Cook County Board Finance Committee Proposed 2025 Budget Hearings

Cook County Board of Commissioners Finance Committee
2025 Budget Hearings 
October 30, 2024, morning

Cook County Health – Dr. Erik Micaitis, CEO
    2025 Proposed Budget:  $5.247 Billion
    2025 Proposed FTEs:      7,809

The Cook County Health System (CCH) provides patient care to all residents and immigrants regardless of ability to pay.  Locations include Stroger and Provident Hospitals, the new Bronzeville family health center, an HIV-AIDS clinic, and 12 community health centers throughout the county.  CCH also provides health care at the Cermak Jail, the Juvenile Temporary Detention Center, and through its Managed Care Insurance Plan known as CountyCare.  CCH reported that over 600,000 patients walked through its doors this last year. The following shows the totals for the Health Enterprise Fund only (exclusive of Special Purpose Funds and Grants)
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                              2025 Proposed Budget        Proposed FTEs:
   Public Health:                      $24 M                       125
   Managed Care:                $3.189  B                       435
   CCH [all other]                $1.933  B                       6,766
   CCH   TOTAL                   $5.146  B                       7,326

Highlights from the Presentation and Commissioner Questions

• Pam Cassara, Chief Financial Officer, noted that the budget and priorities for the budget is based on the 7 pillars set forth in the 2023-25 Strategic Plan:  (1) Patient safety, clinical excellence, and quality; (2) Health equity, community health and integration; (3) patient experience; (4) growth, innovation and transformation; (5) Optimization, systemization, and performance improvement;(6) Workforce talent and teams; and (7) Fiscal resilience.  
• As Commissioner Lowry said in his closing remarks, the two items most emphasized by Commissioners were the reduction of contracted (agency) help and keeping the Cook County Board apprised of expanded services.  
• The Provident replacement question came up several times, but with Cook County doing a review in 2025 of all properties, there are no plans for 2025 other than changes already anticipated such as the move of family, maternal, and pediatrics healthcare to the near-by Bronzeville facility, the increase in surgical cases, and more emphasis on cardiology.
• Commissioners repeatedly questioned by line item the increase or decrease in headcount.  The most common reason given was the re-allocation or centralization of headcount (for example, behavioral health employees).  There is no increase in the total headcount of 7,326 from 2024.
• For Contract hiring, monthly reports have been initiated as both the Commissioners and the CCH Human Resources Dept. have made the reduction of contract hires a top priority.  There are 581 vacancies for nurses out of a total of 1835 positions.  Maintenance personnel are also difficult to find.  Commissioner Degnan noted that operations headcount was used for other hires.  She expressed concern over neglecting equipment, infrastructure systems, etc.
• Job fairs have been a big success with a 71% offer acceptance rate.  And the pilot that allows to immediately offer a position at fairs will be continued. More outreach to Macomb Community College has also begun for nursing graduates.
• There are 113 bi-lingual positions across the system in all types of positions.
• A Doula RFP to advise, inform, and offer emotional and physical comfort to a pregnant person before, during, and after the birth of their child. is in the works this month, and the rollout will begin in 2025.  Commissioner Miller is very interested in this expanded service.
• The Public Health Department noted that ARPA funds are being used to hire/place Behavioral Health specialists at every CCH site.  It is also investing ARPA funds into community organizations to provide behavioral health services to CCH patients.
• Housing for the homeless is an important issue for Commissioner Quezada.  He noted that the homeless population has increased 12% nationally and asked for data on how many homeless individuals come thru the system.  CCH will get back to him on the request.
• Dental care was another issue for several Commissioners. The challenge in filling positions at each of the 12 health centers is staffing:  I dentist, 2 assistants, 2 hygienists and 2 registration clerks are needed at each site.  The plan is to have 3 sites with dental services by the end of 2024, and 3-4 more sites with services by the end of the 2025 summer.
• Clinical trials are being brought in-house.  The Hektone contract will end in March of 2025 and research work will increase.  CCH will be adding investigators and researchers.  When asked if this move would impact Grantors continuation of grants, Dr. Mikaitis said that four funders have already agreed to continue, and CCH expects the remaining to continue when their current grants expire in 2025.
• When asked what the System is doing to attract more patients to in-house services, staff noted that the jail population is being encouraged to continue with CCH after release; a new marketing plan is encouraging CountyCare Insurance customers to use Stroger, Provident, etc.; and the influx of immigrants also is a potential pool.

Meeting Length:  Over 4 hours in total

​Observer:  Diane Edmundson