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

Cook County Health and Hospitals System Board Meeting - April 27, 2018

What did the Board Decide?

• Board president asked the Finance Committee to do a “deep dive” on significant revenue and expense deviations – and in particular – claims, payments, increase in charity care numbers, and overtime issues.  Director Robert Reiter is the new Finance Chair replacing departed Ric Estrada.  
  
• Approved contract for new space to consolidate the County’s Public Health Operations.  Will be located on Roosevelt Road in Hillside.
  
• Accepted the resignation of Director Virginia Bishop for health reasons.  The Cook County Health & Hospital Committee of the Cook County Board of Commissioners will be asked to convene and recommend replacement nominations.

What did the Board Discuss?

• Behavioral Outpatient Services.  A behavioral staff member asked the board to bring this department back to Stroger.  It was moved to Austin Clinic and Provident Hospital when the old Fantus Clinic was torn down.  Dr. Shannon responded that most of the need is on the south and west sides which is where services are offered in addition to Telephone Psychiatry services.  It is not scheduled to return to the new clinic or Stroger.  However, all 15 ambulatory clinics have services. Director Richardson asked for metrics and continued feedback at future board and committee meetings.  
  
• While no discussion ensued, the Board was told that the System anticipates a “final” Shakman review from the Department of Justice regarding the Cermac Jail Health Facility.
  
• A report was given on the Districts Behavior Health progress since the Evidence-Based Strategies were initiated three years ago.  The report is yet to be posted with the board agenda nor were the April 27 board minutes available as of May 7, 2018.  In 2017,  over 53,000 patients were screened for baseline mental health evaluation, treatment options, referral locations, and follow up.
  
• The Public Health Department presented a quick overview of its quarterly report.  Highlights include their focus on high risk infants, screening newborns for hearing, and a reporting system for adverse birth outcomes - the Adverse Pregnancy Outcomes Reporting System [APORS]. 

Observer - Diane Edmundson