Category: Strategic Plan

Outgoing Cook County Health CEO Begins Strategic Discussion On Self-Pay For Medical Services

1/2/2020

Cook County Health Board Meeting - December 20, 2019

Following up on the 2020 budget deliberations and the very real issue of the increased cost for charity care, Dr. Shannon, presiding at his final board meeting before leaving the system, led a discussion on “self-pay” and how other major public hospitals across the country handle it.

For purposes of discussion, self-pay is used in place of charity care. There was a 17% increase in year-over-year charges from FY 2018 to 2019 from $158 million to $185 million. The percentage of self-pay was 1.2% in 2018 but dropped to .4% in 2019. The largest service increases are: Radiation Therapy [75%], Family Practice [50%], Gynecology [33%] and Surgery [29%].

Comparisons of NY Health & Hospitals; Jackson Memorial [N. Texas & Oklahoma]; Parkland [Dallas]; and Grady [Atlanta]; self-pay plans were passed to the Board and include:

Sliding scale fees based on Federal Poverty Levels
All or a portion of the patient responsibility paid in advance
Services covered limited to emergent [emergency]
Six months residency required to qualify for charity care

Dr. Shannon listed several strategic considerations:

Continuous improvement in revenue cycle process
Refine and update self-pay policies and procedures to include collection of co-pays from insured or payment for others [self-pay].
Refine and update policies on taking self-pay transfers from other healthcare facilities
Build-out point of service collections/payment capacity including:

1. Online payments as part of patient portal improvements
2. Kiosks with payment options
3. Training staff to collect/swipe cash or credit/debit cards
This would be a major change in policy for CCH as well as culture. Several board members questioned whether the County Commissioners and President would accept this concept. President Hammock responded that the System should provide an analysis and recommendations so that both it and the County elected officials have a base to work from including possibly deciding to provide more revenue to CCH to handle charity care.

Laurence Msall, President of the Civic Federation stated in public comments “The Civic Federation remains adamant in our support of this [volunteer] board…..” He also recommended that the System steer clear of initiatives that do not fit with its core strategy, but did not state what they might be.

Observer - Diane Edmundson Meeting Length: 2 ½ Hrs.

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Cook County Health Approves Preliminary 2020 Strategic Plan

7/30/2019

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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

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Cook County Health Nearing Completion of 2020-22 Strategic Plan

6/15/2019

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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

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Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

4/7/2019

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Cook County Health (CCH) Board Meeting
March 29, 2019

Director Mary Richardson-Lowry was elected Vice Chair of the Board replacing the long serving Commissioner Butler who resigned from the Board in 2018. Director Richardson-Lowry has been a member of the Hospital Board since 2015, Chairing the Human Resources Committee. A partner in the Chicago office of Mayer Brown law firm, her illustrious career includes having served as Commissioner of the Chicago Department of Buildings, Past President, Chicago Board of Education and Metropolitan Family Services Board member.

What did the Board Discuss?

Using locally sourced, market-savvy investigators, 2 million dollars in overpayments to providers in the 4th Quarter of last year were identified, only a small fraction has been recovered thus far, pending the appeals process.
Net operating loss exceeds budgeted loss of $72 million by $35 million in first 2 months of fiscal year due to persistent excess external claims expense paid to non-CCH network providers. Increasing use of CCH facilities is the challenge with below budgeted volumes this year of primary & specialty care, surgical cases and deliveries. Director Reiter said the financials are comparable to previous years.
Willingness to recommend Stroger and Provident Hospital in the bottom 40% of hospitals.
45% uninsured system-wide, composed of 32% African-American, 47% Hispanic, 4% Asian and approximately 17% White. Director Suleiman Gonzalez requested uninsured data based on language spoken to capture data on the numerous Polish and Middle Eastern groups.
Strategic Plan updates:

Dr. Fegan reported on the medical staff demographics (PowerPoint on CCHHS website), challenges of a unionized medical staff which has a lack of job title specificity, incentive structure and slow implementation of use of Relative Value Units, the industry standard measuring “work”. High value specialists are not retained. Board discussed hybrid system for physicians of unionized with incentives.
E-consult communication of physician with patients has been implemented with positive patient response.

Items to Watch for in the Future

CEO Shannon said the new merger of Healthcare companies Centene and WellCare will result in the largest Medicaid insurer nationally with 12 million beneficiaries and anticipated major savings in their cost of care provision which will threaten CountyCare’s current dominant position in the Cook County Medicaid market.

Observed by Barbara Hayes and Susan Kern Meeting Length: 3 hours 15 minutes

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Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

1/6/2019

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Cook County Health (CCH) Board of Directors Meeting - December 21, 2018

What did the Board Discuss?:

Commissioner Deer, 2nd District, has a background in health care. After being appointed to replace retired Commission Jerry Butler as Chair of the Cook County Board Health Care Committee, he was then appointed to the Cook County Health Board and assumes the role of Vice-Chair. Newly elected Cook County Commissioner Donna Miller (6th District), also in attendance at the meeting was introduced to the Board by Chairman Hammock. She expressed her long-held interest in the health care services provided in and by Cook County. Commissioner Deer noted that he will be advocating for more minority contract opportunities.
CountyCare, the county's managed care health plan, is aggressively marketing its benefits to current and potentially new customers during this year’s Medicaid open enrollment period due to close the end of January 2019. Current membership stands at 333,704 against a 2019 target of 345,000. Of particular note - two out of every three CountyCare members do not use Stroger, Provident, or Cook County ambulatory clinics as their primary provider. CCH is aggressively working to change this metric.
The interim Human Resources (HR) Director implemented a new technology and outreach plan in an effort to achieve its goal of a 90 day hiring cycle (current average is 96.4 days). In 2018, 15 new bilingual hires were added to the work force with another 10 in the pipeline, and 30 more job titles with bilingual ability as a minimum requirement are under review to establish new job codes. In addition to adding bilingual staff and working to improve cleanliness perceptions, CCH is focusing on decreasing waiting times and improving phone access. A revised performance management policy [employee evaluation] is to be rolled out early in 2019 with on-line performance management to follow.
The Finance report through the first eleven months showed no new surprises. The CFO noted that CountyCare has contributed $184.5 million to date to the Revenues. He also noted that while Cermac Health Services, the correctional system health operation, has seen fewer patients, those seen require more resources. The top three referrals are oral care, ear, nose, and throat, and visits to the hand clinic.
The Quality and Patient Care Committee noted that the willingness to recommend Stroger to others has increased but statistics were not cited. Each Tuesday the in-charge coordinator for cultural improvement is going on rounds throughout the hospital and asking two questions: 1) What are your concerns? and 2) How can we help? One other item pulled from committee metrics is that at any given time, about 80 surgical residents are working in the County hospitals.
Board member Gonzalez asked Dr. Mason, CC Public Health Director, for a geographic mapping for HIV, Hepatitis C, and all sexually transmitted disease cases. This request followed a slide presentation mapping the “suburbanization of poverty” areas in Cook County. Dr. Mason added that the mortality rate for African American mothers is 3 times that of Caucasian mothers, and he said that the number of African Americans living in Chicago has dropped by 15% while the number of Hispanics in Cook County has risen by 20%.
Dr. Shannon recognized the retirement of the highly esteemed IT Director, and she gave a brief presentation to the board including what the future in IT holds for the System: artificial intelligence, predictive analysis, and prescription analytics. Dr. Shannon also noted that the newly implemented Kiosk check-in is being well received.

Items to Watch For in the Future
Ongoing:

Director Lowery asked for a comparison of the System’s nursing openings to other like institutions across the country.
Board Chair, Hill Hammock, asked for feedback on what percentage of claims are never collected because of coding, timeliness, and/or processing issues.
Chair, Hill Hammock asked for a detailed dive into pension costs, projections, and percentage of takeover from the County by the Cook Health System.
A Board decision on CountyCare’s proposal to stop paying providers who treat CountyCare patients when the patients’ visit is outside their assigned network of providers.

New

The Fiscal Year ended on November 30. Watch for final revenue/expense variances, and metric results vs targets (e.g., hiring cycle and higher revenue specialties such as surgeries and maternal deliveries).
The new Vista Clinic in Arlington Heights with preventive and specialty care services such as dental and behavioral health delayed its opening to January 14, 2019 with the grand opening to follow sometime soon. A similar model clinic in Riverside is scheduled to open by mid-year. Look for details on the openings as tours will also be scheduled for those interested.
2020-2022 Strategic Plan presentations and discussions will likely get under way in earnest at the January Board Meeting and go on through the May meeting.

Observer - Diane Edmundson Meeting Length: 2 ½ Hours

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Cook County Health Board Undertakes Strategic Planning

12/8/2018

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Cook County Health Board of Directors Meeting - November 30, 2018

CountyCare Update:

Total CountyCare Medicaid managed members September 2018 is 335,126.
50,149 of CountyCare members are receiving their care in Cook County Health clinics.
Medicaid Open Enrollment has started. Open enrollment happens once a year when Medicaid members can change plans. Illinois Healthcare and Family Services began mailing out letters letting members know the date they can sign up for 2019 plans.
CountyCare is promoting itself during open enrollment as the largest Medicare managed care plan in Cook County by using texts/emails to members and providers; by sponsoring member events; by using social media, Facebook and You Tube; by using website information; and with ads on bus shelters, CTA, and banners.

Recent statistics show system-wide, Cook County Health provides 42% of charity care in Cook County. Illinois non-profit hospitals receive property tax exemptions based on the charity assistance given to their communities even though there is a wide definition of charity care and community benefits. The subject of Cook County non-profit hospitals providing charity care is an issue.

Subjects to be addressed in future countywide Cook County Health strategic planning:

locations of health care delivery systems
social determinants in life expectancy
population shifts
population demographics
suburbanization of poverty
elderly and disabled populations and their special needs
access to healthy food, food insecurity
areas of high unemployment rates as economics affect health and social conditions
suburban public transportation
Primary Care Physicians as key entry to Cook County Health specialists
if Cook County Health clinics have followed population shifts
competition with large non-profit health system

Observer - Michele Niccolai Meeting Length: 2 hours

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Outgoing Cook County Health CEO Begins Strategic Discussion On Self-Pay For Medical Services

Cook County Health Approves Preliminary 2020 Strategic Plan

Cook County Health Nearing Completion of 2020-22 Strategic Plan

Director Mary Richardson-Lowry Elected Vice Chair of Cook County Health Board

Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

Cook County Health Board Undertakes Strategic Planning

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