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Cook County Health Continues to Have Funding Challenges

10/25/2019

Cook County Health (CCH) Board of Directors Meeting
October 25, 2019

Board Discussion:
CEO Dr. Jay Shannon summarized recent Cook County Health (CCH) positive developments:

The IL Health Facilities Board has approved the application for a new Provident Hospital;
The National Committee for Quality Assurance (NCQA) has given CountyCare high approval ratings;
The US Congress passed a continuing resolution through November 21, to continue the current $157m in “Disadvantaged Share Hospital” (DSH) funding to CCH, though, he cautioned, this agreement must be monitored.

But CCH faces serious funding challenges: it is $30m over budget in charity care despite $25m in new revenue this year. In 2020 CCH anticipates providing $590m in uncompensated care, for which the only designated funding sources are the federal DSH ($157m) and BIPA ($132m) allocations. The demand for charity care has grown by $100m since 2017. CCH is now providing about 60% of all charity care in Cook County. Of Stroger Hospital’s total patients, 47% are on Medicaid, 15% Medicare, 5% insured, and 35% uninsured. The possible solutions to the funding gap do not inspire hope: more state and federal funding, possibly County funding from a sales tax.

Committee Reports:

Human Resources: Of 757 vacancies filled, 541 were external; average 101 days to hire.
Managed Care: 320,177 CountyCare members as of 10/6/19, 31% of the total 1,012,425 managed care members in IL. 83% of CountyCare members choose to re-enroll in the program. Since January 2018 managed care enrollment has diminished by 180,000. An estimated 200,000 IL residents are eligible for Medicaid, but have not submitted applications. 96% of CountyCare claims are adjudicated within 30 days, but only 32% are paid within 30 days.
Quality and Patient Safety: 72% of patients are now willing to recommend the Stroger Hospital. The hospital’s readmission rate is currently 9.7%, vs. a 15% national average.
Finance: operating revenue is 23% below budget for 2019; the state is 2 months behind in payments. Primary care visits are up by 10%, specialty care up 6%, Emergency Room visits down 2%, deliveries up 5%.

Significant contract awards:

Cerner Corporation for software support - $191m for 5 years, $38.2m per year
Medline Industries for medical and surgical supplies - $70m for 36 months;
Paschen Ashlaur Joint Venture to construct Belmont-Cragin Health Center - $12m.

Observed by: Linda Christianson Meeting Length: 3 hours

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Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

10/4/2019

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Cook County Health (CCH) Board of Directors Meeting
September 27, 2019

What did the Board Decide:

Cook County Health (CCH), CEO Shannon explained that underestimation of external claims from non-CCH Network providers of the Managed Medicaid/CountyCare program exceeded the total appropriated dollars. Payment of these bills necessitates transfer of funds from other CCH budgeted items still showing a positive balance. Over $80M was transferred form special Purpose and Wage Funds to cover the claims.

The Board voted to purchase a renovated Blue Island building replacing the closing Oak Forest Clinic for $15.3 million, a savings over a 10 year $17.3 million lease.

Located at 12757 S. Western Ave. servicing the same population as Oak Forest Clinic/hospital, it will be a multi-disciplinary clinic including radiology, lab, specialty and primary care services.
Several Board Directors expressed concerns over the lack of parking and access as the nearby L station is slated to be shuttered. Administration pointed out that “L” station closing would open up their parking lot, and an adjacent building might be purchased for parking.

What else did the Board discuss or refer to committee?

New vendor using “Big Data” and algorithms identified $1.9 million in overpayments which CCH hopes to recoup.
Cultural Competency course & training program for CCH staff in development. Leadership are contributing components. Director Gugenheim urged that all levels of the organization be involved in its creation.
Dr. Mason, CEO of Cook County Dept. of Public Health reported adoption of the Good Food Purchasing Program (GFPP) by Chicago Public Schools; soon to extend to the County Sheriff’s Office and Juvenile Detention Center. It is a national organization and movement to bring ecologically positive changes to food sourcing including: 1) locally grown food 2) animal welfare and nutrition 3) environmental sustainability such as compostable cutlery and plates
Public Speaker, Laurie Cohen, of the Chicago Civic Federation called for greater transparency in presentation of CCH's finances. She alluded to the Board’s Sept. Finance Com. discussion & PowerPoint which states : CountyCare-CCH reimbursement rate has been adjusted to 100% of the Medicaid rate for current fiscal year. There was no explanation of how this impacted the system or budget.

CEO Shannon responded at the end of the meeting: Medicaid rate education would be considered. This response does not seem to address Ms. Cohen’s concerns that the consequences of various financial metric variations are not elaborated on to the public.

Observed by: Susan Kern, MD and Megan Kennedy Meeting Length: 2 hours and 45 minutes

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Cook County Health Board Approves Preliminary 2020 Budget

9/20/2019

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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

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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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CountyCare Enrollment Declines by 33,000 in 2019

4/28/2019

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Cook County Health (CCH) Board Meeting - April 26, 2019

CountyCare - Managed Care Organization Update

Medicaid enrollment in CountyCare, Cook County's managed care organization, has declined by 33,000 from January-March of 2019. And statewide, since its April 2018 peak at 2,298,000, membership in Illinois' managed care organizations (MCOs) has declined by 205,890, most of them “Affordable Care Act” patients, older adults without children. The consequence of this decline for CCH is that the number of uncompensated emergency and primary care visits will increase.
CountyCare currently has 31.5% of market share, a total of 316,973 members, but Meridian (Wellcare) and Illinicare (Centene) will soon merge to become Cook County’s largest MCO with 33% of market share.
CEO Shannon praised new healthcare leadership in Springfield, including former CCH Deputy CEO Doug Elwell who now oversees the state of IL Medicaid program.
Dr. Shannon will visit Washington DC this summer to negotiate Medicaid and DSH (Disproportionate Share Hospitals) payments, hopefully to offset threatened funding cutbacks.

What did the Board discuss?

Personnel status - 7,265 positions, 1,265 vacancies, 2.8% turnover, 103 days to fill a position
A $33.6 million budget shortfall for 3 months ending in February 2019, less than the $43 million projected, due in part to lower-than-expected pension costs. CCH has 21 days’ cash on hand.
45% of patients are uninsured, 5% have commercial insurance; almost all others are covered by Medicare (15%) or Medicaid (33%).
Primary care visits are up 4%, specialty care up 3%, surgical care down 2%, ER visits down 3%. 65% of Stroger patients would recommend the hospital.

Items to Watch for in the Future

Many accolades went to Marketing/Communications Director Caryn Stancik after her presentation showing the consistent growth in the department’s activities to raise awareness of the value of CCH and alerting staff to the upcoming MAKING AN IMPACT campaign highlighting CCH accomplishments.

Other Comments or Observations

Dr. Terry Mason, Director of the Cook County Department of Public Health, alerted the board to a Countywide increase in sexually transmitted infections (STIs), due, he said, to the large number of phone apps that can lead to anonymous sex.

Observer - Linda Christianson Meeting Length: 3 hours

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Cook County Health Continues to Have Funding Challenges

Cook County Health Board Transfers Millions from Special Purpose and Wage Funds to Cover External Provider Claims

Cook County Health Board Approves Preliminary 2020 Budget

Cook County Health Approves Preliminary 2020 Strategic Plan

Cook County Health Nearing Completion of 2020-22 Strategic Plan

CountyCare Enrollment Declines by 33,000 in 2019

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