Cook County Health Board Approves Preliminary 2020 Budget

Cook County Health Board Meetings
August 30 and September 13, 2019

Special Meeting - September 13

• With two abstentions, at a special meeting on September 13, 2019, the Board approved its 2020 preliminary budget for presentation to the County Board on September 26.  The abstentions were in support of more revenue from the County for the Health System.  CEO Shannon described it as “no doubt the most challenging budget” to prepare and meet since he became CEO in 2014.   The $2,966 billion budget includes cuts to headcount in the form of eliminating 400+ vacancies in ambulatory care clinics and up to another 200 vacant positions in other areas.  
• Investments made over the last four years, primarily funded by the revenue brought in from its County Care Insurance Program, include substantially increased behavioral health and drug addiction services; a broader care management approach focusing on preventive care and housing/food insecurity; transportation services; a County authorized Direct Access Insurance Program* for the uninsured; and investment in new facilities, equipment and technology.  This while absorbing a decrease in county funding from 25% in 2013 to 5% in 2020.
• Expense drivers include Uncompensated Care which has risen almost 88% from $314 million after the ACA was enacted in 2014 to a projected $590 million in 2020, employee compensation, overtime, and rising prescription and medical supplies.  Uncompensated Care includes charity care and bad debt.  Dr. Shannon stated there is “no question other providers are redirecting charity care to CCH” and that the system cannot cut its way [expenses] out of the increase cost of charity care.
• For more information on the preliminary 2020 budget CLICK HERE:  
  

* Direct Access is a subset of Charity Care and county residents qualify based on income.  About 50% of charity care costs is attributed to the Direct Access Program.

Committee Reports from August 30, 2019 Board Meeting:

• Human Resources: 7,200 total positions, 836 positions in process, 628 positions filled year to date.  Average days to hire 102.  Average vacancies per year 1100 to 1200.  
• Managed Care: CountyCare membership trending up to 318,676.  Cook County continues to have a 31.6% market share, which is the largest among the seven Managed Care Operations in the county.  However, when Meridian’s merger is completed at the end of 2019, it will pass CCH in market share.  While state approval time for Medicaid applications is improving, there is still a 100,000 backlog to get initial application and redetermination applications approved.  Illinois is looking at outside contracting for help in reducing the backlog.
• Finance:  The 2020 preliminary budget was pulled from the August 23 agenda to be further worked on and presented at the August 30 board meeting.  See above September 13 board meeting text, as presentations and discussion at the August 30 meeting were similar except there was no vote.  
  
• ​Requests:  Chairman Hammock asked for a longitudinal chart on monthly memberships in the Health System’s County Care Insurance Program.  He did not specify how far to go back.

Other information of note:

• The Deloitte forensic audit of the Health System’s County Care financials and the System’s overall method of accounting was completed, and on September 4, 2019, CEO Shannon submitted the Deloitte report and the Health Systems response to the highly critical Inspector General (IG) Report of June 26, 2019.  CCH Executive Management stood behind its initial public response that the IG got it wrong and provided a 15 page rebuttal.  It also claimed in public comments that the Deloitte report mainly agrees with CCH.  The County board will review both the Deloitte report and the Health System’s response at its September 26, 2019 meeting.  CCH Management will attend as likely will the Cook County Inspector General.
  

Observer - Diane Edmundson                            Meeting Length:  4 hours total