Cook County Board of Commissioners 
Health & Hospitals System Committee Meeting
March 16, 2021

Following two public comments urging that additional vaccination sites be set up in the western and southern suburbs, coincidentally, the presentations by both the Department of Emergency Management & Regional Security and the Department of Public Health (“DPH”) focused on the criteria that has been used in establishing County-sponsored vaccination sites in the suburbs and how this is changing.  Both Departments acknowledged the need to provide more vaccination opportunities in the southern and western suburbs and said that they expect, with the promised increase in vaccination doses, to be able to do so.

• Executive Director of Emergency Management William Barnes explained that the County started by looking at large sites in order to be able to get as many shots in arms as possible.  Convention Centers were looked to, such as the one in Tinley Park.  Began rethinking as heard from communities wanting their own sites, as well as the Federal and State governments now also wanting to be involved.
• Currently looking at large commercial sites, such as big box stores, which are located all over the County and are very flexible (can use large or small areas as required), have lots of parking, generally are easy to locate, and often accessible by public transportation (all key factors).
• But also looking at other alternatives:  know that while about 40% of people happy to go to large sites, the rest prefer smaller sites.
• CEO of Cook County Health Israel Rocha, Jr. said that currently there are more people wanting the vaccine than those needing more education about it.  He touted the number of contacts from residents to the vaccine web site, www.vaccine.cookcountyil.gov, and the vaccine hotline, 1-833-308-1988.
• Dr. Kran Joshi reported that 18% of suburban residents have received at least 1 vaccine shot and 9% have received 2. 
• A Mobile Vaccination Strategy is in place to help reach more places, with a pilot successfully conducted in Maywood recently.  More are scheduled.
• Dr. Rachel Rubin reported that the DPH finally has a significant workforce in place to do contact tracing.
• DPH presented its 1st quarter report (Item 21-0798) which focused on its grants of $5 million to 42 community organizations to help educate and vaccinate people and of $1 million to 5 worker centers to help reach temporary workers over the 6-month period from Dec. thru May.  With more funds coming, DPH expects to continue the efforts through the end of 2021.

DPH also told the Commissioners that it had received reaccreditation in Feb. for the next 5 years.

Priscilla Mims, Observer

Cook County Board of Commissioners - Committee Meetings  
December 16, 2020

Zoning and Building Committee:

• Commissioners Britton and K. Morrison have revised their proposed Tenant and Landlord Ordinance with input from the parties concerned.  This ordinance would give tenants in Cook County suburbs more protections from evictions, payments, and other tenant issues.  Several thousand comments were submitted to Board members, both in favor of and against the original ordinance.  Because this latest iteration of the ordinance was just completed and Board members and the public should have time to review it, the vote on this was delayed until the January Zoning and Building Committee meeting. The new (2nd) substitute ordinance (Agenda Item 20-3562) is over 21 pages long.  Meeting observers did not have access to the substitute during this meeting.

Rules Committee:

• Commissioners Deer and Moore proposed adding Juneteenth as a 14th paid holiday for all Cook County employees.  This ordinance (Agenda Item 20-3460) commemorates Black American freedom.  There was not a cost analysis presented that this observer could see.  All commissioners spoke in favor of the ordinance and it passed in this committee.
• An archive ordinance (Agenda Item 20-3950) will provide for all Cook County offices’ and departments’ historical records dating to 1876 to be formally archived. A Manager of Archives (hired from DuSable Museum) will coordinate this preservation of history of Cook County.

Finance Committee:

• An Ordinance (Agenda Item 20-4357) which included edits to the Independent Forecasting Commission Ordinance passed.  This will “better serve the purpose of this commission,” according to sponsor Comm. Anaya.  This commission analyzes new revenue streams proposed by Board members and the President.  There was no mention if this includes the Hospital System.

Health and Hospitals Committee:
The 3rd and 4th quarter reports were presented  by the Cook County Department of Public Health (CCDPH). 

• The 3rd quarter report addressed COVID cases, violations & mitigations, and inspections of businesses violating COVID “rules” such as indoor dining and congregate settings.  Over 200 locations have been cited and are listed on the CCDPH website.  Among the current rules are the following for Cook County:  no indoor dining, retail at 25% capacity, no sports events—games or spectators, restricted visitation at long term facilities.
• The 4th quarter report presentation covered flu/COVID combination concerns, vaccine distrust, challenges in vaccinating Cook County communities, logistics of vaccinating, and strategy. 

There were many questions and comments from commissioners.  Points brought up include the following: 

• Flu vaccination rate in Cook County is less than 50% (less in Black communities) and the CCDPH wants to use public service announcements to get higher rates of vaccination. 
• Challenges to vaccinating for COVID mentioned were myths surrounding the vaccine, distrust of vaccine, unclear support from the state, limited resources, and defining critical populations when the vaccine is limited.  The current strategy of vaccination for Cook County is health care workers are the first to be vaccinated; County is partnering with CVS, clinics, etc. to distribute the vaccine; tracking and monitoring who has gotten the vaccine will be done.  It will take 4-5 weeks to get hospital workers vaccinated.  Comm. Deer asked if there will be mandatory vaccinations for Cook County Health workers.  Answer will be sent later. Dr. Joshi stated that even after a person is vaccinated there will still be a necessity to mask as it is unclear if the virus can still be spread from that person.
• Both quarterly reports were voted on and passed. 

Legislation and Intergovernmental Relations Committee:

• An Ordinance (Agenda Item 20-4415) transferred special purpose funds to the County Clerk’s office due to the consolidation of the Clerk and Recorder of Deeds offices and cleared up references to the Recorder office (which no longer exists) .  Discussion centered on how many Recorder employees will be hired in Clerk’s office.  This issue of guaranteeing that employees would have jobs in the new consolidated office was decided by the CC States Attorney office—that the Board cannot interfere in these types of hiring decisions.  Comm. Johnson still desired that all the employees have guaranteed jobs—perhaps elsewhere in county government— in order to keep a job and health care. Forty-five have been retained so far.  There was a big discrepancy between what the SEIU (union representing those workers) and the Clerk’s office say regarding hires.  SEIU has brought a notice to strike in court.  This strike would be all SEIU employees in the County.  However, the court has enjoined that some essential workers are not allowed to strike. 

Follow Up Items: 

• Tenant/Landlord Ordinance (Agenda Item 20-3562) at January meeting
• Board of Review hearing in near future
• Hiring between Clerk’s office and now-defunct Recorder office
• COVID vaccination procedures and results

Observer:  Karin Hribar                                                   Meeting(s) length total: 5 1/2 hours

Cook County Board -  Health & Hospital Committee Meeting
February 26, 2020

Meeting Report 
The CC Health & Hospital Committee had two items on its agenda:

Agenda Item 20-1118 went through two substitute iterations with the final dated February 24, 2020 and contains major amendment changes to the 2008 Health and Hospitalts System Enabling Ordinance that established the independence of the Hospital System from the County President and Board and set up the mechanism for appointing an independent board.   The chair of the committee, Dennis Deer, was not in attendance nor were Commissioners Moore and Tobolski.  Commissioner Arroyo, Vice-Chair, ran the meeting. 

• All commissioners in attendance strongly supported the need for a viable and vibrant county public health care system and it was reflected in each of their remarks.
• Agenda Item 20-1118 was passed out of Committee with the only exception to a unanimous vote being Alma Anaya who voted "present".  Her comments are below as are selected other commissioners:
• Larry Suffredin:  Led off the discussion by stating that he strongly supports the amendments and considers them to allow for "re-balancing" of the relationship between the Cook County and System Boards as well as ensuring collaboration on executive hiring, financial, strategic planning, and labor relations issues.  He offered that the Cook County Board is the Health Board for the County; and he pointed to the large increase in uncompensated care; the two highly critical Inspector General reports; and the increased number of grievances and arbitration cases as reason for the need to re-balance.  
• Sean Morrison:  Stated he often communicated belief that the problem lies with the executive team.
• Bridget Gainer:  Stated that outward collaboration as well as between the Hospital and the CC Board is needed.
• John Daley:  Strongly supportive and stated that nearby U of I Hospital and Rush Hospital are both expanding their ambulatory centers and that the HHS System needs more help from them.
• Alma Anaya:  Stated she does not believe the amendments solves the root cause issues.  She advocates creating a process such as a task force to identify, dissect, and address the problems - particularly financial.  Wants to review and then change rather than "jumping the gun" with the proposed amendments. 

Agenda Item 20-1229 was deferred without discussion.  It would require top executive compensation and severance package approval by the President and County Board and because the matter is also covered in 20-1118, it may be withdrawn

Public testimony

• ​Dr. Lindsay Ray Murray, Health & Medicine Policy Research Group.  Stated that the System cannot cut its way out of its financial deficits.  Called for a blue ribbon commission from a cross-section of health care professionals and experts to thoroughly explore the issues and make recommendations before approving changes to the 2008 enabling ordinance.  H&M Policy Research Group is a member of the nominating committee that provides HHS board nominations to President Preckwinkle for her and the CC Board approval.
• Laurence Msall, Civic Federation.  His main objection is that 20-1118 gives the county board say over the selection and compensation of the CEO.  He said that he has heard of no explanation on how the proposed changes will correct the System’s financial problems. The Civic Federation is also a member on the nominating committee for HHS board nominations.
• Susan Avila, Collaborative Health Equity.  She is also on the H & M Policy Board and worked at Stroger for a number of years.  She stated that there was not enough information before the changes were proposed and is for a comprehensive analysis of the problems and at what works best (Best Practices approach).
• Mr. George Blakemore also spoke and is in favor of more County Board involvement.

Significant Amendment changes included in Agenda Item 20-1118

• The System Board will no longer have sole authority to hire the CEO, or interim CEO, or fix the compensation.  Henceforth, it will recommend, subject to the advice and consent of the Cook County Board and the President’s departments on development of its three-year strategic plan as well as its operational and policy strategy. 
• Requires the Hospital System Board to direct its CEO to collaborate with President Preckwinkle and her departments on development of the strategic plan as well as its operational and policy strategy.
• Increased HHS board membership from 11 to 12 – The twelfth member will be hired by and reports directly to President Preckwinkle and will serve the same 4-year term as the other directors.  This appointee and the CC Board appointee, currently Dennis Deer, cannot serve as chair of the HHS Board.
• Allows the System Board to recommend instead of fix compensation of employees and provides that the compensation must be in line with the county board’s budget appropriation.
• Gives more responsibility to the Cook County Human Relations Bureau in handling grievance issues.
• Provides that the HHS board shall meet 12 times a year.
• Specifically states that the Cook County Board does not delegate Home Rule Authority to the System board.​
  
• Sets a threshold for county approval for capital expenditures at above $150,000 with monthly reporting of such expenditures of $5,000 to $150,000.

Diane Edmundson - Observer

Cook County Board of Commissioners Health and Hospitals Committee
Public Hearing
September 26, 2019

This hearing was requested by the Cook County Board of Commissioners to note and understand discrepancies between the Inspector General (IG) Report and the  rebuttal of Cook County Health (CCH) and the firm—Deloitte—hired by CCH to analyze the Inspector General's Report.  The IG Report generally stated that CCH’s insurance program, County Care, was unsustainable and was being subsidized by Cook County taxpayers.  The IG report looked at ALL of the CCH finances, not just County Care.   CCH disputed this and hired Deloitte to analyze the IG report —mainly the viability of County Care—and report to the Cook County Board.  Deloitte did NOT do an audit as this was done previously by another division at the firm.  It also only looked at County Care and not all of CCH.

There was a lot of confusion by the Board on what was being stated by both the IG Office and Deloitte.  Mainly this was because of the Accounting Systems used by CCH and the various ways accounts receivable, payable, assets, etc. can be interpreted.  All parties are looking  at the financials and cash flow differently.  The main question of the Cook County Board was “Do we have any concerns about the stability and viability of CCH?”

Here are the basic findings as this Observer understood them:

Inspector General Report

• CCH is using other assets to pay claims in County Care, so the “hospital system is subsidizing the County Care Insurance program.” 
• There is between $501-$700 million in outstanding bills -—not paid or paid late. 
• Vendors are not supplying some necessary hospital, medical items because they are not being paid.
• Transparency of revenues and losses is an issue. 

Deloitte Analysis--

• Revenues from County Care (provided from governments state and county) have covered its expenses.
• CCH needs to make more timely payments to providers (90% of claims are processed but not nearly that number are paid) and this is a concern
• County Care is profitable and can run the program
• Assets and Liabilities in County Care are sustainable
• At any point in time, County Care will have a $500 million or so liability because as old bills are paid, new ones come in that need to be paid -a backlog.
• Funds from the State and County are sometimes not timely, which puts payments behind.

Dr. Shannon (CEO of CCH) Statements:

• The premiums that County Care receives are more than enough to pay its expenses in County Care and in fact subsidizes some of the charity care and other programs that CCH undertakes. 
• CCH has suffered reputitional damage due to the IG report.  People will not be willing to use CCH if they don't feel confident in its sustainability and viability. 
• The State of Illinois needs to speed up its application process for Medicaid enrollees. 
• CCH is in deficit due to increased charity care and non-payment by individuals who have insurance—NOT because of County Care.

Cook County Budget Office:

• CCH will be working with the Cook County Budget Office to use best practices and increased transparency in reporting between CCH and Cook County Board. 
• There is room for improvement on the cash/payments flow system and they are working on it.

Observer :  Karin Hribar                              Length of Committee Hearing:  2 hours and 20 minutes

Cook County Board of Commissioners - Finance Committee Meeting
Mid-year Budget Review - July 17, 2019 

What did the Board decide?
Several commissioners requested follow up numbers from Cook County Health (CCH) on a number of issues.

Other Discussion:
Debra Carey (in the absence of Dr. Shannon, CCH CEO) presented the review of the budget and stated there is a projected shortage of $103M this year.  She said they expect to be able to eliminate the deficit. They just received a payment of $77M from Medicaid for County Care and the rest they hope to cover by budget tightening and not filling open positions. Charity care is up for the first time since the implementation of the Affordable Care Act (ACA). This was blamed on a problem in Springfield because there is a backlog of eligibility determination and Medicaid is down 7%. The state is addressing this but it will take time.
It seems that coding and documentation is a big issue both for collecting revenue and the outside coding agencies are the delayed accounts payable cited by OIG. There was a lot of discussion on how this is being addressed.

Additional observations:
Commissioner Tobolski asked if there is a structural deficit for the hospital and wants CCH to pay more attention to the business aspect. ​

Observer - Lisa Slankard           Observed for 1 hour