New Federal Administration Raises Medicaid Reform Concerns at Cook County Hospital

Cook County Health (CCH) Board of Directors Meeting
November 22, 2024; 9 am   

Aaron Galeener, Chief Administrative Officer CountyCare, the County Health and Hospital System’s Medicaid managed care organization, responded to questions by Board Directors on how the incoming Trump  administration might affect the Hospital System.  Lots of concerns that the Hospital’s Medicaid block grants might be at risk noted Galeener.  CountyCare was founded utilizing a 1115 Medicaid waiver.  CFO Cassara added that CCH leadership would be conducting strategic discussions on possible impacts.  Governor Pritzker, Cook County Board President Preckwinkle and others will support CCH initiatives others commented.  Should CCH be concerned Director Robinson queried, with Galeener responding that they were hoping moderating influences would prevail.

Board Action: 

• Lyndon Taylor was re-elected unopposed as Chair of CCH Board by Directors.
• CC Commissioner William Lowry was elected unopposed as Vice Chair of CCH Board of Directors.
• Contract and Procurement items were all approved with: 

• Director Bhatt dissenting and voting “present” rather than “yes” on items 11 (Deloitte Consulting LLP: service-supply chain optimization consulting $598,095 extension of existing contract) and 20 (Deloitte Consulting LLP: service-human resources optimization, consulting and support services; $9,211,367 competitive bid RFP ).
• Likewise, Director Sorrell voted “present rather than yes for items 7 (Rush University Medical Center: service-clinical services agreement—no fiscal impact, extension of sole source contract) and 43 (Rush University Medical Center: service-renal biopsy studies, consults & conference moderation; $149,999, extension of contract--competitive bid RFP).  No discussion on reasons for dissent.
• Sept. 30, 2024 CCH Financials show $51,255,000 unfavorable variance to Budget for line item: supplies & pharmaceuticals.  This was attributed to increasing use of expensive biologic and genetic drugs, such as sickle-cell anemia gene treatment and others. 

Research and Grant Funding Discussion:

• Discussed the Life Science Department, newly established in 2024 to win research and other grants and contracts and manage them to increase a larger flow of extramural funds and expand the base of funders with the goal of supplementing revenue to CCH.

• Hektoen Institute has historically managed CCH’s grant solicitation and management.  Transition of Hektoen staff to permanent CCH positions is on-going with nearly 100 FTEs expected to transition by March 31,2025 at comparable salary & benefits.
• Directors posed numerous questions: 

• Institutional Review Board required to enroll human subjects— who will manage IRB, obtain informed consent, process research grant specimens? Answer: The program that sponsors the grant will manage IRB .  Clinical trial lab specimens will be processed at CCH.  
• Will participants recruited for clinical studies reflect CCH population? What about patients not eligible for study enrollment?  
• Grant funders have asked serious questions about the capability of CCH to manage their research grants. 
• Hektoen charges an 11% management fee—can CCH really provide services at this financial break point?  Will we generate more revenue than currently using Hektoen?
• How will we retain clinical investigators at CCH to be competitive?
• Director Reiter, Acting Board Chair in the absence of Lyndon Taylor, tabled the topic for further discussions at subsequent meetings.

Items to Watch for in the Future:

• Hektoen transition of grant management to new CCH Life Sciences Department status in 2025.
• Potential changes to Medicaid and healthcare provision impacting CCH in 2025 under new USA administration. 

Observer - Susan Kern, MD


Cook County Health Human Resources Committee Meeting
 November 14, 2024

Dr. Mikaitis introduced the newly hired Chief of Human Resources, Mr. Win Buren who joined the System just three days before on November 11.  The interim Chief, Carrie Pramuk-Volk was thanked for her leadership during the position search.

Metrics October 30, 2024:

• 1700 vacancies – 1200 of which are currently in the HR hiring/replacement process
•   113 days on average to fill positions and a 64% offer acceptance rate
• 1060 total filled positions of which 725 were external hires

December 1 – October 31 metrics:

• 290 Nurse hires and 173 separations:  117 net new nurse additions
•   107 days on average to fill positions
•   173 Retirements
•   216 Resignations
•     56 Discharges

September Agency Hires:  1,378                      October Agency Hires:  1,224

Recruitment Process Improvements: 40% reduction in positions not posted within 14 days of approval
Decision to Hire packets not completed within 14 days of submission also showed a 40% reduction.

Provident Scholarships:
2022    31 scholars $348,000 awarded           
2023    60 scholars $900,000 awarded
2024    91 scholars $1.3million awarded 

Observer - Diane Edmundson