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New Director Appointed to Cook County Health Board

2/15/2019

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Cook County Health Board of Directors Meeting - January 25, 2019

Items of Note from Reports to Board

At the January 24, 2019 Cook County Board meeting, Commissioners approved the appointment of Michael Koetting to the Cook County Health Board of Directors. Mr. Koetting is a healthcare and strategic planning consultant as well as an adjunct member of UIC's faculty. From 2010-2015 he served as Deputy Director for Planning and Reform Implementation for the Illinois Department of Healthcare and Family Services.
Managed Care: Total CountyCare members as of January 7, 2019 is 326,026 of whom 45,446 are served by Cook County Health clinics (13.9%).
The Arlington Heights Health Center opened January 14, 2019. This new 35,000 sq ft center has 24 exam rooms, six dental suites, WIC nutritional services, mammography, behavioral health services and on-site lab. The comprehensive patient care team includes bilingual Spanish speaking staff members.
Through January 3, 2019, Cook County Health's (CCH) Fresh Truck partnership with the Greater Chicago Food Depository has resulted in 152 visits to 12 CCH health centers. Collectively, theFresh Truck distributions have totaled more than 420,000 pounds of fresh produce delivered to individuals, most of whom are food insecure. Access to better nutrition can lead to better health outcomes.
February is Heart Health Month and the American Heart Association's Go Red for Women. CCH and CountyCare sponsored several programs to increase women's heart health awareness.
Governor Pritzker named Theresa Eagleson as new Director of the IL Dept of Healthcare and Family Services. This agency oversees the state's Medicaid Managed Care programs and child support services.
Recently approved state rules lowered blood lead levels to 5 micrograms/deciliter. This rule change will allow children to be identified as having lead exposure when their blood lead levels are at or above 5 micrograms/deciliter. This earlier detection of lead exposure is important as it will result in more children receiving public health intervention.

Post Meeting Review Report submitted by Michele Niccolai

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Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

1/6/2019

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Cook County Health (CCH) Board of Directors Meeting - December 21, 2018

What did the Board Discuss?:

Commissioner Deer, 2nd District, has a background in health care. After being appointed to replace retired Commission Jerry Butler as Chair of the Cook County Board Health Care Committee, he was then appointed to the Cook County Health Board and assumes the role of Vice-Chair. Newly elected Cook County Commissioner Donna Miller (6th District), also in attendance at the meeting was introduced to the Board by Chairman Hammock. She expressed her long-held interest in the health care services provided in and by Cook County. Commissioner Deer noted that he will be advocating for more minority contract opportunities.
CountyCare, the county's managed care health plan, is aggressively marketing its benefits to current and potentially new customers during this year’s Medicaid open enrollment period due to close the end of January 2019. Current membership stands at 333,704 against a 2019 target of 345,000. Of particular note - two out of every three CountyCare members do not use Stroger, Provident, or Cook County ambulatory clinics as their primary provider. CCH is aggressively working to change this metric.
The interim Human Resources (HR) Director implemented a new technology and outreach plan in an effort to achieve its goal of a 90 day hiring cycle (current average is 96.4 days). In 2018, 15 new bilingual hires were added to the work force with another 10 in the pipeline, and 30 more job titles with bilingual ability as a minimum requirement are under review to establish new job codes. In addition to adding bilingual staff and working to improve cleanliness perceptions, CCH is focusing on decreasing waiting times and improving phone access. A revised performance management policy [employee evaluation] is to be rolled out early in 2019 with on-line performance management to follow.
The Finance report through the first eleven months showed no new surprises. The CFO noted that CountyCare has contributed $184.5 million to date to the Revenues. He also noted that while Cermac Health Services, the correctional system health operation, has seen fewer patients, those seen require more resources. The top three referrals are oral care, ear, nose, and throat, and visits to the hand clinic.
The Quality and Patient Care Committee noted that the willingness to recommend Stroger to others has increased but statistics were not cited. Each Tuesday the in-charge coordinator for cultural improvement is going on rounds throughout the hospital and asking two questions: 1) What are your concerns? and 2) How can we help? One other item pulled from committee metrics is that at any given time, about 80 surgical residents are working in the County hospitals.
Board member Gonzalez asked Dr. Mason, CC Public Health Director, for a geographic mapping for HIV, Hepatitis C, and all sexually transmitted disease cases. This request followed a slide presentation mapping the “suburbanization of poverty” areas in Cook County. Dr. Mason added that the mortality rate for African American mothers is 3 times that of Caucasian mothers, and he said that the number of African Americans living in Chicago has dropped by 15% while the number of Hispanics in Cook County has risen by 20%.
Dr. Shannon recognized the retirement of the highly esteemed IT Director, and she gave a brief presentation to the board including what the future in IT holds for the System: artificial intelligence, predictive analysis, and prescription analytics. Dr. Shannon also noted that the newly implemented Kiosk check-in is being well received.

Items to Watch For in the Future
Ongoing:

Director Lowery asked for a comparison of the System’s nursing openings to other like institutions across the country.
Board Chair, Hill Hammock, asked for feedback on what percentage of claims are never collected because of coding, timeliness, and/or processing issues.
Chair, Hill Hammock asked for a detailed dive into pension costs, projections, and percentage of takeover from the County by the Cook Health System.
A Board decision on CountyCare’s proposal to stop paying providers who treat CountyCare patients when the patients’ visit is outside their assigned network of providers.

New

The Fiscal Year ended on November 30. Watch for final revenue/expense variances, and metric results vs targets (e.g., hiring cycle and higher revenue specialties such as surgeries and maternal deliveries).
The new Vista Clinic in Arlington Heights with preventive and specialty care services such as dental and behavioral health delayed its opening to January 14, 2019 with the grand opening to follow sometime soon. A similar model clinic in Riverside is scheduled to open by mid-year. Look for details on the openings as tours will also be scheduled for those interested.
2020-2022 Strategic Plan presentations and discussions will likely get under way in earnest at the January Board Meeting and go on through the May meeting.

Observer - Diane Edmundson Meeting Length: 2 ½ Hours

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Cook County Health Board Undertakes Strategic Planning

12/8/2018

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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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New Director Appointed to Cook County Health Board

Cook County Board Commissioner Dennis Deer Joins Cook County Health Board and Assumes Role of Vice-Chair

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

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