Cook County Health Board of Directors Meeting –
December 17, 2021

Human Resources:

• The Human Resources (HR) department is down to four recruiters from nine in 2020.  To help with the backlog, it hired contracted recruiters.  In January 2022, four agency recruiters will start and four former recruiters will come on board in a part-time capacity.  
• Strategic plans for 2022 include hiring a consultant to help overhaul the entire hiring process and also to help answer the question:  “how do we rebrand ourselves” to be more competitive in a very competitive health hiring market.

Human Resources Metrics

• Turnover of 10% to date is higher than normal, particularly in nursing.  Covid a factor
• To date, 614 positions filled:  453 external hires, 76 promotions, and 85 transfers.
• Avg time to fill a vacancy continues at 105 days.
• Separations to date total 653:  215 Retirements, 396 Resignations, Discharges 42.  

Managed Care

• Membership is now at 422,266 - 10% of which are Ambulatory Care Center members. Number expected to drop mid-2022 due to state reactivating the assignment process which was halted during 2020-21 Covid. 
• 42% of the Plan’s membership have had at least 1 dose of the Covid vaccine. This number includes 5 year olds and up.  36% are fully vaccinated as of 12/3/21.
• A 2022 Strategic Price Increase will focus on room & board which is approximately 55% below market and the surgery rate which is approximately 78% below market.
• Medicare membership revenue of $13,044 continues to lag well behind budget of $30,974.  

Quality & Patient Care

• The 30-day readmission rate is to up 10.78% against a goal of 9.93%.
• There was a significant drop in the “Recommend the Hospital” index from 87.91% in May to 63.16% driven by scores for cleanliness, nurses treating patients with respect, and buzzer response.
• The committee is reviewing its dashboard process for metrics and said it may present a new format in 2022.

Finance Committee

• On an accrual basis as of October 31, CCH shows a $12 M positive variance.  On a cash basis,$40 M.  This is partially due to a slowdown in CountyCare utilization of CCH facilities.
• County Care membership 414,000 as of October 31, 2021 with an operational gain of $10 M.  Both revenues and expenses are higher due to membership growth.
• The quality and quantity of patient TV use was discussed - particularly education and/or training programs.  This could be an area for savings.
• Primary Care and ER revenues are below budgeted expectations.
• The $10 cash payment required for charity care services was eliminated in 2021.

CEO Report:
Last month, 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.]

Highlights for this month include:
Provident Hospital:  

• Completed ICU monitor installation.  ICU beds delivered and nursing station construction is completed.
• Funding identified for new phlebotomy chairs, lab chairs, and updated refrigeration.
• Phase 2 Ambulatory Bay renovation work to begin in December.
• Installation of MRI scanner has begun in the new and enhanced diagnostic imaging center.
• Developing a plan to increase dialysis volumes.

Ambulatory

• YTD primary care volume is tracking with budget. Specialty care continues to lag.
• Working on year-end push to increase mammograms, eye, and colorectal screenings among managed care patients.
• Increasing scrutiny of the specialty schedules to understand which are underutilized and re-appropriate them to needed areas.

Note:  All of these reports can be found HERE.

Observer:  Diane Edmundson

 Cook County Health Special Board Meeting - September 11, 2020

After one hour of testimony and four hours of discussion, the Cook County Health Board approved a budget of $3.3 billion for 2021.  The budget for 2020 was $2.8 billion.  However, along with the approved budget, it also voted 6-4 to add an amendment asking for an additional $23 million which equates to the "indirect" costs of CC Correctional and Public Health Departments.  Interim CEO Carey and Interim Chief Business Officer Gibson were asked to ASAP identify what services, staff, etc. would be restored if the $23 million was granted.

Hours were spent in discussion with a majority of board members stating that they wanted to have more early involvement in setting budget priorities.   The Board’s Vice-Chair made the following points:

• The budget process is too reactive and needs to be more proactive.
• The System needs to explain what services cannot be performed because of revenue shortfalls.
• The System needs to articulate who is its targeted population.

Interim CEO Carey noted that there were over 100 public speakers during the two budget hearings and the Sept. 11, 2020 special board meeting to approve the budget.  Two programs eliminated in the 2021 budget generated a significant amount of testimony:

• Health Care service at the Morton East High School.  Carey indicated the System believes it can find a replacement provider, but Directors want more feedback on who or what would be the replacement.
• Children's Advocacy Center.  In 2020, the budget was $500,000 for mental and physical health services.  The Center offers many other services that will continue, and Carey said the System is looking into alternatives.  Director Deer who is both a Director on the CCH Board and an elected Cook County Commissioner expressed concern, and used this as an example of why the Directors should be involved earlier in the discussions of what will continue, be cut, or added when developing the annual budget.

As the meeting closed, several members of the board restated the following points:

•  More revenue is needed to fulfill the System’s mission and mandates.
•  The System needs to develop a robust Regional Planning process which must include a strategic discussion on charity care.

For those wishing to have more information about the budget categories and amounts, the 2021 proposed budget can be found HERE.

Diane Edmundson - Observer

 Cook County Health (CCH) Board of Directors Meeting - July 26, 2019          

Board Decisions:
The board unanimously approved the preliminary 2020 strategic plan, which will be available for public input later this summer and presented to the Cook County Board in September. 
The plan calls for:

• Increased surgeries, emergency visits, primary care, specialty care, and deliveries;
• 5% cost savings; and
• Sustaining CountyCare membership,

Challenges to the system include:

• Salary increases, 
• Increased cost of equipment and supplies;
• Revenue loss in CountyCare;
• Consolidation of hospitals
• A $52m pension requirement. 

CEO Dr. Jay Shannon pointed out that CCH needs to attract and retain paying patients  When CCH loses CountyCare patients, there is a 53% chance they will present for charity care, which consumes 25% of CCH revenue.

Committee Reports.

• Human Resources: 7,265 total positions, 1,151 vacancies, 830 positions in process, 364 external positions filled. Hiring for coders and billers difficult; not enough qualified candidates.  
• Managed Care: CountyCare membership 316,730 as of May 2019, 31.6% of market share. Home visits to high risk patients to encourage them to use CountyCare. Commissioner Sidney expressed concern that patients were being “auto-assigned” to health care plans without patient input.
• Quality and Patient Safety: CCH has a 16% readmission rate (near national average), attributed to hypertension and kidney disease; 8 falls with injury per month average; no hospital acquired conditions in last 3 months, but some infections.  74% willing to recommend Provident, 69% to recommend Stroger.
• Finance: Budget 23%  below target due to increased (1) charity care, (2) clinical activity and (3) pharmacy costs.  “We need to be better compensated for care to the uninsured,” CEO Shannon commented.  Finance Chair  Robert Reiter pointed out that CCH provides half of the charity care countywide; other hospitals are providing less.  Commissioner Mike Koetting emphasized the “centrality of making sure we are the provider of choice; otherwise the percentage of charity care will continue to grow.”  45% of CCH patients are now uninsured. 51% of patients identify as African American; 32% identify as Latino.

CCH Board Chair Hill Hammock announced that the Deloitte accounting firm will examine CCH’s financial books and accounting principles, with a response from CCH by the end of August.

Observed by:   Linda Christianson                                      Meeting Length: 3 hours

Cook County Health (CCH) Board Meeting - May 31, 2019

What did the Board discuss:

• The 2020-22 planning process started in the Fall of 2018.  After months of considering key issues, industry trends, looking at future needs, and seeking input through community town halls and surveys, the Cook County Health (CCH) Strategic Plan 2020-22 is nearing completion.
• CCH recognized its nurses May 6 - 12 during the annual National Nurses Week.
• CountyCare, the CCH Medicaid managed care organization, numbers were slightly down again as of May 5, 2019 to 316,831 members.  The Illinois spring legislation addressed problems with Illinois Medicaid: reducing  lapse of care when benefits are terminated, and establishing an easier process for initial Medicaid applications and redetermination for individuals to stay on Medicaid.  CountyCare will benefit from these improvements.
• CCH committed $1 million toward the Flexible Housing Pool- a partnership that has the goal of housing  vulnerable homeless and connecting them with support services.  Overall this support is a cost effective way to help them improve their lives and health.
• The Board acknowledged the Cook County Health Foundation.  This foundation partners with CCH giving financial support to further the health systems mission of health care to residents regardless of their ability to pay.  The foundation increases awareness of CCH and raises money to help the health system build for the future and remain a leader in public health.
• A May presentation "Diabetes Update" explained that over time elevated blood sugar (glucose) levels damages both large and small blood vessels.  This damage can lead to complications that affect the whole body.  A CCH study showed that a gain in patients' knowledge of diabetes management is associated with better blood sugar control.
• CCH contracted with an architectural consulting service to review the physical spaces of its out-patient clinics.  The goal is a positive patient experience in waiting areas and a good experience when being efficiently moved through clinic areas.
• The Board approved a furniture contract for new clinics in  Hillside, North Riverside, and Blue Island.

​ Observer - Michele Niccolai                                          Meeting Length:   3 hours