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 

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

Cook County Health and Hospitals System Board Meeting
January 26, 2018                                           
Meeting Length:  2 ½ hours

What did the Board Discuss?

• Status of the new clinic/Administration building elucidated by contractor: June 25, 2018 projected substantial completion on budget ($112,640,000) with move in of equipment and furniture budgeted at $19,148,179. Sept/Oct. 2018, building open for business.
• Naming rights for new building—philanthropists welcome!
• CountyCare membership after Aetna and Family Health Network acquired was 425,000 in December but dropped by 40,000 to 385,000 by January 1, 2018.  Drop expected, primarily lost to Blue Cross Blue Shield but silver lining is that CCHHS saved on purchase price which was based on Jan. 1, 2018 membership.  
• Anticipated early financial projections for the massive increase in CountyCare, managed Medicaid members were not available due to complexities in merging the numbers from acquisition of 159,692 (Family Health Network) and 125,240 (Aetna).  Metrics delayed till Feb. Board
• New director of Managed Care, a transplant from Family Health Network, named​

What did the Board Decide?
Stroger Hospital downgraded from two to one-star rating computed by the Centers for Medicare/Medicaid Services from years 2016 to 2017.  Downgrade related to:

• Above average readmission rate 
• Below average: Experience of Care, Timeliness of Care in the ER and Effectiveness of Care 
• Interventions are planned by category of deficiency.  Cleanliness, cited as major negative in Experience of Care measure is being met by staffing, capital equipment and increased intensity of oversight and inspections of care areas

University of Illinois Hospital, another Medical District hospital also received one star


Items to Watch For in the Future

• CEO Shannon delivered a PowerPoint update of expected changes/progress in the County Hospital’s Strategic Plan 2017-2019
• Establish use of Relative Value Unit coding of all physician work to measure productivity
• Implement utilization management program, with goal of balanced budget with overtime reduced by 20%
• County Hospital’s uninsured numbers increased in 2017.  Changes in outdated payment formula of the Hospital Tax Assessment Program that most hospitals contribute millions of dollars to in order to generate higher federal matching Medicaid funds, is being revised effective July 2018.  Many safety net Hospitals who have been receiving far more dollars back from the program than they contribute may collapse when these funds dry up, resulting in uninsured flooding CCHHS.
• Collective bargaining contracts coming up in 2018 may stress the hospital’s budget

Observer - Susan Kern, MD

Cook County Health & Hospital Systems Board Meeting - June 30, 2017    

Significant Decisions:
Mr. Hammock was reelected Chairman and Mr. Butler reelected Vice-Chairman of the Board. Mr. Bob Ryder is new Board Member.

Significant Topics Discussed: 
County Care (Managed Care): 

• Enrollment at 68.9% is below the 70th percentile target. Use of County Care in May 2017 was $88.3 million; budget is $132 million. 
• CCHHS has submitted its proposal in response to an RFP issued by the Illinois Department of Healthcare and Family Services to revamp its Medicaid Managed Care Program. However oral presentations have been pushed back from June to July. Stephen Glass, Managed Care Executive Director believes they will have one of the successful proposals.

Finance:

• At the year’s midpoint, income to budget is off by $60 million. YTD Loss of net income was $51,495. Key drivers of costs are the pharmacy (increasing cost of generic drug and single-source brand for treatment of certain diseases) and professional (overtime). 
• Through end of April, $254 million was spent outside of the CountyCare system. Visits to all departments were significantly lower than target. 
• As the 2018 budget will require significant increases in salaries, capital improvement, and equipment, the Committee has developed a comprehensive cost-saving plan across all departments in the system.

Quality & Patient Safety: 

• Audit by the Joint Commission on Hospital Accreditation was successful.

Comments on Strategic Plan:

• Dr. Shannon commented that if the Illinois General Assembly does not pass a budget, this would cause a significant impact on the System’s Strategic Plan.
• In addition, the current efforts to change the American Affordable Care Act would decrease the federal match for Medicaid by 35%. If the state is required to fund 90% of Medicaid, the state won’t be able to participate in Medicaid expansion. In this case, the System will pursue a policy change. Since Illinois law states Cook County Health & Hospital System has the right to operate CountyCare, the strategy is to make CountyCare the managed-care plan of choice. 

Observers: Bill Edmundson and Jeanne Mayer                           Meeting Length - 3 hours 

Cook County Health and Hospitals System Board Meeting -  September 29, 2016

Key Board Member Resigns  
Cook County Health and Hospitals System (CCHHS) Board Member Dr. Wayne Lerner submitted his resignation, with many commendations for his service by board members and by CEO Dr. Jay Shannon.  As chair of the CCHHS Managed Care committee, Dr. Lerner stressed the importance of CountyCare’s focus on (1) quality care; (2) risk management; (3) improving health status: and (4) a distribution of membership between healthy and less healthy to even out cost of care.

Significant Topics Discussed:

• Public speakers complained of abruptly closing the Oak Forest Health Center cafeteria that served 500 staff and patients.
• CCHHS Director of Public Health Dr. Terry Mason described the Partnership to Improve Community Health (PICH), funded through  three annual grants of $2m each from the Centers for Disease Control. The funds have been used for community programs focused on better access to smoke-free environments, healthy food, and street and forest preserve signage improvements for better access to physical activity, with encouraging results.
• Despite efforts only 57% of surgeries at Stroger Hospital start on time, due in part to staff shortages. Family Medical Leave Act allows up to 12 weeks of unpaid leave for staff members.  Patient satisfaction level about 70% for both Stroger Hospital and the Ambulatory and Community Health Network (ACHN) experience.
• CountyCare membership below expectations, attributed to time-consuming redetermination process.  CountyCare seeks to grow membership in the coming months through marketing fairs and telephone contact.
• Dr. Shannon suggested CCHHS has more managers than needed, with an assessment due in coming months.  Time to hire averages 110 days, with 839 current vacancies.
• CCHHS is owed $20m in accrual from State of Illinois.  Loss of $22m in salaries/benefits due to 7.9% overtime. Explanation: expectations were that patient activity would lessen in 2016, so staff were accordingly reduced.
• The new plan to provide healthcare for uninsured Cook County residents earning up to twice the federal poverty level will be presented to the full county board in October.

​To Watch For:  With the resignations of Lewis Collens, Dr. Erika Marsh, and now Dr. Wayne Lerner, the CCHHS Board has lost expertise that has guided the board through the formative years of CountyCare and a challenging strategic planning process yielding a 3-year plan for the organization.  Can the new board members master the complicated workings of CCHHS and move the organization forward to achieve the aggressive goals laid out in the Strategic Plan?  Stay tuned. 

Observer - Linda Christianson                           Meeting Length - 3 hours

Cook County Health and Hospitals System Board Meeting -  July 29, 2016

Significant Actions Taken:
The Proposed 3 Year Strategic Plan was approved unanimously with commendations from board members for its

• attention to metrics
• safety net for patients
• best practices
• staff involvement. 

CEO Dr. Jay Shannon said the plan will allow HHS

• to transform into a modern health care system,
• to form partnerships with like-minded organizations
• to retain its focus on patient needs. 

Board Election/Changes:  The Board re-elected Hill Hammock as HHS Board Chairman and Jerry Butler as Vice-Chairman. Dr. Shannon commended outgoing board members Carmen Velasquez and Dorene Wiese for their dedication and leadership. 

Contract Awarded: Morrison Management Specialists were awarded a $13,900,000 contract to provide labor, supplies and software for food and nutritional services, replacing former contractor Sodexo.

Significant Topics Discussed:

• Stroger Hospital now ranks in the 37th percentile nationally in willingness of patients to recommend the hospital; 60% report satisfaction in moving through their visit; 56% report satisfaction with the phone access.
• Valence Health Systems, administrator for CountyCare, has been purchased and will be split into 2 businesses, selling the largest portion to Evelent for $145m.  Valence’s existing leadership will transfer to Evelent and stay in Chicago with no change to services provided to HHS.
• CountyCare membership 154,000 as of June, down from 160,000 in March.  $84.8m = profit plus what HHS pays itself, close to the 2015 figure. Membership is down partly due to inefficiency/challenges of call center: Valence staff inexperienced, are calling from Texas.  In-house call center at Oak Forest must try to conform to state Medicaid regulations and reach newly-insured Medicaid population who are confused about cards, may have no permanent address or phones that can only call out.
• As of June HHS was $49,254,000 over budget, which, combined with its $128,638,000 pension obligation, totals $177,892,000 net loss.  HHS has $5,069,215,000 in total liabilities.  It has 48 days’ cash on hand.  CountyCare’s revenue was budgeted at $26,284,000, but its actual revenue was $17,291,000 (revenue left in the system once other providers are paid.)  The shortfall is attributable to (1) reduced headcount and (2) reduced capture of available revenue when other providers are chosen.
• When Dr. Shannon was asked to comment on budget considerations for 2017, he cautioned that (1) there has been no significant pension reform by the state; (2) no significant growth in state revenue; (3) there will be union-negotiated 2.5% salary increase (resulting in increased pension obligation) and step increases; and (4) HHS will be on its own in generating revenue for capital improvements.  “We will not be able to cut our way out of budget challenges; we have to GROW.  We have to invest in things that allow us to grow.” 

Observer - Linda Christianson                                   Meeting Length: 2 hours, 40 minutes