Cook County Health Board of Directors Meeting
November 19, 2021

CCH Board President, Lyndon Taylor, announced that the board will no longer hear reports from the various committee meetings.  Instead, if a committee has held a meeting since the last Board meeting, the committee chair will highlight important issues and ask if there are questions.  If a committee has not met, it will make a presentation to the board members.  All committee minutes will be voted on at one time. 
 
CEO Rocha reported that moving forward, divisional updates will be provided to ensure that the CCH Board of Directors “has a deeper understanding of operational successes, opportunities and challenges.”   Areas to be covered include:
 
. Stroger Hospital                                                                            . Correctional Health
. Provident Hospital                                                                       . Public Health
. Ambulatory Care                                                                           . Cook County Health Plan Services
                            Administrative [regulatory, legislative, strategic initiatives, etc.]
 
Rocha also stated that his monthly reports will include strategic highlights and that 95% of the System’s employees are fully vaccinated and 98% have had at least 1 dose.
 
Human Resources

• Turnover of 10% to date is higher than normal, particularly in nursing.  Covid a factor
• 1,035 positions are open
• Average time to fill a vacancy is 105 days
• Contract staff still needed to support the HR team – it is also needed to fill nursing and other vacancies
• Although a new effort, job fairs are helping to identify candidates – finding qualified nurses is critical

 
Managed Care

• County Care has proposed a Medicaid/Medicare Plan to capture Medicaid patients who will soon turn 65 and be eligible for Medicare.  This will require investment and increased cost as the System will need to increase its capacity to serve geriatric patients including pharmacy needs
• The Cook County Budget was amended to include $30 million to establish reserves

 
Finance Committee

• On accrual basis as of September 30, System shows a $42 M positive variance.  On a cash basis $97 M. 
• County Care membership 410,000 as of Sept. 30, 2021 with an operational gain of $9 M.  Both revenues and expenses are higher due to membership growth.
•  2021 savings from contract re-negotiations:  Goal $16.5 M    To date: $12.2

 
Public Health

• Every 5 years Illinois state law requires certified local health departments to complete an assessment of community health needs.  Cook County calls theirs “We Plan 2025”.  Dr. Joshi presented the Cook County Department of Public Health’s Plan which was very thorough.  Director Koetting cautioned that there can be a risk of getting outside of the control of the Public Health Department – he said to be realistic vs theoretical on how people actually “get access to health care needs”

 
Note:  All of these reports can be found on www.cookcountyhealth.org
Observer:  Diane Edmundson

Cook County Health Board of Directors Meeting
September 24, 2021​

Meeting Highlights:

Human Resources Committee
Separations are outpacing hires.  There was a net of 91 fewer employees this past quarter. Resignations lead the separations. There is an 8% turnover rate, up 7% over the 3rd quarter last year.  Unfortunately HR is understaffed so hiring has slowed and average time to fill positions is up.  The market is very competitive right now.

Managed Care Committee
Membership numbers continue to increase and are up 10% over prior year. September 18, 2020 there were 371,248 members and September 9, 2021 there were 411,664 members. County Care’s market share increased to 10.7%, a slight increase from 10.5% a year earlier.  The membership numbers are over budget in part due to paused redetermination.  The call center and encounter rates have worsened. Claim’s payments have improved.

Quality and Patient Services Committee
Quality metrics are mostly unchanged except HbA1C indicator which is down to 66.7% (lower is better) toward a goal of 24% in outpatients.  At the start of the year it hovered near 90%.

Finance Committee
The agenda item receiving the most engagement from the board involved the 32 million dollar contract request for MHN ACO LLC. There is a contract already in place but an extra 32 million dollars is needed to be paid to finish off the contract which expires at the end of December 2021. This provider covers care coordination for County Care subscribers. The increase is primarily due to the increase in subscribers.  There was a lot of discussion on getting bids for this contract.  County Care has not started the bid process even though the contract only has 3 months left.  The board was concerned that the time left was inadequate and they offered help in getting this done. CEO Rocha will work with the managed care committee on a timeline for a request for proposal for next year's contract.  It was pointed out that the current company is a high performance vendor.
There was a transfer of 14 million dollars from salaries to Registry help and Human Resources.

CEO Report
All employees must be vaccinated by October 1. So far 83% are fully vaccinated with 92% having started the vaccine series. The hospital is making vaccinations available around the clock and are holding town halls to answer questions. Also, they are working with the unions. The gap on vaccination rates by race has decreased

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues 
• Managed Care costs and contracts

Observed by:     Lisa Slankard                          Meeting Length:     2 ¾ hrs

Cook County Health, (CCH) Board of Directors Meeting
August 27, 2021

A Special Meeting of the Finance Committee of the CCH Board was held on 8-23-2021, Public Hearings were held August 23 and 24 and individual budget briefings with community partners including the League of Women Voters of Cook County, were convened to deliberate the proposed preliminary County Hospital System’s budget for fiscal year ending in 2022

County Health Board of Directors voted to adopt this proposed budget which will now be forwarded to the Cook County Board, representing the Unit of Government responsible for adopting any final Appropriations Bill.  Cook County Public Hearings on the County Health System’s proposed budget will be scheduled on a date not yet determined  in October/November 2021.

Proposed 2022 budget Highlights:

• Nearly 4 billion dollars ($3,889,000,000) an increase of $501 million dollars over last year
• 758  additional Full Time Employees for total of 7,560 FTEs
• Increased revenue assumptions include: 1) Enhanced utilization of CCH services by CountyCare members 2) Increased volume of surgical cases and procedures 3 )Increased Federal Medical Assistance payments (DSH/BIPA) 4)newly eligible for IL. State Medicaid ,undocumented population 55 years and older (IL Legislation 2021/2022, state funded; no federal funding)                    
• Board members requested regular updates on volumes and revenue for surgical cases, emergency, primary care and specialty care visits, deliveries and bed utilization census: projected increases  in most of these categories are cited in the 2022 budget 
• Cook County taxpayer Support of Cook County Health included in proposed 2022 budget is $137,700,000
• Additional Cook County taxpayer Support of Cook County Health not included in 2022 budget - Pension cost of $162,900,000; Debt Service $136,400,000; and Capital Equipment $9,000,000

Items to Watch for in the Future:  Cook County Board hearings on this Cook County Health System budget in October 2021.  Will there be amendments or significant changes to the proposed budget approved by the Cook County Health Board ?

Virtual Meeting Observer:  Susan Kern, MD             Meeting Length: 2 ½ hours

Cook County Health (CCH)  Special Board Meeting
August 9, 2021
Preliminary Presentation of 2022 CCH Budget

Highlights of the Presentation

• Cook County Health’s preliminary $3.9 billion budget for the 2022 fiscal year factors in an expected boost in surgical procedures and Medicaid managed care plan enrollment. Spending will increase by $501 million.
• The assumption is that next year will look more like the patient volumes experienced in 2019, but CEO Israel Rocha warns it will take years for Cook County to fully recover from the COVID-19 pandemic.
• Compared with fiscal 2021, the proposed 2022 budget would increase spending by $501M, or nearly 15 percent. The bulk of the growth is related to CountyCare, the health system’s Medicaid managed care plan, which is growing faster than expected with about 410,000 members.
• Cook County Health covers Stroger and Provident hospitals, a network of neighborhood clinics, Medicaid and its new Medicare Advantage health plans, the County’s Department of Public Health, and medical services for detainees at the Cook County Department of Corrections.
• The health system is set to get a tax allocation of $137.7 million from the county. While the majority of the funds would be used to cover public health and correctional health operations, about $8 million would go toward providing free care to low-income patients, according to Andrea Gibson, Interim Chief Business Officer. The health system previously has not received money from the county to cover charity care expenses.
• Ms. Gibson noted that charity care costs are expected to increase 6 percent to $384 million in fiscal 2022.  This does include bad debt, which is billed but not recovered. Costs associated with charity care declined during the pandemic as more people became eligible for Medicaid and others avoided medical care. 
• The preliminary budget also includes investments in neurology, cardiology and oncology to help grow the health system’s patient base. Currently, one of the reasons that CCH loses patients to other specialty care providers is its long wait times. 
• Full-time equivalent (FTE) employment is expected to rise by 780 FTEs or 11% to 7,583 FTEs. New positions in behavioral health and other areas aim to improve services and reduce patient wait times. Plus a “float pool” of employees will be put in place for FMLA coverage and to reduce the use of agency nurses.

Observer:  Diane Edmundson 

Cook County Health (CCH) Board of Directors Meeting    
June 25, 2021
All board members were in attendance.  It was Director Mary Driscoll’s last meeting and she was lauded.

Highlight of the Meeting:

• Cook County Health has received a $25,214,437 federal grant. It will be a two-year project  (June 1, 2021 – May 31, 2023) The focus will be on priority communities and populations, with an expectation that this funding will impact 100% of jurisdiction through systems change.

There was no public testimony received at this meeting.

What did the Board decide?

• Approved 12 month purchase of reinsurance for CountyCare Health plan not to exceed $1,559,000.00. Since the inception of CountyCare, Cook County Health (CCH) has purchased reinsurance to offset the risk of its high-cost members. Claims costs incurred in excess of a per member threshold amount within a calendar year are reimbursed to CCH. Coverage is priced on a PMPM basis for Medicaid and Medicare by population type (e.g. FHP, SPD, ACA Adults, MA, SNP).
• The CCH policy is issued under a County-wide insurance brokerage contract with Alliant Insurance Services, managed by the County’s Office of Risk Management. CCH recommends entering a stop-loss policy coverage for twelve months, through December 31, 2021. Based on the bids submitted, and pricing and risk analysis, the recommended policy would establish a threshold for reinsurance at $2,750,000 for Medicaid and $300,000 for Medicare.
• Approved transfer of funds from salaries to contract position.  This was not connected to the strikes but due to delay in FEMA funds.

Committee Reports:
Human Resources Committee:

• Very little change in vaccination rates from last month. The union is working to encourage members to get vaccinated and VP Kamala Harris visited the CFL. 
• There have been 2 strikes this past month.  Both nursing and SEIU struck because of overdue contracts and staffing shortages.  There has been a significant increase in resignations this year
• New Chief Human Resources officer is Valerie Amos
• New Chief Revenue Officer is Curtis Haley

Finance Committee:

• Discussion on y-t-d financials, accrual vs cash methods.  Positive variance using accrual but negative variance using cash method

Quality and Patient Safety Committee:

• Elevated 30 day readmission rate with sepsis overtaking Congestive Heart Failure (CHF) as top diagnoses.

Items to Watch for in the Future:

• Vaccination rates among employees
• Staffing issues regarding strikes and open positions due to increase in resignations

Observed by:     Lisa Slankard                               Meeting Length:     2 ¾ hrs  

Cook County Health Board of Directors Meeting
May 28, 2001

Covid Vaccine Update:
Director Gugenheim was surprised at the Low 63% Employee COVID Vaccination Rate. Director Gugenheim further asked whether the Cook County Health System was working with their “Labor Partners” to increase employee vaccination.   Yes, but vaccination is voluntary and vaccine hesitancy has been an issue, staff replied.  

• Employee vaccination by race/ethnicity as of 4-30-21 reported as: Black/African-American 49.4%; Hispanic/Latino 67.6%; White 76.1%; Asian 81.7%.
• Vaccination by Job Category:  Nursing 63%; Doctors 85%; Administrative/Clerical, Non-clinical Leadership, Pharmacy and Public Health 100%
• Vaccination by Union & Non-Union:  Non-Union 76%; Union 61%

30 minutes of Public Comments addressed to the Board by employees and groups of employees largely centered on ongoing Labor Union negotiations.  Assertions included: lack of leadership by Administration & managers, unwillingness of Administration to negotiate on salaries and work rules, understaffing, and untrained Agency temporary nurses.  Strike threat was voiced by one speaker.

​Board Reports:

• CountyCare managed health plan: 20% increase in members over last 12 months-- total 398,534 exceeds budget and unexpected higher capitation rate awarded by State Medicaid yielded a small net operating profit.
• System wide financials, net loss of $21,802,000 is a result of increased claims cost but is less than budgeted loss of $32,551,000. 
• Compassionate Care initiative introduced in the Hospital System Ambulatory Clinics to address low (56% in hospital rankings) “Likelihood to Recommend” on Hospital System patient surveys. There are 3 Key Drivers impacting the ranking:  1) Courtesy of Registration Staff  2) Sensitivity to patient’s needs       3) Concern for Patient’s privacy
• Cook County Public Health Department’s Dr. Joshi reported on the Opioid epidemic: significant incremental increase in opioid-related deaths in Cook County 1,121 in 2018; 1,227 in 2019; 1,771 in 2020.   Chicago & CC Suburbs all showed increases.  Deaths due to Fentanyl far exceed those from heroin or prescription pain relievers.

Items to watch for in the future:

• Board attendance by new Board Directors, selection of Board Chair, selection of new Chief Financial Officer & new CEO of CountyCare.

Observed by: Susan Kern, MD                                               Meeting Length:  3 hours