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

Cook County Health Board of Directors Meeting 
September 30, 2022 

KImberly Craft gave the semiannual EPO (Employment Plan Officer) report. As with other departments she had staffing issues which made it difficult to monitor the plan. A new Program Manager and Information Coordinator have recently been hired. There were an unusually large number of vacancies during the reporting period. The hiring process was revised and a new plan was rolled out in July. There were a number of hiring problems found. Part of the problem was in coordinating plan rules with the outside vendors. The 22-page report is informative and detailed.

CountyCare's 10th anniversary was celebrated. Cook County Health’s emergency medicine and preventive medicine residency programs were recognized in Becker’s Hospital Review for being among the best clinical training programs, according to Doximity’s 2022-2023 Residency Navigator.

Cook County Public Health has sent out a survey to collect data from 34,000 adult (18 and older) suburban Cook County residents concerning their health-related risk behaviors, chronic health conditions, and access to health care.  Using startup funds from CDC’s Health Equity Grant, CCDPH’s Epidemiology Unit is collaborating with UIC’s PHAME Center and Metopio to design and deploy an online atlas for exploring and sharing health information concerning the suburban residents of Cook County. The atlas allows stakeholders to examine, visualize and download health data using maps, charts and tables. The site is at https://cookcountyhealthatlas.org/

Iliana Mora, Chief Administrative officer for Ambulatory Services reported on the Asylum seekers that were bussed to Cook County from Texas. All seekers were seen by medical staff promptly and screened for disease and vaccinated. Children received all vaccines needed to attend school. Ambulatory staff handled everything, but additional help is needed if this is to be a continuing need. Contracted staff will be onboard next month. Money was allocated for this but CCH is working with state and federal agencies for reimbursement. 

An overview of the Substance-Use Disorder program was presented by Dr. Juleigh Nowinski Konchak. It is a Multidisciplinary and Patient-centered plan. 

An overview on Monkeypox was presented by Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health).

Human Resources: While there is still a lot of work to be done to get staffing levels up, there has been a slight improvement and several vendor agencies have been contracted to help with the process. Slalom Program Management will ensure the vendor resources are allocated effectively to accelerate hiring. The other HR partners are:

• Cross Country – Onboarded March 2022 - Recruitment support for 500+ vacancies (Clinical), Talent sourcing support & marketing
• Incredible Health – Onboarded June 2022   Talent sourcing support in Nursing
• Brazen – Onboarded June 2022  Virtual hiring fair platform 
• Deloitte – Onboarded September 2022  HR Optimization - Compensation, performance management, workforce development, operations technology

Listening sessions have been scheduled to help with employee retention.

Managed Care: CountyCare’s enrollment has increased 7% over the past 12 months, ahead of the  Cook County increase of 4%. CountyCare’s enrollment decreased 0.1% in July 2022 compared to the prior month, ahead of the Cook County decrease of -0.2%. The vaccination rate of CountyCare members is still too low, especially among children. Only 21.78% of children 1-11 years are fully vaccinated. And only 45.2% of all members are fully vaccinated.

Quality and Patient Safety: Committee minutes were presented. Dr. Erik Mikaitis was hired as Chief Quality Officer.  The readmission rate was down to 7.49% in May, the lowest it has been in the last year and well below the goal of 9.93%. The case mix index for surgical patients, the top box score and the HbA1C goal were not achieved.

Finance: The finance committee met this month. On an accrual basis, interim financials show that CCH ended May with a $13.4M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $300.2M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses. 

Recognitions:

• CountyCare's 10th anniversary was celebrated.
• Cook County Health’s emergency medicine and preventive medicine residency programs were recognized in Becker’s Hospital Review for being among the best clinical training programs, according to Doximity’s 2022-2023 Residency Navigator.
• Dr. Michael Alebich, Co-Director of Medical Student Programs and Attending Physician in the Division of Hospital Medicine, has been named an “Emerging Leader” by the Health & Medicine Policy Research Group (HMPRG).
• Dr. Dhara Amin, Director of Quality Improvement and Patient Safety and Attending Physician in the Department of Emergency Medicine, has recently been named as a Fellow in two prestigious health care programs.  Dr. Amin was named a Fellow in Medical Justice in Advocacy by the American Medical Association and Satcher Health Leadership Institute. She was also named a Fellow in Diagnostic Excellence by the Society to Improve Diagnosis in Medicine (SIDM).

There was no public speaker testimony and no closed session this month.

​Observer: Lisa Slankard

Cook County Health (CCH) Board Of Directors Meeting ​
July 22, 2022 

Human Resources Report:
Currently Stroger Hospital is operating with a staff level of 65% of budget. This has led to adding $75 million to the outside staffing budget for the remainder of the fiscal year and has had some effect on Quality metrics. It also has led to increased resignations of existing staff. The Human Resource committee presented their statistics and the current hiring is barely keeping up with the staff losses and not helping make up for past separations. Before starting the new goal of hiring 400 new employees between 5/16 and 9/1, it has taken 36.8 days on average from the time an offer has been requested to the offer being made to the applicant. 450 offers were made and 317 were hired. The ultimate goal has been to cut the 36.8 days to THREE days. From May 16 to July 22, 220 candidates accepted offers. Since 94 were internal hires, the net result was 126 new employees.
The hiring initiatives are as follows:

• Offers made within 72 hours
• 20 nurses sourced per week
• Train 100% Hiring Managers
• 6 Hiring Events by Sept 1, 2022     200+ positions    
• Increase frequency of new employee orientation by 50% as needed
• To help with this a contract was made with a third recruiting company

Appointments/Recognitions:

• Arnold Turner has been named Chief Hospital Executive for Provident Hospital, Aaron Galeener has been named Chief Administrative office of Health Plan Services and Karolina Duszczak will be Interim chief operating officer of Health Plan Services.
• US News and World Report named Stroger as a high performing hospital in four categories: Chronic obstructive pulmonary disease • Pneumonia • Heart attack • Heart failure.
• Chicago Magazine recognized Dr. Elizabeth Marcus as a top doctor for breast oncology. Dr Mike Alebich was identified as an emerging leader by Health & Medicine Policy Research Group.  
• Becker’s Hospital Report recognized Andrea Gibson as Great Health System Chief Strategy Officer and Linh Dang as Outstanding Health System Chief Experience Officers.

Public Health Update:

• An overview on Monkeypox was presented along with the midyear budget review.
• Dr LaMar Hasbrouk (CEO of Cook County Department of Public Health) presented the quarterly report from the Cook County Department of Public Health- Building Healthy Communities: Initiative and funding process overview.
• The CCH board signed on to the Cook County Board’s PROPOSED RESOLUTION REGARDING AN ASSAULT WEAPONS BAN.

Committee Reports:

• Managed Care: As of 7/5/2022 County Care has 32.6% of market share, up from 32.5% the previous month but the actual number of members is 433,248 compared to 434,021 last month. Initial target was set to develop $50M in reserves in FY 2022. To date, total reserves have been funded at $75M. The public health emergency has been set to end October 15, 2022. At that time redetermination is set to begin 60 days later and 1/12 of membership will be looked at each month.
  
• Audit and Compliance: A review of the CCH Compliance Program & Regulatory Environment was presented. It included a presentation on the Boards fiduciary and oversight obligations. 
  
• Quality and Patient Safety: Provident CAP (College of American Pathologists) Survey occurred May 12, 2022.  There were three low-level citations and actions were submitted and received acceptance of    those actions on June 30th.
  
• Finance: On an accrual basis, interim financials show that CCH ended May with a $36.1M positive variance to budget. On a cash basis, the County’s preliminary cash report on revenues and expenses shows a $225.5M positive variance primarily due to the timing difference of CountyCare PMPM payments impacting the revenue and claims payments impacting expenses. While there was a lot of discussion on the $75 million  request for Vaya Workforce Solutions, it was approved.

Observer: Lisa Slankard

Cook County Health (CCH) Board Meeting
​January 28, 2022

Presentation - Stroger Hospital Stroke Program by Dr. L. Warrior

• On June 8, 2021 Stroger Hospital was certified as a Primary Stroke Center by the Joint commission.
• An ischemic stroke: a blood vessel is blocked preventing blood flow to the brain.  A hemorrhagic stroke: bleeding inside or around the brain.  Treatments for ischemic stroke are clot dissolving drugs, best given up to 3 hours of occurrence and removal of the clot (thrombectomy) best performed up to 6 hours of occurrence- “Time Is Brain”. 
• 51% of CCH’s stroke patients are black as compared to 30% in other Chicagoland hospitals and close to 20% in other IL hospitals.  30% of CCH’s patients identify as Hispanic as compared to approximately 15% in Chicago hospitals and less than 10% in IL hospitals.  CCH’s stroke patients are black, Hispanic and younger, most age 46-65, while in other IL hospitals the median age is 70 years. 
• For acute cases, goal is to get patient to CT scan under 15 minutes after entering emergency room.  CCH provides community stroke education events, stroke support group.

Public Testimony from Nursing Staff

• It was noted that CCH has a dedicated nursing staff, many with long years of service who have worked through the Covid-19 health crisis. 
• Nurses are working understaffed (shortage night shift), facing burnout which lowers defenses to disease,  working without hazard pay or hourly Covid differential pay, and some have contracted Covid-19.  There is concern with the need to use regular sick/vacation time for Covid-19 illness.  Nurses are quitting for agencies that pay higher wages over CCH wages. 
• Hiring agency nurses at times is a patient safety issue as some have to be supervised/trained by CCH staff making extra work.  ICU/trauma units need specially skilled agency nurses. 
• CEO Rocha stated that early in the pandemic, nurses moved to areas of the country with surges/flare ups with good intentions.  Over time this has become a bidding price war for agency nurses.  CEO Rocha said CCH is addressing these issues.

Finance Committee

• The FY2021 Preliminary Financial Report ending 11/30/2021 was presented. 
• CCH uses the Accrual Basis of accounting and interim financials show that CCH ended Nov 30, 2021 with a $5M positive variance. 
• CountyCare managed care program had a year to date operating gain of $10.0M.  Health plan spends 92.3% of revenue on medical claims and 4.7% on administrative cost FY2021.

Managed Care Committee

• CountyCare as of Jan 5, 2022 has 425,290 members, a 10% increase in FY2021- still the largest Medicaid managed care organization in Cook County.  10.4% of members are in CCH clinics.  Actual membership is still higher than the budgeted amount as redetermination is paused and will be extended to the end of March/April. 
• 34.6% of total membership is fully vaccinated as of 1/7/2022. 
• The 2021-2022 marketing campaign for open enrollment is “CountyCare is There” highlighting benefits that provide dependable health coverage.
• Dr Collins, Chief Medical Officer for CountyCare, gave a presentation on Health Equity Updates.  80% of CountyCare membership live in disproportionately-impacted zip codes (children in school lunch programs, receive SNAP benefits, below poverty line).  Data from April 2020 to March 2021 was presented on specific zip codes where emergency room visits and hospitalization rates were high and primary care visits low. This data allowed focus on members with gaps in care which resulted in a targeted outreach contacting those members to schedule primary care visits and mammograms.

Audit and Compliance Committee

• The formal CCH Research Compliance Program was introduced February 2021 and implemented during FY2021 to ensure research compliance with regulations/agency laws and enforcement bodies. 
• The number of total active research studies at CCH as of mid-Nov 2021 was 1,023, an under recognized aspect of CCH.

Human Resources Committee

• Dept is committed to meet the priority staffing needs of clinics, public health, CountyCare, Provident and Stroger hospitals by process improvements, technology improvements (on-line application Taleo), streamline recruitment and by adding consultants.  The number of recruiters has dropped over the years to 5 today. 
• 1,252 positions are in the recruitment process, with 29 hires for FY2022. 
• HR recognizes there is a national shortage of health care workers, especially nurses, and job fairs for Lab and Managed Care were held and fairs for Social Work, Nursing and Respiratory are planned. 
• With the Covid resurgence, 350 agency nursing jobs and 210 other agency staff added in FY2022.

Report from CEO Rocha

• CCH recently reopened three of its mass vaccination sites: Des Plaines, Forest Park and Matteson.  The large well-coordinated team of CCH employees involved with quickly setting up these sites was recognized at the board meeting.  To date at the mass and community vaccination sites/programs more than 965,000 vaccine doses have been administered. 
• KN95 masks are being distributed at mass sites, CCH clinics, and community organizations. 
• CCH provides Covid testing at six locations by appointment: cookcountyhealth.org/covid. 
• The American Rescue Plan Act’s (ARPA) funds will support the response to and recovery from the Covid-19 public health emergency.  Cook County will receive funds over several years for well-being community programs: Healthcare, Mental Health, Public Health, Food Security, Housing. 
• The FY23-FY25 strategic Plan timeline was introduced.

What to watch for in the future:

• ARPA funds for CCH
• FY23-FY25 Strategic Plan

Observer - Michele Niccolai

Cook County Health Board of Directors Meeting
November 19, 2021

CCH Board President, Lyndon Taylor, announced that the board will no longer hear reports from the various committee meetings.  Instead, if a committee has held a meeting since the last Board meeting, the committee chair will highlight important issues and ask if there are questions.  If a committee has not met, it will make a presentation to the board members.  All committee minutes will be voted on at one time. 
 
CEO Rocha reported that moving forward, divisional updates will be provided to ensure that the CCH Board of Directors “has a deeper understanding of operational successes, opportunities and challenges.”   Areas to be covered include:
 
. Stroger Hospital                                                                            . Correctional Health
. Provident Hospital                                                                       . Public Health
. Ambulatory Care                                                                           . Cook County Health Plan Services
                            Administrative [regulatory, legislative, strategic initiatives, etc.]
 
Rocha also stated that his monthly reports will include strategic highlights and that 95% of the System’s employees are fully vaccinated and 98% have had at least 1 dose.
 
Human Resources

• Turnover of 10% to date is higher than normal, particularly in nursing.  Covid a factor
• 1,035 positions are open
• Average time to fill a vacancy is 105 days
• Contract staff still needed to support the HR team – it is also needed to fill nursing and other vacancies
• Although a new effort, job fairs are helping to identify candidates – finding qualified nurses is critical

 
Managed Care

• County Care has proposed a Medicaid/Medicare Plan to capture Medicaid patients who will soon turn 65 and be eligible for Medicare.  This will require investment and increased cost as the System will need to increase its capacity to serve geriatric patients including pharmacy needs
• The Cook County Budget was amended to include $30 million to establish reserves

 
Finance Committee

• On accrual basis as of September 30, System shows a $42 M positive variance.  On a cash basis $97 M. 
• County Care membership 410,000 as of Sept. 30, 2021 with an operational gain of $9 M.  Both revenues and expenses are higher due to membership growth.
•  2021 savings from contract re-negotiations:  Goal $16.5 M    To date: $12.2

 
Public Health

• Every 5 years Illinois state law requires certified local health departments to complete an assessment of community health needs.  Cook County calls theirs “We Plan 2025”.  Dr. Joshi presented the Cook County Department of Public Health’s Plan which was very thorough.  Director Koetting cautioned that there can be a risk of getting outside of the control of the Public Health Department – he said to be realistic vs theoretical on how people actually “get access to health care needs”

 
Note:  All of these reports can be found on www.cookcountyhealth.org
Observer:  Diane Edmundson