Cook County Health and Hospitals System Board - June 24, 2016

Significant Topic Discussed:
Strategic Plan Update:

• A final draft of the Strategic Plan overview will be available for public comment on July 15 and is 
• slated for adoption at the regular Board meeting on July 29.  
• A 2017 budget, expected in late August, will be derived from the Plan.
• Directors expressed different views on the limits of the population that CCHHS should serve, ranging from “access to all” to “not encouraging persons from outside Cook County to come and receive care at the expense of the Cook County taxpayers, except emergencies under the Emergency Medical Treatment and Labor Act (EMTALA)”.
  

The Board discussed a preliminary draft of the plan, not available to observers, which centered on key Goals and Focus Areas.  
Goals:

1. Improve health care equity
2. Provide high quality, safe and reliable care
3. Demonstrate value and adopt performance benchmarking
4. Develop human capital
5. Lead medical education and clinical investigation

Focus Areas:

1. ​Increasing competitiveness with other hospitals
2. Expanding coverage to jail detainees via state policy changes
3. ​Fostering fiscal stewardship by maximizing reimbursement through provider capturing all possible disease codes
4. Incentivizing physicians to practice efficiently and more cost-effectively
5. Hiring the best employees and holding the medical leadership accountable for resident/medical student training that promotes a quality educational experience
6. Evaluating clinical effectiveness using relevant analytics and benchmarking
7. Advocating for patients that are marginalized, uninsured or justice-involve 

Other Topics Discussed:

• Quality Metrics for both Stroger and Provident Hospital: OR start time, willingness to recommend, continue to show no improvement this month with cleanliness, long wait times and poor staff communication most frequently cited by patients.
  
• Board voted to negotiate and execute an Agreement between CCHHS, Duke University Clinical Research Institute and Harvard Pilgrim Health Care Institute which would allow Cook County to join a national network of patient centered research clinical trials.  In furtherance of the Strategic Plan Goal to lead clinical investigation, this new agreement aligns with the partnering of CCHHS earlier this year with all major academic medical centers in the Chicago region, and the VA.  Initial projects are to evaluate patients who had asthma, sickle cell anemia and recurrent intestinal infection with Clostridium difficile.

Observer -  Susan Kern, MD     Meeting Length - 3 hours 15 minutes

Cook County Health and Hospitals System Board Meeting - May 27, 2016

Strategic Plan Update:
Using input received through Cook County Health and Hospitals System (CCHHS) staff interviews, Richard Sewell, Associate Dean for Community Health Practice at UIC’s School of Public Health, presented an external, internal, and situation analysis of the CCHHS system that identified features of the system’s current state,as well as assumptions, strengths, challenges, and opportunities concerning its future.  Sewell will release the preliminary strategic plan for board review on June 17, after which the board will have two meetings (including the scheduled board meeting on June 24) to select about five key priorities along with cost associated with each priority, then approve the draft plan before it is released for discussion and input at a series of public meetings.  Once the three-year plan receives final approval at the CCHHS board meeting on July 29, it will serve as the basis for the 2017 budget negotiations to follow, as well as a guide for the budgets of the two subsequent years.

Significant Topics Discussed:

• Board transitions.  Two board members, Lewis Collens and Dr. Erika Marsh, have resigned.  The terms of Mary Richardson Lowry, Carmen Velasquez, and Dorene Wiese will expire on June 30.  The nominating committee has met, and decisions on new members are anticipated in the next two months.
• Due to a “labor hold”, only 99 vacancies have been filled this year, leaving 635 open positions.  At this time last year 448 positions had been filled.  Time to hire: 102 days.
• CCHHS has 66 days of cash on hand, with 100 days as a goal.  Charles Jones, chief of Supply Chain Management, explained the five sole source contracts. Sodexo American was awarded a contract for $8,300,000 to provide food and nutrition services. 
• Terry Mason, Chief Operating Officer, Cook County Department of Public Health, illustrated in a power point presentation the effect of the 1934-68 practice of “redlining”, defining which neighborhoods could receive mortgages.  The practice resulted in still-extant concentrations of poverty, where residents have fewer educational opportunities, shorter life expectancies, and poorer health outcomes.   Mason proposed support for pro-equity policies to equalize access to healthcare; training for staff in bias awareness; and stratifying quality metrics by race, ethnicity and primary language.  He also proposed an aggressive lead abatement program in affected neighborhoods that conforms to the CDC recommendation.

Observer - Linda Christianson                               Meeting Length: 3 hours

Cook County Health and Hospitals System Board
Special Meeting - May 5, 2016

Purpose of Meeting: An update for Cook County Health and Hospitals System (CCHHS) Board Members on how health policy and financial decisions in Springfield and in Washington DC may influence what happens within CCHHS in the next 3 years. Presenters were lobbyists who work with Illinois and Federal Government representatives and officials on Health Policy and County Government. This meeting is part of the planning process leading to the development of the CCHHS 3 year Strategic Plan to be approved in June. 

Significant Topics Discussed:

• Part of the Affordable Care Act (ACA) was the phase out of Medicaid Disproportionate Share (DSH) payments which have been a part of the CCHHS budget for many years - $162m in 2015. DSH payments in the past have been made to those hospitals serving a large number of uninsured and Medicaid patients but with the expansion of Medicaid as part of the ACA it was thought that these payments could be phased out within a few years. The phase out that was scheduled to begin in 2014 has been pushed back to 2018 and the presenters indicated that they did not think the cuts to DSH are going to happen any time soon. The money received in DSH is being monitored closely with ongoing audits and County had to have $362M in cost to justify their reimbursement of $162M in 2015.
• Another possible revenue stream that could be investigated is federal money that is allocated for health care of Native Americans. Director Wiese stated that most of that money goes to Indian Reservations but a large percentage of Native Americans no longer live on reservations and perhaps some of that money would be available for health care of persons in Cook County. 
• The Medicaid Managed Care Rule was released on 4/25/16. Outcome measures are a very important component of the ruling. Another component is the “whole person” concept of medical care - how is health care coordinated with other services such as substance abuse treatment, housing, mental health, social services, and nutrition. How can a Public Hospital change the way they deliver care to work with others to attain good outcomes and spend as little as possible? The challenge for CCHHS.
• Pertinent Statistics - 1 in 4 Illinois Residents is on Medicaid and 37% of the population of Cook County is at or below 200% of the Federal Poverty Level.

What to Watch for in the Future:
The Board will be developing the 3 year Strategic Plan in the next few months. They will be developing strategies with measurable goals to achieve the identified priorities that have already been determined.

Upcoming Meetings in the Strategic Plan process:

• May 16 and 17 from 6-7:30pm Town Hall Meetings - to gather input from the public
• May 23 from 4-7pm - Another Board Strategic Planning Session to develop Action Plan
• May 27 - 9am Board Meeting - more work on Action Plan
• June 24 - 9am Board Meeting - adopt Proposed Plan 
• A Public Hearing will be scheduled after adoption of Plan

All information on the Strategic Planning Process is available on the CCHHS Website.

Observer - Cynthia Schilsky                          Meeting Length: 3 hours
​

Cook County Health and Hospitals System Board Meeting - March 25, 2016
                       
Significant Topics Discussed:
Board Plans for Draft of Strategic Plan by Late May 
In the months ahead Cook County Health and Hospitals System (CCHHS) Board Members will:

• assess data
• identify initiatives
• determine resources
• establish goals
• and determine metrics for measuring success. 

The initial overview will be shared with the staff and community both online and in a series of town hall meetings to take place in late April or early May.  Board members are being asked to consider investments in ambulatory facilities, primary care, high tech equipment, clinical lines including partnerships, and, critically, the system’s ability to finance investments.

To further guide them in their strategic planning, the Board will receive presentations on:

• the Medicaid managed care environment
• nursing strategies
• current makeup of the medical staff
• upcoming changes in medical practice
• an overview of current staff makeup and possible changes
• graduate medical education now and going forward

Changes within the Cook County Health System to be considered by the board as they undertake the planning process will include the following. 
Since 2013

1. Inpatient days have decreased by 6%
2. Observation days (not admitted to hospital) have increased by 31%
3. Emergency Department use has declined by 12%
4. Trauma Center use has increased 20%
5. Total provider visits have declined by 7%, to about 42,000
6. Radiology use has increased by 36%
7. MRI use has increased by 27%
8. Surgeries have increased by 19%. 

In addition only about 900 babies were delivered at Stroger Hospital, compared with about 2,000 at Northwestern Hospital within the same time period.   And beginning on January 1, 2016, Medicaid payments to the CCHHS hospitals are based on patient diagnoses, determined by codes, rather than on per diem patient days.  The former fixed patient  “Encounter Rate”  fee is now, instead, dependent on the patient diagnosis.  The Board is being asked to consider these changes as they make recommendations for the system’s future.

Other Topics Discussed:

Stronger Hospital was granted a 3 year accreditation by the Joint Commission.
The Joint Commission evaluates and accredits nearly 21,000 health care organizations and programs in the U.S., requiring an on-site survey and quality evaluations in multiple categories every three years.

Current Metrics presented to the Board:

• COUNTYCARE enrollment is 16% lower than the predictions made last July
• 131 days required to hire new staff
• 25 days’ cash on hand
• 9 ½% overtime as a percentage of gross salaries.

CEO Dr. Jay Shannon  introduced a resolution honoring the recently-deceased Dr. Quentin Young, former Chair of Medicine at Cook County Hospital, Chair of Chicago Board of health, active civil rights worker, and strong advocate of social justice and universal access to healthcare.

Observer:  Linda Christianson                  Meeting Length: 2.5 hours

CCHHS Board of Directors Meeting - February 26, 2016

Significant Decisions:
A new unit for women and children in remodeled space at Stroger is planned to be open by the end of the year that will consolidate pediatric and maternity inpatient and outpatient services. This is an urgent response to retain patients.The Peds ER has already merged with the Main ER. Physicians and other Stroger staff were present as public speakers to oppose this plan because of their concern that quality would suffer. Administration said that there would be no staffing cuts of physicians or support staff with pediatric expertise.
 
Two sole source contracts were approved:

• A contract for $1,312,049 with Community Counseling Center of Chicago to provide behavioral health services connected to the early release program with mental health support in the criminal justice system. The intent is to decrease prison population of non-violent inmates with cost-savings.
• A contract signed with Favorite Healthcare Staffing Inc. for $1,028,760 to provide temporary contract services of Operating Room nurses and technicians. The intent is to improve operating room utilization and efficiency and to enhance revenue by cost savings.

Significant Topics Discussed:
Director Collins reported that CountyCare (Medicaid managed care) is failing to capture the business of its members who continue to use other Hospitals & Clinics in the network resulting in a $10m shortfall from budgeted income in Dec. 2015.  Corrective action plans include:

1. Primary care physician outreach - encouraging them to refer patients to CCHHS, explaining that the perception of long waiting lines for services and appointments is no longer a fact
2. Addressing lack of patient parking by relocating employee parking to a remote lot & providing shuttle service
3. Lack of cleanliness has been addressed by contracting with a a new cleaning service 

Dr. Shannon, CEO presented an overview of the new Strategic Plan for CCHHS that   the Board will be developing over the next 5-6 months. Board meetings will be devoted to creating the Strategic Plan, and committee reports will be curtailed.
The 5 principal objectives of the Strategic Plan:

1. Improve healthcare equity
2. High quality,safe,reliable care
3. Demonstrate value, use benchmarking
4. Develop human capital
5. Leader in medical education and clinical investigation.

​Items to Watch For:

• Strategic Plan posted to CCHHS website
• More labor unrest due to “change” and market-place pressures CCHHS must adapt to

Observation: 
The CCHHS Board, are dedicated, represented by a diverse background of experiences and in Chair Hammock, CEO Shannon and Deputy-CEO Elwell have strong, focused and business-orientated leadership. Net operating margin loss of 199 million for 2015 is less of a loss than in 2014 by 9 million.  Challenges include labor unrest, 30% uninsured patients, and stiff competition from other Hospital Groups. CCHHS will continue to require subsidies from Cook County to survive and budgetary deficits at the State level will be aggravated in 2017 when 5% of the cost of new Medicaid patients will revert from federal to State payments.

Observer: Susan Kern              Meeting Length: 3 hours