CCHHS Budget Review, October 22, 2013

Cook County Health and Hospital System Chairman David Carvalho summarized that primary and preventive care are now at the forefront; the System's "failures" go to the hospital. This change requires new and different job skills, new and different job titles, new and different salaries as we compete in the marketplace.  Dr Raju added that the task is to create a viable, sustainable health care system while serving our mission of providing care.  Dr Raju stressed the intangible but very significant value of CountyCare participants' having a healthcare card, providing them with security and pride.  As services improve, more patients will choose CCHHS and resources will be maximized.

VISION:

•  Build a HMO to go on the market by October 2014 providing a variety of health care plan options, so that as participants' needs change, they can adapt their plans and still choose to receive care through CCHHS.  In that way, CCHHS can become (1) Plan, (2) Provider, (3) Payer, and (4) Manager, and the result will be an AFFORDABLE plan because there will be many participants. 
•  Make sure every vendor contract has deliverables and accountability by vendor. 
• Invest in IT. Better documentation and reporting by physicians will result in increased revenue collection.  (In the past this was not necessarily true.)
• Transform Provident to a regional ambulatory care center by 2015.  Currently only 10% of Provident bed capacity is in use, diminishing each year.
• Improve dental care.  Next year 11-16 dental care providers will be located across the County.

ACCOMPLISHMENTS

• As of October 22, 2013, 115,000 CountyCare applications have been filed.  Of these 48,000 have been approved by the State, which can now approve 500 applications per day.
• The ACA is allowing CCHHS to be reimbursed for serving a segment of the population that we were already caring for, so the increased revenues can be used to improve the system.
• The wait time has been reduced to 110 minutes in the Stroger ER 
•  729 positions were filled this year, vs. 420 last year. 
•  Thanks to an IT investment, CCHHS has been awarded Level 1 Meaningful Use and brought in $8 million in federal funds for IT improvements. 
•  $46 million/month will accrue to CCHHS due to the CountyCare program
• There are now 138 primary access points for healthcare in Cook County.
• New CountyCare patients choose Federally Qualified Health Centers for care by a 2 to 1 margin.  Most CCHHS CountyCare patients have chosen to stay with CCHHS.

CONCERNS

• Cook County jail has an estimated 2500 mentally ill detainees.  22 mental health workers are to be added at Cermak Clinic, but that number may be insufficient.  Tobolski cautioned that for the county as a whole it is the state's job to provide mental health and they should be held accountable to do that, not CCHHS.
• There will still be uninsured people in Cook County (including undocumented), and CCHHS will have to provide care for them.  We can't eliminate the subsidy needed to provide this care, but to continue to provide $500 million in uncompensated care is a danger to the system's sustainability. 
•  Stroger Hospital needs to improve its image in order to attract more paying customers.  Stroger's  reputation as a burn, trauma, and wound center is unparalleled, but many are not aware of the high quality of services in other areas.

ACCOLADES

Most commissioners strongly commended Dr. Raju, David Carvalho and the CCHHS board for their many accomplishments in the last two years - improving financial stability, improving information systems,  improving healthcare services, and making these services available and affordable for a much larger segment of Cook County's population.

submitted by Linda Christianson