Cook County Health (CCH) Board Meeting - October 26, 2018                                            


What did the Board diiscuss:

• As part of its goal to attract patients to The Cook County Health and Hospitals System, CEO, Jay Shannon, announced a name change to “Cook County Health” and the ribbon cutting for the new Fantus Clinic & Professional Building for Monday, October 29.   He also announced that the new “model” Arlington Heights Ambulatory Clinic will open sometime in December with preventive and specialty care services such as dental and behavioral health.   A similar model clinic will open early in 2019 in Riverside.
• The County Health’s insurance plan called, “County Care” is aggressively marketing its benefits to current and potentially new customers as the open enrollment period for Medicaid patients is from October 2018 to February 2019.   See the LWVCC October 18, 2018 Managed Care Eyewitness Report for more details.  As a reminder, County Care is the largest Managed Care Medicaid Provider in Cook County followed by Blue Cross Blue Shield.   
• Cook County Health continues to decrease the hiring cycle – from 203 days in 2014 to 95 days in 2017 and 2018.  The interim HR Director acknowledged that even more needs to be done and has implemented a new technology and outreach plan to achieve its goal of 90 days.  Overall vacancies stand at 725 of which 244 are nursing positions.  Filled positions stands at 575, separations through the 3rd quarter are 367 including 161 retirees.  Turnover 6%. 
• Dedicated efforts including new hires and a change in contractors has resulted in an improvement in the cleanliness of the hospital environment.  Guiding principles in 2018 and going forward include improving the patient experience, patient safety and satisfaction, and the health system’s reputation.  A recent in-house inspection found no cleanliness issues.  Changing patient perceptions will take longer, and the System continues to educate and train its workforce on the importance of patient experience to the success of the system.  In addition to cleanliness perceptions, CCH is focusing on waiting times and phone access.  
• The Finance report through the first eight months showed no new surprises.  Revenue is 33% higher than budgeted due to the influx of new Managed Care Patients from Health Network and Aetna.  However, revenue is offset by the expenses incurred to service these new members.  The System serves the highest number of Charity Care patients [by visit] at 42%.  The next highest is Northwestern Hospital at 7% and Mt. Sinai at 4%.  The YTD net loss is almost $17 million above budget or $98.8 million against a budgeted loss of $72 million.  
• noted that the System has been successful in getting the State Legislature to lift the “moral or philosophical objection clause” for health care workers.  Workers will now or soon be required to take the Flu Shot.  
• He also mentioned the $8 billion Federal package to address the Opioid epidemic in the US is a good first step but the problem will not be effectively addressed by grants alone.  Federal laws are needed.
• CEO Shannon gave a brief overview of the 2020-2022 Strategic Planning and a recap of the 2017-2019 Plan. To see the Strategic Plan update report delivered by CEO Shannon go to this link.

Items to Watch For in the Future

• Director Lowery asked for a comparison of the System’s nursing openings to other like institutions across the country.
• Board Chair, Hil Hammock, asked for feedback on what percentage of claims are never collected because of coding, timeliness, and/or processing issues.  
• Chair, Hil Hammock asked for a detailed dive into pension costs, projections, and percentage of takeover from the County by the Cook Health System.
• In the context of the 2020-2022 Strategic Plan, CEO, Jay Shannon, mentioned that that System will be evaluating “incentive based” motivation for management to hit targets.
• A Board decision on County Care’s proposal to stop paying providers who treat County Care patients when the patients’ visit is outside their assigned network of providers.

Observers - Diane Edmundson & Sarah Edwards                          Meeting Length:  2 ½ Hours 

Cook County Health & Hospitals System
CountyCare Managed Care Committee Meeting - October 18, 2018 

What was Discussed: 

• CountyCare holds largest share of Cook County Medicaid managed care market, ahead of Blue Cross Blue Shield, with 335,484 enrollees as of August 2018.
• CountyCare has launched a series of social media marketing strategies to promote enrollment for 2019, including two YouTube videos with over 400,000 views combined within the last month
• New campaign slogan designed to appeal to working enrollees: “You don’t have time for a sick day”
• CountyCare enrollment goal for 2019 is 345,000; CountyCare saw a small drop in their Affordable Care Act enrollment in 2018
• Primary care providers in Cook County agreed to send out a total of 130,000 letters to potential enrollees supporting CountyCare as the best managed care option for their patients
• Patients with CountyCare can now get LASIK eye surgery and qualify for a monthly package of diapers if children are fully vaccinated 

How is CountyCare doing?

• State of Illinois is behind on making payments to CountyCare. Because of this delay, CountyCare is paying only around 50% of their claims to medical providers within 30 days of submission
• CountyCare saw a decrease in completed patient care plans for members in July after absorbing Aetna plan patients. Care plans are vital for managing high-risk patients
• As of now, 30% of visits to primary care do not occur with assigned primary care provider within the Ambulatory and Community Health Network clinics (these numbers are similar to other provider groups within the CountyCare network). CountyCare plans to stop paying providers who treat patients who have a different primary care provider

What else did the Board discuss:

• The board discussed sending out a patient survey to determine why some patients seek care outside of their assigned primary care provider

Items to Watch For in the Future

• New member enrollment into CountyCare plan and how well the plan holds onto current members for 2019
• The impact of the new marketing campaign on 2019 enrollment
• An explanation for why 30% of primary care visits do not occur with assigned primary care provider within the Ambulatory and Community Health Network clinics

Observer: Sarah Edwards                                                     Meeting Length:    One Hour 

Cook County Health and Hospitals System (CCHHS) Board Meeting - August 31, 2018  

What did the Board Discuss:

In discussion of the proposed CCHHS budget, CEO Dr. Jay Shannon identified these key focus areas:

• Improvement in behavioral health;
• Long overdue equipment and facility improvements;
• Improvement in the system’s financial position;
• System’s continuance as the state’s largest managed care organization;
• Continuing to reduce reliance on local taxpayers while taking on pension costs. 

The budget anticipates:

• $182.2m in CountyCare revenue;
• $132m BIPA and $157m DSH (federal flow-through payments); 
• $494m in patient fees due in part to a 5-6% increase in surgeries, ER visits, primary care visits, specialty care,and an 11% increase in deliveries. 

Other assumptions:

• Uncompensated care will total $292m in charity care and $213m in bad debt, unchanged from 2018. 
• Full Time Employees (FTEs) will total 7,138. 
• Insured patients will account for 61%, while 39% of patients will be uninsured.. 
• A move of out patient services from the Oak Forest campus by the end of the first quarter of 2019 to better-located facilities in the south suburbs. 
• The Cook County local tax allocation is projected at $102m, 3% of the system’s operating revenue.

With the approval of the CCHHS Board the budget is now slated for review and approval by the Cook County Board on September 12.

Committee Reports:

• Human Resources: currently 870 vacancies; 94 days to hire, down from 203 in 2014; 424 vacancies filled so far in 2018.  New employment policies allow CEO to make final determination of salary and of discipline policy.
• Managed Care: total CountyCare members 335,000 of whom 53,555 are served by CCHHS clinics (16%).  The 2019 budget anticipates an enrollment increase to 345,000.  CountyCare is already the state’s largest managed care organization, with the fewest complaints.
• Quality and Patient Safety: 70% of patients would recommend Stroger Hospital; 63% of surgeries start on time; 84% rated ACHN clinics as clean.
• Finance: 34 days of cash on hand (goal is 60); overtime totals 7.6%; the physical plant is 24.4 years old (goal is 10.7).  Bills spend 97 days in Accounts Receivable, down from 125 in 12/17.  22% of initial claims are denied.

To Watch For: Dr. Shannon announced that the ribbon-cutting for the new clinic/admin building will take place October 29.

Observer - Linda Christianson                                              Meeting Length:  3 hours

Cook County Health and Hospitals System (CCHHS) Annual Board Meeting
June 29, 2018

The CCHHS Board requested that Human Resources properly designate positions with a unique job code if the job requires bi-lingual skills. These positions would be more highly compensated due to the requirement for these skills. It is felt that filling these positions appropriately would increase the cultural competency of staff along with ensuring proper care for patients. It was indicated that a bi-lingual worker would be especially helpful in working with many Out Patients. The Board also requested that Human Resources review the process for exit interviews with Department heads’ as there is currently a lack of helpful information being received.

Other Committee Actions or Discussions:

• Managed Care Committee-Increase of membership from 331,000 to 338,326. Board wanted a breakdown of the membership and the number of people who would be aging out of Medicaid.
• Quality and Patient Safety Committee-Discussed the 2018 proposed plan. Board talked about their concern about maternal deaths and the reasons behind them along with how to increase the number of woman who chose to give birth within the system.
• Audit/Compliance Committee-Fraud/waste/abuse have maintained from last year. New contract requires there to be one investigator per 100,000 members so with our 338,000 plus members, we will need 4 investigators. The issue of revenue recovery will continue to be a major issue for the system and the results from the systems in place and those being put into place will be closely monitored. Board Chairman Hill Hammock and CEO Jay Shannon presented these revenue recovery strategies to Cook County Board at a hearing on June 5.

Other Data Presented to the Board:
As part of the Cook County Department of Public Health 3rd quarter report, an update was given on current TB Prevention efforts. It has been found that those most affected with the disease live in the suburbs and 70% are foreign born and have been living in the United States for 5 or more years. The city of Des Plaines in the Northwest suburbs is the most infected area. There has been no direct correlation between TB and Poverty Rates.The current treatment is provided by nurses as part of a program called Directly Observed Therapy (DOT}. This program provides for a new treatment that takes 12 weeks instead of the old method that averaged 6 months. Each patient is assigned to a nurse who assumes responsibility for ensuring each of their patients takes their medication. This means these nurses are driving around the county doing DOT on a daily basis. 

Observers - Bill Edmundson and Jackie Buttafuoco                     Meeting Length: 3 hours