Employee Awards and Covid Strategies Focus of Cook County Health CEO Rocha Board Report

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