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Cook County Health Board Meeting

4/29/2024

Cook County Health (CCH) Board of Directors Meeting
April 26, 2024
Attendance: Lyndon Taylor, Dennis Deer, Jay Bhatt, Robert Currie, Raul Garza, Joseph Harrington, Robert Reiter, Sam Robinson, and Tanya Sorrell. Absent: Mia Webster Cross

Public Testimony: There were 6 written statements submitted that focused on inequity in pay scale for RN’s working in public health and concern that recruiting and hiring of RN’s has not been effective and increased work loads of Health System staff nurses. One nurse spoke at the meeting focusing on these related concerns.
Finance Committee: Approved a new contract funded by the Cook County Equity Fund at $1,050,000 00 for CCDPH to advance policy and systems changes that support the work of the Suburban Cook County Worker Protection Program. Several other large contracts were approved to provide staffing services.

Action items:

Report from Interim Chief Executive Officer
- HR Report: Continue with 3 vendors working with Human Resources:
  - Slalom contract ends July 24 main focus was creating dashboards, modernized on line presences and access to real time recruitment and digital job description library.
    - Director asked question what was the cost total cost per hire over 2023. Interim Director will get back with the answer.
    - Discussion focused by Commissioners that the vacancy of 1700 is almost the same as FY22 and questions around what progress we have made in light of the dollars spent on consultants.
  - Deloitte contract ends April 24 (pending) helped modernize orientation plan for new employees, pipeline learning development and benchmarked jobs identified as not competitive. A transition plan has been created.
    - Discussion: HR now creating an RFP for building on work Deloitte started over this last year and half. Still don’t have HR staffing to follow up with work done by Deloitte.
  - Cross Country contract ends Jan 2025. Helped hire fair support, modernized recruiting and piloting accelerated hiring process.
Report on Robotic Surgery Launch: March 8th first robotic surgery done at Stroger and now total 48 cases completed.
The Audit and Compliance Committee minutes were approved which included the approval of the 2024 CountyCare Compliance Plan, the CountyCare Fraud, Waste, and Abuse Plan, and the Internal Audit Charter
Report from Cook County Department of Public Health on their tobacco prevention program and associated social media outreach. This program is funded through State dollars and has established a tobacco free coalition.

Observer: Susan Avila

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Cook County Health (CCH) Board Committee Meetings

4/29/2024

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CCH Quality and Patient Safety Committee
April 19, 2024

The Operation Excellence (OpEx) workgroups from Stroger, Provident and Ambulatory and Community Health Network (ACHN) provided updates. At Stroger, progress is being made on both lowering central line and catheter infections and decreasing Pulmonary Embolism and Deep Vein Thrombosis occurrences. Provident Hospital has also shown improvement in their goals. Sepsis occurrence has decreased and hand hygiene has improved.
The Stroger OpEx readmissions workgroup reported lowering the readmission rate for Congestive Heart Failure and Chronic Obstructive Pulmonary Disease patients. Since these diagnoses are common, they were chosen to start this goal. The work will also be extended to less common but high readmission rate diagnoses.
The various factors identified as problematic were presented along with changes made to ameliorate them. The Ambulatory services (ACHN) have explored how to get patients’ blood pressure under control. It was found that there were inconsistencies in how blood pressure readings were determined. The standard for ACHN is to take the reading 3 times and average it. The procedure is to make sure the patient is comfortable and positioned properly. It was found that newer staff in the specialty clinics were not aware of the procedure and have now been trained. They also developed an algorithm that allows the nursing staff to change doses.
Both hospitals are due for the Joint Commission on Accreditation of HealthCare Organizations (JCAHO) surveys later this year and are preparing. Mock surveys were done in January. There were very few comments from committee members and no closed session. Items to Watch for in the Future: JCAHO preparation.

Observer: Lisa Slankard

Managed Care Committee
April 19, 2024

Metrics - 442,652 total members [well above budget projections]. 13,849 ACHN Members [5.4%]
It continues to be the leading Managed Medicare Plan in CC with 32.3%. BC/SH is next with 27.6% market share. The CountyCare staff received kudos for its 80% Redetermination rate and its marketing and outreach efforts including billboards along the expressways.
CountyCare Access (health benefits for immigrant adults and seniors) - Effective January 1, 1013, Immigrant Medicaid members residing in CC have been auto-assigned to CountyCare except for those with a family member in another plan. To date, a total of 34,679 have been enrolled. 79% are in the adult category [vs seniors].
Healthy Choice Illinois RFP - The RFP by the State has been delayed for a year. The new expiration date for the State’s approval of CountyCare is December 2026, and a new contract would start January 1, 2027.
Quality and Equity Choice Campaign - Primary care engagement strategies will focus on adults 18-24. Equity efforts will start with smoking cessation via education and prevention. Other efforts center around the food care project, the flexible housing pool with a goal to provide permanent housing and wrap around services to 58 participants. Clinical Services will focus on accomplishments particularly with behavioral health participants.

Observer: Diane Edmundson

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Cook County Health Board Meetings

3/29/2024

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Cook County Health Board Of Directors Meeting
March 22, 2024

Public testimony

Michelle Gutierrez, Pres. California Nurses Assn, rep for CCH Nurses. 1200 nurses are owed back compensation, covering many years. Nurses worked overtime and extra shifts, supporting CCH through the pandemic and ongoing due to staffing shortages. The CCHHS Board approved the payments in Oct 2023, but none have been made. Delays occur in Human Resources, Finance and Payroll. These “retro” payments are owed since Oct 2023 and “justice delayed is justice denied”.

Board and Committee Reports

Minutes of the Board and each committee were accepted and approved. However, non-emergency medical transportation at an increased cost, not to exceed, $12 million, provoked Dr. Harrington to ask for customer survey data.

Report from Interim CEO, Erik Mikaitis, MD.

Dr. Mikaitis reviewed the description of measles and emphasized the contagion risk of two hours for this airborne virus. CCDPH is support partner at the new arrival shelters. Vaccination rates for all new arrivals are very low. All vaccinations are by appointment only but will examine and vaccinate walk-ins. Added availability of vaccination for measles to Covid Hotline. 1 case suspected in CCDPH jurisdiction. 50 doses of MMR (measles, mumps, rubella) vaccination allotted for each Affordable Care Health Network clinic. Thru February 2024 there were 60 measles cases reported for the US against 58 in all of 2023. In Illinois 17 cases were reported 15 of those in Chicago
$44 million in grants to be awarded for Behavioral Health. Proposals accepted until 17Apr2024, 5pm. Source of funds was not identified.
First robotic surgery was performed at Stroger in March 2024, and Stroger is now a Certified Stroke Center providing 25/7 care. It must also provide tele stroke and be able to deliver vagus nerve stimulation. The goal is to achieve certification as a COMPREHENSIVE Stroke Center. However, half of the staff neurologists left in last 12 months which limits ability to complete expansion of stroke services such as home infusion. More funds and more doctors are needed to complete goals.

Employment Plan Officer, Semi-Annual Report. Kimberly Craft

The Employment Plan (EP) is a manual containing structured processes for hiring and other employment actions applied system-wide. It prohibits discrimination, contains proactive and requires transparent processes and requires collective bargaining agreements to be honored.
The Employment Plan Office which is part of HR added 2 positions and is now staffed at 4. Investigations were behind, but are catching up: Carryover 78 (closed 46, new 4, pending 46).
Board member concerns: When asked if this evaluation system was automated, the response: loading & sharing is automated. However automated in this context means that the information is online. All review is a manual process. Policy updates are pending

Managed Care, Aaron Galeener

CountyCare enrollment is 32% of overall managed care enrollment 426,395/1,319,686 through Dec2023. Lower enrollment over 2022 is following all of managed care; main cause is redetermination.
Actual enrollment in 2024 is 20-30% ahead of budget projections
Call volume Dec-41,586; Jan-54,936; Feb-53,682
2024 acute admits much lower than 2023
Percentage of claims paid in 30 days is returning to pre-pandemic levels

Human Resources Committee, Carrie Pramuk-Volk.

Positions filled: 70% of offers made is 281 YTD, (57 net new hires); Overall time to fill 195 positions was 126 days.
Accelerated nurse hiring during Aug2023-Feb2024 411 offers: 231 accepted (56%), 30 pending, 150 declined.
completed an examination of the duration of the hiring timeline for one role: 85 days on average, 167 of external hire and 64 for internal against a goal of 45 days.

Quality & Patient Safety Committee Meeting
March 7, 2024

OpEx dashboard expanded to include monthly scores As requested by the committee last meeting, the new rolling dashboard now includes monthly data. Last month Chair Bhatt requested that future updates include information on the actions being taken and timeline for improvement. This was referenced this month but actions being taken and timelines were not presented.
For Stroger hospital, with the exception of the readmission rate of the same hospital the data did not show much improvement.
For Provident, patient experience improved but clinical outcomes (hand hygiene and "left without being seen" rate are trending in the wrong direction)

Observer: Victoria Cerinich

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CCH Board Finance Committee Meeting

3/8/2024

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Cook County Health Board of Directors
Finance Committee Meeting
March 7, 2024

Attendance: Chair Robert Reiter, Directors: Joseph Harrington and Sam A Robinson. Not present: Director Deer.

Link to all documents/slides presented: https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/

Public Testimony: There was none

IV Items Under Chief Procurement Officer
Action Items:

Contracts and Procurement (All Approved)
- #1 Population Health Surveillance Program: Grant Funded project $856,000.00 from the Cook County Health Dept: Requested: Cook County Department of Public Health
  - The funding will be used to develop a comprehensive evaluation design that will evaluate impact, usage, process and overall impact of the Cook County Health Atlas which is housed at UIC School of Public Health.
    - For background information on this program: This link with Dr Hasbrouck explains the usages of the Atlas https://youtu.be/IzcyW2duuDg
- #2 Beyond Green Sustainable Food Partners: Grant Funded project $230,000.00 Requested: Cook County Dept of Public Health
  - Audit and provide technical assistance to the 3 purchasing departments (CCH, Sheriff’s office, and Cook County Juvenile Temporary Detention Center). The vendor will build capacity and coach staff who are directly involved in food purchase and prepare food at these 3 sites. This grant supports implementation outlined in GOOD FOOD PURCHASING POLICY (18-1650 _5/16/18)
#5 Kaizen Health Inc: Increase contract to a total for 2 years for $12 million covering FY24 and FY25. (Previous amount was $11,400,000.00 for total of 36 months from 7/1/23 to 6/30/25.). This service provides transportation for patients.
- Rationale: There has been a surge in their shuttle and ride service of about 4,000 to 5,000/month due to addition of New Arrivals and increase in County Care patients.
Report of Emergency Purchases
- As temporary stop gap CCH emergency purchase of Hematology/Oncology services for the Dept of Medicine for $1,137,800.00.

Items under Chief Financial Officer

Transfer of Funds: Transferred 13,479,000.00 from the Nursing Registry FY24 Budget to Professional FY24 Budget for services after termination of Hektoen Institute contract.

Observer - Sue Avila

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CCH Board of Directors Meeting

3/6/2024

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Cook County Health Board of Directors Meeting
February 23, 2024

Before the public testimony and the remaining agenda items, the Board recognized:

a successful first Forum on Behavioral Health – over 700 participants from more than 300 organizations participated on 15Feb2024;
2024 Press Ganey Horizon Award for High Reliability;
Other awards received by – Diabetes & Endocrinology, Corrections team;
four doctors are on the Chicago Magazine Top Docs list;
five members recognized by Commitment to Excellence
Civic Leadership Academy award to Gina Massuda Barnett, Deputy Dir, Public Health Programs.

Oral testimony: Karen Rush, DuPage County Resident, in-person
Request Cook County HHS to recognize that the frequent flooding of parking lots and homes is a health hazard. Asks that CCHHS examine the land owned by Cook County and if it contributes to the flooding that Cook County improve land management to mitigate the flooding. Submitted written information & photos.
Public Speaker had technical difficulties. (Recording is not available as of 28Feb2024)

Item IV. Board and Committee Reports.

Minutes of the Board and each committee were accepted and approved.
Donna Miller, Cook County Commissioner 6th District, reported that since the last CCHHS Board meeting, a resolution supporting doula and social services support services aimed at improving maternal health outcomes was proposed by Cook County to the National Association of Counties was unanimously approved for presentation to all NACO members.
The Quality and Patient Safety Committee has reorganized their meeting agenda to put Action Items earlier in appearance to provide more time for discussion.

Link to Slides on Managed Care Metrics.
https://cookcountyhealth.org/wp-content/uploads/Item-IVD-Managed-Care-Metrics-02-23-24.pdf
Board Member concerns:

Fewer CountyCare Managed Care (MCO) members over 2023: Board member asks for way to acknowledge MCO members who return to or renew with CountyCare. (Loss of members due to resumption of redetermination: member must rejoin or pick new MCO annually fall when they validate their eligibility.) Reduced enrolment in CountyCare has a negative effect on income.
CountyCare members who do stay or return to CountyCare tend to need more acute care. Outreach to existing and new members is focusing on a broad spectrum of profiles.

VI. Recommendations, Discussion/Information Items

Quarterly report from the Cook County Dept of Public Health.

Lowest childhood vaccination coverage in 10 years.
As low as 10% in some jurisdictions.
Three exemptions identified: medical, religious and philosophical. Presenter said that Illinois permitted all three types of exemptions. (This Observer researched and Illinois Public Health only recognizes medical and religious.)
Illinois and Cook County are at risk for cluster outbreaks; measles cluster outbreak is possible.
CCHHS expanded the public education spend to $310K in 2023 and will continue the spending trend. Media includes Face Book, Instagram and Snapchat, broadcast media (purchased and invited as subject matter expert source), bus ads on PACE routes, print (community media in English and Spanish, Lawndale Citizen, local vaccination clinics.
HPV is included in marketing but this is a smaller, targeted group
https://cookcountyhealth.org/wp-content/uploads/Item-VIA-Q1-CCDPH-Report-02-23-24.pdf

Board member concerns:

Causes for very low rates 55% or less in some school districts.
Asked staff to use “Boost Up” metrics to report on potential correlation between data and vaccine rates.
Schools must request visits by public health nurses (PH RN). Presently, only 24 PH RNs on staff.
PH RN role and trajectory is different than traditional clinical RN, but must have changed over time.
1. Focus is on case management of lead poisoning, premature infant care and expanding vaccination rates.
2. Will need more PH RNs if asked to expand roles.
COVID clinic visits can engage persons who need other vaccines, but capacity/time is limited.
Outside contracted RNs provide home health visits and can give vaccines.
Board members suggested connecting with other MCO’s which also have financial incentives to maintain healthy members and vaccinations are a tool.

Item VII. Resolution/Recognition and Board Member testimony on contributions of Director Otis L. Story, who is leaving the CCHHS Board. Mr. Story was directly appointed by Pres. Preckwinkle.

VIII. Interim CEO Report

https://cookcountyhealth.org/wp-content/uploads/Item-VIII-CEO-Report-02-23-24.pdf
Nursing Update.
https://cookcountyhealth.org/wp-content/uploads/Item-VIIIB-Nursing-Update-02-23-24.pdf
1. First ever CCH Nursing School Summit: 50 Participants.
2. Contract Labor decline from total of $12.7M for 2022 down to $7.5M for 2023.
  1. Board wants these savings to be used to meet long term goals for patients & staff.
  2. 17% of Nurses are expected to retire in next three years.
  3. FTE needed = 2179, filled =1282, Vacancies = 896 (41%)
  4. Six Nursing Workforce Strategies
    1. Innovative Staffing Models
    2. Mentorship/Professional Development Program
    3. Focus on Self Care & Personal Development
    4. System & Workflow Redesign
    5. Virtual Nursing – Research & Evidence Based Practice
    6. Transformational Leadership

ITEMS TO WATCH FOR THE FUTURE

1. Qualification for Magnet Award in Nursing excellence in 2024. Will use a consultant for next steps toward Magnet Award.
Strategic Deployment goals were consolidated from 250 to 60 and finally 27. These 27 were further grouped into seven pillars;
1. Patient Safety, Clinical Excellence & Quality
2. Health Equity, Community Health & Integration
3. Workforce: Talent & Teams
4. Human Experience: Employee Wellness and Engagement; Patient Satisfaction
5. Fiscal Resilience
6. Optimization, Systemization & Performance Improvement
7. Growth, Innovation and Transformation

Virtual Observer - Victoria L Cerinich

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CCH Finance Committee Meeting

3/6/2024

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Cook County Health Board of Directors
Finance Committee Meeting
Feb 15, 2024

Attendance: Chair Robert Reiter, Directors: Joseph Harrington and Sam A Robinson. Not present: Director Story and Director Deer.
Link to all documents presented: https://cookcountyhealth.org/about/board-of-directors/board-committee-meetings-agendas-minutes/
Public Testimony

Several members of the registered nurses’ union (NNOC) testified that they have not received retro check for work done during the COVID epidemic which was promised in Nov 2023.

Items under Chief Procurement Officer Charles Jones

Cook County Department of Public Health
- Grant Funded contract continue to provide staffing for call center for unhoused prevention for suburban Cook County
- Grant Funded for lead risk assessments for CCDPH’s Lead Hazard remediation program. Dr Hasbrouck in response to question from one of the Director’s regarding cost of remediation, the rough estimate of cost of remediation/home is around $40,000 to $50,000.
Report of Emergency Purchases
- Contract with Alivio: Provides bilingual patient community facilitators: Extended contract from 5/23 to 4/24 Not to exceed increase: $317,886
- Favorite Health Care Staffing: Contract for new arrivals staffing clinical services: Extended to 4/24 Not to Exceed Increase: $682,135.97
Revenue Cycle Transformation Plan
- Reviewed status of Revenue plan transformation: Has added ability to bill/collect through vendor with international ability. Has contract with Salud and Meduit to work with patients on payment plans.
Contract Vaya for nursing registry service
- Question from Director Reiter: time to hire for RN’s is estimated now around 71 days. Human resources will report figures at next finance meeting.
- Extensive discussion with the Directors regarding what is the recruiting points for RN’s coming to the Health System around raw salary vs salary and benefits and professional goals.
- Registry usage from 9/23 to 12/23 reported FTE’s showed little variance.

Observer - Susan Avila

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