Cook County Health (CCH) Board of Directors Meeting  –
February 26, 2021

Public Testimony: 

• Regarding the SEIU Local 73, 12-hour strike on December 22, 2020 by CCH essential workers, union representatives gave testimony regarding President Preckwinkle's pushback and CCH's investigatory hearings of members.  The strike came after union members were unable to come to an agreement over pandemic pay and safe working conditions: short staffs and lack of PPE.
• A group of CCH employees from several departments was recognized. for their efforts to improve inpatient bill collections.   Discharged Not Final Billed (DNFB) collections: a delay in completing an inpatient's bill on discharge due to coding or documentation gaps that leads to a delay in payment.  Employee cooperation from IT, Health Information Management and Finance lead to completing patient bills within 4 to 6 days after discharge meeting the target in December 2020 for DNFB collections.

Human Resources (HR)

• Their 2023 Strategic Plan focus includes: an increase in hiring bilingual employees; reduction in the time to hire; developing the cultural competency of the workforce; and maximizing HR information systems. 
• The staff at CCH numbers 6,054 employees, based on the 12/4/2020 payroll. 
• The people leaving CCH through January 31, 2021 have been retirees at 65% and resignations at 29 %.  There is an Employee Exit Survey and the response rate is 26 % which falls within the Industry Wide Standard. By job category, nurses are the largest group to complete the Exit Survey.
• First Quarter FY 2021 filled positions is very high due to Contact Tracing hires.  The Average Time to Hire in FY20 and FY21 has met the goal of 90 days during the Covid pandemic. 
• Covid 19 Contact Tracing Hires:  As of 1/31/2021 285 positions have been filled, 71 case investigators, 203 contact tracers, 6 supervisors/managers, and 5 other. 228 positions are in the hiring process with CCH leading Hektoen Institute in the hiring process.
• CCH is developing an improved volunteer program.  304 National Guard are unpaid vaccination personnel: 143 at Tinley Park Convention Center; 36 at Triton College; 89 at Health Centers North Riverside/Morton College, Robbins & Cottage Grove, Arlington Heights, and Blue Island; 18 at Stroger/Provident/Core and 18 at McCormick Place (not a CCH site).  For the Covid-19 Hot Line launched 12/21/20, 34 volunteers are assigned to give out test results.

CountyCare Medicaid Managed Care Plan

• As of February 4, 2021 County Care has a total membership of 385,741, of which 39,751 are in CCH clinics.  This total member increase is 5,300 more over last month, due to increase plan choice and auto-assignment by the state.  There are 1,000 more members in CCH clinics over last month. 
• CountyCare's 31 % market share of all Cook County's Medicaid Managed Care Plans has held steady.  CountyCare's enrollment has increased 17.4% over the past 12 months following the trend of all Cook County Medicaid Managed Care Plans.

Financial Update

• The December 2020 Net Patient Service Revenue was better than expected due to slightly higher charges.  The December admissions were less than a year ago.  A one-time payment of $6M was received from BCBS Equity Program.  
• From the CARES ACT, approximately $6M is to be reimbursed for Covid-19 expenditures. 
• First Quarter FY2021 is on pace to save $5M from completed/near completed Vendor contract negotiations.  Uncompensated care decreased in December 2020 from Dec 2019 and Medicaid revenue increased in Dec 2020 over Dec 2019. 
• Payment denials/write offs met the Dec benchmark of 5%.  More than half of denials were related to prior authorization (focus is on infusion, radiology, outpatient surgery). 
• On an accrual basis, interim financials show that CCH is ending December 2020 $2.32M ahead of budget.  December 2020 Health Plans Financials showed a Loss of $1.6M consists of $0.4M from CountyCare and $1.2M from Medicare.  Membership in Medicare is lower than budget, driving lower than expected revenue and members have more serious health conditions.
• Contracts were approved for purchasing specialty surgery supplies, instrument & equipment repair, mammography equipment upgrades, an ultrasound system, neurological power tool accessories, medical/surgical acute care beds, aortic endo-grafts used by surgeons to repair the aorta, and job posting system maintenance/enhancements.  A software company contract was approved for the "CMS Interoperability and Patient Access Final Rule Integration".  Interoperability is the ability to share data between different computer systems.  Goal is to have data flow securely between CMS regulated payers, providers and to give patients access to their health information.
• Two grants were received and filed for approval by the Cook County Budget Director:  An IDPH grant for "Cities Readiness Initiative Program" which is designed to enhance the response to large public health emergencies needing medicine/medical supplies in large metropolitan centers.  A second CCH Foundation Grant is for mass vaccinations/ support patient recovery.

Cook County Dept. Public Health (CCDPH) serves CC suburbs: 

• The Public Health Accreditation Board has continued accreditation of the CCDPH for 5 years. 
• CCDPH in collaboration with Hektoen Institute has awarded nearly $5M to 42 community-based organizations (CBO) for a 6 month project Dec 2020 to May 2021 for Covid-19 Community Supports and Worker Protection Programs.  Investing in existing community assets, since they are credible and trusted places, will help to reach populations where hesitancy and distrust exist.  These programs are in communities/populations most disproportionately impacted by Covid-19.  The Community Supports program provides outreach, education, expansion existing programs/services, testing.
• The Worker Protection Program provides employers and workers information, resources and support to minimize the spread of disease to promote health and safety in workplaces.

Covid-19 Vaccination: 

• As of 2/16/20, 70% of CCH staff and 56% of CCH employees have been vaccinated. 
• As of 2/19/21 vaccine doses distributed at Chicago & Suburban CCH Points of Distribution (POD) to CCH patients and public who meet current eligibility = 43,636. 
• Vaccine doses distributed to general public who meet current eligibility at Mega PODs = 46,453 and vaccine doses distributed to specific eligible populations at Targeted PODs = 1,264. 
• Other community vaccination access is from CCDPH Mobile Units, CCH/CCDPH Strike Teams (homeless shelters, home-bound and hard to reach populations), Drive-Thru at CC Forest Preserve District sites,  Loyola and Advocate hospitals, Pharmacies, Federally Qualified Health Centers, and Oak Street Health. 
• CC is currently in Vaccine Allocation Phase 1b which includes individuals 65 and over and frontline essential workers. 
• Vaccination registration & appointment information is available at Website: vaccination.cookcountyil.gov     Call center: 1 833 308 1988, M-F  7am to 7 pm.
• Covid-19 Vaccination at CC Department of Corrections & Juvenile Temporary Detention Center; Staff: since 1/20/21 more than 3,500 doses have been administrated.  Detainees and prisoners are Phase 1b.  To date, nearly 1,300 detainees have received their first dose.

CCH Covid-19 testing: 

• As of 2/21/21, from all tests conducted at CCH (107,334) the positive rate of patients is 8%.
• Covid-19 testing at Cermak (CCH health center at CC jail) remains a high priority and plays a critical role in the containment of Covid-19 at CC jail.  The rolling 7 day positivity rate as of 2/23/21 = 0.8% even as the jail census as of 2/22/21 = 5,435.

Observer:  Michele Niccolai                                   Virtual Meeting length:  2+ hours

Cook County Health (CCH) Board of Directors Meeting - January 29, 2021 
All directors were present, and there were no public comments submitted.

Report of Israel Rocha, Chief Executive Officer:

• Annual I-C-A-R-E employee awards were announced. I-C-A-R-E includes Quality, Integrity, Collaboration, Accountability and Excellence.  CEO Rocha talked about the importance of these qualities for the System and its employees to thrive.
• He then turned to a status report on Covid-19 reporting numbers as of January 27, 2021.  Confirmed CC cases 448,546; deaths 8,756; and total tests 5,625,530.  The new Covid website is up and running: vaccine.cookcountyil.gov, and the phone number is 1-833-308-1988.  Cook County residents can sign up to receive the vaccine, but it was made very clear that the holdup to the vaccination program is not the operational aspects but the availability of the vaccine supply.  Residents who sign up will be notified and given a date only when the Department of Public Health can ensure the vaccine is available.  The Chicago and Suburban Cook County Health Departments are working together.  Chicago will give vaccinations to suburban CC residents working in the city, and CC Health will do likewise for city residents working in Suburban Cook County.
• CCH is involved in a suburban Cook County community support program that includes $5 million awarded to 42 community-based organizations and a “Mask-Up Campaign”.  Community organizations are providing masks and care packages.
• On January 27, Cermak (Cook County Jail health facility) reported a rolling 7-day positivity rate of 4.4% and a census count of 5,324.  2000 of the staff members have been vaccinated and detainee vaccinations are in progress.
• CEO Rocha reported that 2,825 or 49% of the 6,033 staff have been vaccinated -– job category percentages include Doctors 80%; Nurses 49%; non-union 62% and union 47%.  An effort to educate employees on vaccine safety is under way.

Committee Reports:

Human Resources:

• Year-end Report [11-30-20]:  325 total positions were filled [146 externally].  Average time to fill positions was 91 days against a goal of 90 days.  Separations totaled 546 of which 271 were resignations, 288 retirements, 36 discharges, 11 deceased, and 50 laid off.  Chair Hammock asked for a summary of exit interview reports listing the reasons given for leaving Cook County Health.
• Covid Hiring as of January 22, 2021:  154 tracers, 93 Case investigators, 6 Supervisors, 7 Leadership.  Another 33 are scheduled to come on board in the next two weeks.  

Managed Care as of January 4, 2021: 

• County Care Managed Care Organization (MCO) continues to have the highest enrollment in Cook County at 380,386 or 31% of which 38,695 or 10.2% actually use the CCH hospitals and ambulatory care centers.  Because it has received Illinois’ highest quality ranking among the Cook County MCOs, County Care’s share of the State’s auto assignment will rise to 50% on February 1.  
• The State has continued to pause its annual redetermination requirement.  This along with the newly reopened Federal ACA enrollment opportunity is expected to further the rise in CCH’s MCO enrollment.  It is also expected that until later this year the System will receive a fee for service reimbursement rather than the current Medicaid rate for undocumented Cook County residents aged 65 and older who meet the financial need requirement.

Quality & Patient Care: 

• Stroger’s readmission rate on November 20, was 8.69% against a target of 8.56%.  Heart failure continues to be the leading cause. 
• Unfortunately the rate of patients that would recommend Stroger dropped to 64.39 % from a 77.9% rating reported at the December 4 board meeting.  The target is 71.3%.    

Finance:  

• In December, the System approved an emergency purchase of $8.4 million with Dialysis Care Center Holdings to operate the renal dialysis center at Provident.
• The board approved a $2,069,820 contract with Specialty Consulting for environmental assessments at the Oak Forest Health Campus, the CCH Administration Building, the Department of Public Health’s Forest Park, and Provident Hospital.  The Cost for 2021 is $1.7 million and will be funded by Cook County’s capital improvement budget.
• On an accrual basis, the System ended the year $35 million ahead of budget due to emergency funds received from the Federal government.  Revenues were up due to emergency Medicaid payer mix improvement, a decrease of 16% in patient volumes, and the receipt of $153 million in CARES Act funding.  Expenses were over budget but most Covid expenses were reimbursed.  In addition uncompensated care, including Charity Care, was down due to Covid.  
• CountyCare had an operating loss of $51 million in FY2020.  The new Medicare plan is not expected to show a profit for the next year or possibly two.  As of January 2021, there is an intergovernmental agreement with the State to reduce the revenue payback.  It was noted that due to Covid there was significant drop in claims, but that was offset by the higher cost of inpatient claims.  Board member Curry asked for a separate Medicare financial report.
• Domestic spend was $225 million compared with the $173 million budgeted.  Mr. Rocha said that he and Mr. Galeener, Interim CEO of CountyCare, are working on a revenue generating strategy.   Board member Koetting asked to be included in discussions to improve profitability.  He commented that he would not support a “wholesale” adoption of the strategies used by other MCOs.
• Grants:  The System’s lawyer described the new grant review procedure due to a change in the County appropriation ordinance and resolution for FY 2021 that did not include grants.   The CC Board will no longer approve, but will receive and file them.  Going forward the County Board must approve grants over $150,000 and the County budget director will approve grants under $150,000.  The lawyer assured the directors that the new process was not intended to eliminate CCH’s control over grants.

Observed by:  Diane Edmundson                                    Meeting Length:  3 hours

Cook County Health (CCH) Board Meeting
October 30, 2020

From Public Health to Finances to Human Resources to the Managed Care Program, Cook County Health officials reported that COVID-19 impacted most sectors of the System's operations.  

Public comments:   The League of Women Voters of Cook County and Civic Federation's comments urging the continuation of live streaming and archival recording of board and committee meetings post pandemic was the first to be read - followed by a number of nurses’ statements that Covid-19 testing in the new Blue Island community facility isn't safe due to space limitations and staff shortages. 

Committee/Department Reports:

• Human Resources: The new chair is Mary Driscoll.  312 contract tracing positions are in the recruitment phase with 255 in the interview process and 1 person hired.  Position approval related to Covid and revenue shortfalls has slowed down the hiring activity for non-Covid openings.  Of the 520 positions in H.R., 54% have been approved for active recruitment.  Currently, the average time to fill a position is 91 days against a target of 90 days.  Through September, 622 separations have occurred vs 480 in 2019 - over 100 due to layoffs.
• Managed Care:  The new chair is Vice President, David Menar.  Membership in County Care has consistently increased since the start of COVID and the loss of employer health insurance.  Through October 5, total membership was 373,645 which is 2,000 higher than September and within 500 of the 2020 budget projection.  10.4% or 38,815 of these members use Stroger services.  Illinois Medicaid gives County Care its highest ratings among the Cook County Managed Care Providers.  County Care’s market share in Cook County is 31.4% which is the highest percentage followed by Meridian and Blue Cross Blue Shield at 26% and 25% respectively.
• Quality & Patient Care: The average re-admission rate is 10% which is partly due to COVID.  Patient experience ratings inched up under the “communication with doctors category” and slightly down for “communication with nurses”.  Stroger’s hospital patient recommendation rating is at 70.8%.  Several directors commended the staff for their efforts to get the ratings headed in the right direction.
• Finance:  The board approved the acceptance of four grants totaling over $1.6 million.  Almost $1.5 million is from the city of Chicago for mobile units, Stroger, and Provident contact tracing services.  Directors discussed in detail the one year contract with the Hektoen Institute for Medical Research amounting to almost $2.75 million for temporary staffing services.  The contract would allow for up to 60 new hires including one manager, 8 case investigators, 2 case investigator supervisors, and 50 contact tracers. This number is added to the number hired by Hekteon under a 7-23-20 contract and by the System’s Human Resources Department.  Concerns centered on ensuring appropriate discussions and agreement with the AFSME union.  Assurance of contact and discussion was given, and the board approved the contract but requested follow up. As of August 31:   financial results are ahead of budget by $80 million  Negative variances are expense overages, partly due to COVID-19 costs and the loss of revenue due to reduced volumes.  Patient activity revenues have improved to just 22% lower than normal.  Surgery revenue is even closer to normal.   Recent guidelines of how to calculate revenue loss have changed which may negatively affect the amount of the $153.4 million CARES Act monies that can be kept.  DSH monies may also be in jeopardy as Illinois ran out of money in September.
• Public Health:  The System wants to increase the 2020 flu vaccine uptake, particularly for people at higher risk for serious flu and COVID-19.  It is in a collaborative partnership with 23 health providers.  Regarding its COVID-19 response to date, the Cook County Department of Public Health (CCDPH) has investigated over 5,500 cases including over 150 schools with a case or close contact; responded to over 10,000 inquiries; and provided 1,700 individualized recommendations. Compliance efforts in workplaces is ongoing and soon the Department will implement the Worker Protection Program as part of the COVID-19 contact tracing initiative.  This will include conducting pro-active education and outreach to workplaces and workers in Suburban Cook County. In addition, Public Health is planning for COVID-19 vaccinations when the vaccine is available.  Two doses will be needed between 3-4 weeks apart, and it must be the same kind of vaccine for both shots.

Other Items of Interest: 

• Interim CEO, Debra Carey stated that Stroger is one of only two sites in Illinois and one of 24 hospitals in the United States to lead a landmark trial to recruit adults who recently tested positive for COVID-19 to participate in a clinical trial of monoclonal antibodies for the Prevention of Covid-19.  The System is also participating in a Phase III controlled trial for a COVID-19 vaccine known as AZD1222 plus another six trials and studies including being the first hospital in Illinois to participate in a study to understand the effects of COVID-19 on acute myocardial infarction patients.
• In attendance were the three new CCH Board members Robert Currie, Raul Garcia, and Joseph Harrington.
• Moved to the November board meeting is the report from the Audit and Compliance Committee’s special meeting on October 14, 2020 and the report from the Center on Health Equity and Innovation. In addition, Director Guggenheim asked for a report on the COVID-19 mortality numbers of CCH staff.

Observer:  Diane Edmundson                         All 12 board members were present at the 3 hour meeting

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