene together.  The emphasis will be listening sessions from all stakeholders to get feedback on issues such as inequities in BH care, the need for improved BH care and need for increased access to BH care.  This summit will help to develop a CC Behavioral Health Strategic Plan.  There will be upcoming community-based funding opportunities from CC government because of the American Rescue Plan.  The Summit’s listening sessions will also help with guidance for awarding future Behavioral Health grants.  March 6, 2024 will be the date to submit requests for grant funding proposals.

The CCH Board approved a Memorandum of Understanding to be a member of the new corporation, West Side United Not-For-Profit.  Launched in 2018, West Side United is an organization initiated by West Side Health Care Institutions (including CCH), whose main goal is to close the life expectancy gap in the west side diverse neighborhoods of Chicago where there is a high level of poverty.  People in these neighborhoods experience barriers to health and wellness because of education inequities, employment, access to healthy food, safe housing, violence, transportation issues and access to banking.  The founding West Side Health Care Institutions determined that a not-for-profit corporation was needed.  

The CCH’s Patient Bill of Rights & Responsibilities document includes the right to provide “interpreter services, free of charge, including sign language” and information written in other languages.  Two contracts were extended by board approval for phone interpretation, document translation and interpreting services by video remote.

Observed by   Michele Niccolai

Cook County Health Board of Directors Meeting
October 27, 2023     Virtual and in person meeting- observed virtually

Human Resources Committee Report
Carrie Pramuk-Volk, now the Interim Chief Human Resources Officer, reported on the continued positive hiring and retention metrics. For fiscal year 2023 there have been 1146 hires who have started. In 2022 there were 497 and in 2021 there were 562. Turnover rate continues to drop from a high of 11.4% in 2022 to the current rate of 8.4%, which is well under the national benchmark. The accelerated nursing hiring program has resulted in 195 job offers with 120 of them being accepted.

Cook County Department of Public Health Report
Amy O’Rourke and Dr Hasbrouk from Cook County Department of Public Health reported on the Good Food Purchasing Program (GFPP). The GFPP was started to address food disparity in health and wealth. Cook County is the third local government to sign on to this program. Los Angeles did in 2012, Chicago in 2017 and Cook County in 2018. Currently there are 57 institutions and 24 cities participating nationally. GFPP encourages County-run institutions to shift their food spend toward five core values: local, healthy, humane, sustainable, and equitably-produced food.
GFPP implementation is underway and initial investments have been made in local food producers. The 2023 Good Food Purchasing Initiative (GFPI) Community Fund awardees will be announced by the beginning of FY24.
The 19th Annual Chicago Food Justice Summit will be held in early FY24.
GFPP Program Update

• ●  Completed Baseline Assessments for:
  • ○  Juvenile Temporary Detention Center (2020)
  • ○  Cook County Sheriff's Office (2021)
  • ○  Cook County Health (2022)
• ●  Created action plans in development or implementation phases at all County Departments
• ●  Integrated GFPP goals & compliance into food services contracts and solicitations (JTDC and CCSO)
• ●  Implemented menu changes (plant-based proteins, soliciting vendors for organic, sustainable items)
  The program was started with 4.5 million dollars in ARPA funding which is being leveraged to accelerate County’s GFPP implementation, while also developing a more equitable supply chain and good food culture. So far, $234,000 has been dispersed in microgrants to six farms/small-meal-providers located in suburban Cook County.

The program and presentation were well received, and Amy O’Rourke was complimented by several Directors for her enthusiasm and for the breadth of the program.

Other Committee Reports:
The Audit and Compliance, Finance, Managed Care, QPC committees met in October and their minutes were approved with minimal discussion. The CEO reported on the strategic initiative results and the numerous awards won by employees.
The meeting went into closed session and reconvened on October 31 to give the news that CEO Rocha has resigned as of Dec 1, 2023.
Items to Watch for in the Future:    New CEO search

​Observed By: Lisa Slankard

Cook County Health (CCH) Board Meeting
July 28, 2023

Four CCH nurses spoke during the public comment period and talked about the continued staffing shortage, its impact on staff safety, and the time it takes to onboard even agency hires.  Several board members asked pointed questions during the presentation from HR Director, Valerie Amos.  Questions included:

1. How long does it take to onboard agency hires:  Ans:  3-4 weeks including orientation to CCH rules, procedures, policies, and methods of operations.
2. Has management communicated with staff nurses about what HR is doing to increase hireing:  Ans:  Yes.  Nursing leadership held a town hall meeting to explain HR hiring process and onboarding process.  

CEO Rocha commented on staff shortage by saying that there is a higher-than-expected patient onboarding.  That and summer vacations led to even more agency hires. A question was asked about planning for System retirements as the average age of nurses is 51.  Amos acknowledged the challenges facing the system and thanked the board for approving increased staffing.  She started with 3 recruiters and now has 10 plus outside consultants to help streamline the process.  Plus the retention bonus that went to 58% of the nursing staff helped keep turnover down this year.  The System expects the recently approved 12 week paid parental leave to benefit recruitment of nurses and other staff.  

The Cook Couty Department of Public Health reported on their 3rd quarter report that focused on the Sexually Transmitted Infections (STI) Program and the Youth Tobacco Ordinance Awareness Program.
Key points highlighted in the STI's Program:  

1. This program covers all of Suburban CC except  for Evanston, Oak Park, Skokie, and Stickney Township which each have their own Public Health Departments.
2. Engages in surveillance, investigation, interviews, partner services [including sending condoms], education, and support.
3. Reportable STI's include Chlamydia, Gonorrhea, Syphilis, HIV, Mpox, and Chancroid.
4. The data indicate that the number of cases of Chlamydia and Syphilis are increasing as are the number of persons living with HIV;  whereas the number of Gonorrhea and new HIV cases are stable.

Compliance with the Youth Tobacco Ordinance
This fall in partnership with the CC Sheriff’s Office, the CC Department of Public Health will conduct random, inspections at locations where tobacco products are sold in unincorporated CC to ensure compliance with the sales restriction on Flavored Nicotine Products.  These restrictions went into effect on July 23, 2023.
 
In CEO Rocha’s monthly report, he noted a $21 million dollar grant for nursing, several awards, upcoming events, and focused on CCH’s Dialysis Success with the goal to move the conversation from kidney disease to kidney health.  The head Nephrologist stated that race is no longer considered a factor.  Weight and gender are the primary factors.

Observer:  Diane Edmundson

Cook County Health (CCH) Board of Directors Meeting
April 28, 2023     

CEO Rocha, Chief Operating Officer, Dr. LaMar Hasbrouck and staff presented the Cook County Department of Public Health’s (CCDPH) product from a collaborative and participatory strategic planning effort begun in 2022.  The resulting 2023-2025 strategic plan for CCDPH, “Putting the Public in Public Health,” defines CCDPH’s vision, mission, and values.    Based on feedback from across a variety of assessments and many facilitated planning sessions and conversations with staff, community partners, and the Strategic Planning Advisory Group, CCDPH identified five strategic pillars where CCDPH must focus its attention to be successful at advancing its vision and mission over the next three years.  The foundational pillars are:

• Pillar 1:  Strategic Communications.
• Pillar 2:  Community Partnerships and Collaboration.
• Pillar 3:  Workforce and Workplace 
• Pillar 4:  Infrastructure and Operations.
• Pillar 5:  Integration and Systems Alignment.

In brief, Putting the Public in Public Health is the guide that CCDPH has chosen for transformation during 2023-2025.  The strategy within the plan is dynamic and intended to evolve over time.  Metrics that matter will be developed for all major services, programs and initiatives including the strategic plan.  The plan will also serve as a blueprint for accountability as it strives to optimize community health and advance health equity for the residents of suburban Cook County.  A letter from Cook County President, Toni Preckwinkle praising the plan was included stating that “The Covid-19 pandemic illuminated not only the importance of having a strong public health system and infrastructure in times of crisis, but also the ongoing need for investment in proactive approaches to promoting community health and wellbeing.”    

CEO Rocha noted that effective Monday, May 15th masks will be strongly recommended but optional for many patients, visitors and staff.  Masks will remain a requirement for staff providing direct patient care, entering an occupied patient room or in high-risk areas.  Tests and vaccines for COVID will continue to be available at primary care medical homes.

The Community Murals Project unveiled three new murals at Provident Hospital, Blue Island Health Center and the Professional Building on central campus.  Paint parties were held where patients, staff and visitors came together to paint sections of the murals.

Committee Reports:
Human Resources –

• Remains up to 95 days to fill positions but trending down.  Maintaining 4% turnover compared to nationwide average in double digits.   Still catching up from COVID losses.  
• A letter sent by and read into the record by Mr. Lenny D. Asaro, attorney at Faegre, Drinker, Biddle & Reath, LLP seeking “. . . clarification regarding Cook County Health and Hospitals System’s policy in reference to offshoring jobs to India.”  Mr. Asaro referenced RFP #H21-0026, Addendum No.1. requesting 250 full-time equivalents to support the end-to-end revenue cycle. Mr. Asora claimed the RFP was service-based v. technology and does not require technical support for any type of technology.

Finance –

• Eight contracts exceeded $1M including for Nurse Registry services ($70M); two contracts for recruitment (totaling $8.6M); and two contracts for computer software and hardware (totaling $12.9M)

What to Watch for in the Future:

• Although it was indicated that great efforts were being made to reach out to Medicaid patients in their communities and in the health centers to encourage cooperation with renewal, it may still have an impact on enrollment.

Observer - Peg Moster

Cook County Health (CCH) Board of Directors Meeting
February 24, 2023

CCH Human Resources’ goal toward maximizing efficiency and decreasing the time in recruitment and hiring receives continuing support from outside consultants.

• Slalom has taken the lead with HR by adding technology, department staff training and analyzing HR processes with a focus on efficiency.
• Deloitte has reviewed job descriptions, undertaken compensation analysis, added technology focused on employees and revised new hire orientation.  Deloitte’s job recruiters have reduced administrative burden.
• Cross Country has organized monthly job fairs, helped with recruiting and has created marketing strategies and campaigns using Tik Tok, videos, fliers, and social media.
• Brazen- has added virtual job fairs and a virtual hiring platform.

Human Resources Committee

• FY2023 Year to Date through 1/31/2023, filled positions is 253, with 156 positions external hires.  Most of the 127 separations were due to retirement.  The time to fill from the day the job is posted to the day the offer is accepted is 120 days, which is a significant decline from FY2021. 
  
• CEO Rocha added that CCH is a great academic training center and staff gain great skills in their first to fifth year of employment and become very marketable.  Once employees hit the 10 to 15 year employment, pensions and other benefits become important and they tend to stay at CCH.  The retention of the 5 to 10 year employee is CCH’s focus.

Finance Committee

• A contract extension and increase was approved for the The Chicago Lighthouse to be a backup for the patient support center to help with scheduling, registration and insurance verification assistance.  The Chicago Lighthouse was founded in 1906 and provides jobs for the blind and visually impaired, disabled and Veteran communities.
• Interim financials FY2023 ending Dec 31, 2023: On an accrual basis show that CCH ended December with a $37M favorable variance to budget.  On a cash basis, the county’s preliminary cash report on revenues and expenses show a $49.7M favorable variance.  CountyCare shows an operating gain of $6.1M.
• GPO Presentation: A GPO is an organization that through a group’s collective buying power obtains better pricing and value for its members.  Most of all health systems in America are GPO members contracting for medical/surgical supplies, drugs, food, purchased services, technologies, etc.  CCH begins at the start of FY2023 to solicit proposals from vendors and after analysis and attending presentations decides on a GPO by 3/20/2023.

Managed Care Committee

• As of February 7, 2023 CountyCare membership is 450,264 with 41,800 in CCH clinics.  Through December 2022, CountyCare has a 32.6% share of Cook County managed Medicaid market.  Membership is still high as Redetermination has not yet started.  Once it starts April 1st membership numbers are expected to drop. CEO Rocha said a CCH goal is to assist members in the redetermination process.

Items of Interest

• Cook County Dept Public Health Quarterly Report 2023 on the “Suburban Cook County Healthy Work Initiative”.  This report highlighted the plight of essential workers especially during the pandemic.  Another focus is precarious workers.  These are low wage workers with unpredictable/unstable work conditions, work with hazards and without regulatory safety standards.  The goal of this initiative is to improve worker safety and addressing these issues was highlighted.
• CEO Rocha introduced the “One Source Enterprise” project to transform patient access and patient experience.  After calling the Contact Center for non-emergency care needs, a caller can talk to a real person.  The caller can receive  virtual care through nurse triage, connection to  a provider or referral to urgent care sites.  A caller can also  schedule appointments, refill prescriptions, and ask other care questions.  A limited 1st phase urgent care rollout will be spring 2023.  Virtual RN positions at CCH are a competitive opportunity for nurses. 

Observer - Michele Niccolai