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Cook County Health Board Undertakes Strategic Planning

12/8/2018

Cook County Health Board of Directors Meeting - November 30, 2018

CountyCare Update:

Total CountyCare Medicaid managed members September 2018 is 335,126.
50,149 of CountyCare members are receiving their care in Cook County Health clinics.
Medicaid Open Enrollment has started. Open enrollment happens once a year when Medicaid members can change plans. Illinois Healthcare and Family Services began mailing out letters letting members know the date they can sign up for 2019 plans.
CountyCare is promoting itself during open enrollment as the largest Medicare managed care plan in Cook County by using texts/emails to members and providers; by sponsoring member events; by using social media, Facebook and You Tube; by using website information; and with ads on bus shelters, CTA, and banners.

Recent statistics show system-wide, Cook County Health provides 42% of charity care in Cook County. Illinois non-profit hospitals receive property tax exemptions based on the charity assistance given to their communities even though there is a wide definition of charity care and community benefits. The subject of Cook County non-profit hospitals providing charity care is an issue.

Subjects to be addressed in future countywide Cook County Health strategic planning:

locations of health care delivery systems
social determinants in life expectancy
population shifts
population demographics
suburbanization of poverty
elderly and disabled populations and their special needs
access to healthy food, food insecurity
areas of high unemployment rates as economics affect health and social conditions
suburban public transportation
Primary Care Physicians as key entry to Cook County Health specialists
if Cook County Health clinics have followed population shifts
competition with large non-profit health system

Observer - Michele Niccolai Meeting Length: 2 hours

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Cook County Health System Gets a New Name and Opens State of the Art Clinic Facility

10/31/2018

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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

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CountyCare Has Largest Share of Cook County Medicaid Managed Care Market

10/25/2018

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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

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Cook County Hospitals System Bottom-line May be Threatened by Decrease in Medicaid Enrollees and Federal Rule Changes for Immigrants

10/13/2018

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Cook County Health & Hospitals System (CCHHS) Board Meeting
September 28, 2018

Threats to 2019 CCHHS budget predictions presented by CCHHS Administration and Staff:

Illinois Healthcare & Family Services actuaries predict a decrease in Medicaid Affordable Care Act (ACA) enrollees in Illinois by 5% and a drop in the Medicaid FHP category in Cook County by 10% in the next year reported Hospital System CountyCare/Managed Care staff.
CEO Shannon added that the US Dept. of Health and Human Services is chipping away at the ACA provisions such as proposed imposition of work rules which may result in loss of Medicaid eligibility.
Further threats to the increased volume of patients on which the 2019 Hospital System proposed budget is predicated may be the proposed change in Federal Immigration rules. Federally funded programs including Food stamps, WIC, & other Public Aid, when accessed for the legal children of illegal immigrant parents, are considered to be benefiting the entire family. This may be considered a violation of the “public charge law” which will be held against the adults when applying for Green Card/Visa/ Citizenship.
CEO Shannon warned that immigrants might be fearful of accessing the Hospital System.
Nearly 80% of CCHHS patients are Medicaid (36%) or Uninsured/immigrants (42%)

What did the Board Decide?

Approved 73-million-dollar Sole Source contract (MHN ACO, LLC) for care coordination at Federally Qualified Health Clinics (FQHCs) covering approximately 117,000 of the 335,039 CountyCare members. This improves health and reduces cost of care.

What else did the Board discuss:

Heather Prendergast, MD introduced as a new CCHHS Board Director. She is an Emergency Room physician, in leadership positions, at U. of Illinois Hospital which has a similar patient demographics as CCHHS.
A Public Testimony speaker reported that limited patient/visitor parking due to the Central Campus Redevelopment construction may hinder patient use of the Hospital System. CEO Shannon responded that this would be addressed.
Shakman Decree (law to prevent political hiring) imposed by the Courts on Cook County decades ago is set to be lifted next month as compliance in hiring has been achieved at CCHHS.

Items to Watch For in the Future:

CC Board President, Preckwinkle to appoint County Commissioner representation on Hospital Board after Mid-term Elections when new CC Board is seated
Hospital System 2.97-billion-dollar Budget hearings at CC Board scheduled in October 2018
New Professional/Administration Tower to open for business in October, 2018

Meeting Length: 2 hours 30 minutes
Observers - Susan Kern, MD, Michele Niccolai, Sarah Edwards, & Ellen Hunt

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Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

9/6/2018

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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

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Cook County Health and Hospitals System Board Presented with FY2019 Budget Framework

8/17/2018

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

The FY 2019 Budget Framework for the Cook County Health and Hospitals System (CCHHS) was presented at the July 20th CCHHS Finance Committee meeting and then presented to the CCHHS Board on the 27th by Dr. Shannon, CEO and Doug Ewell, Deputy CEO for Finance and Strategy. Dr. Shannon indicated that the FY 2019 Budget drivers are as follows:

Improve the patient experience, reliability and safety culture
Create value and offset costs with higher clinical volumes
Sustain financial position
Sustain and grow CountyCare membership and improve use of CCHHS services by CountryCare membership

Mr. Elwell then discussed the 2019 Revenue drivers:

Modest increase in CountyCare membership
Increased capacity for surgery, dialysis and outpatient health center access
Billing and collection improvements
Greater use of CCHHS services by CountyCare members
Assumes level tax allocation from the County

And 2019 Expense drivers:

Expanding care coordination to improve care and achieve savings
Reducing environmental service contract expense, hiring personnel
Establishing mental health services at the Temporary Juvenile Detention Center.
Rising personnel costs
Projected increase in uncompensated care based on trends

The FY2019 CCHHS Budget will be presented to the CCHHS Board on August 24th for approval and then presented at a CCHHS Public Hearing on August 31st.

Other Data Presented to the Board:

331,548 CountyCare members as of June 1, of whom only 54,047 or 16% have a primary care provider with CCHHS
Overall system operating Revenue for the period ending May 2018 was 25% over budget. However, total operating expenses were 23% over budget leaving an increase in the operating loss of $18,360 over the projected loss.
There continues to be improvement in reducing hiring times and the filling of nursing positions has improved.
Surgical cases are up 5% and slightly above the FY2018 target
System wide uninsured numbers, captured by visit have held at 42%.

To Watch For:
At their meeting on September 12th, the Cook County Board should make the decision on the new CCHHS Directors.

Observers - Jackie Buttafuoco and Bill Edmundson Meeting Length: Two and a half hours

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Cook County Health Board Undertakes Strategic Planning

Cook County Health System Gets a New Name and Opens State of the Art Clinic Facility

CountyCare Has Largest Share of Cook County Medicaid Managed Care Market

Cook County Hospitals System Bottom-line May be Threatened by Decrease in Medicaid Enrollees and Federal Rule Changes for Immigrants

Cook County Hospital Board Approves Preliminary $2.9B FY2019 Budget

Cook County Health and Hospitals System Board Presented with FY2019 Budget Framework

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