Health and Hospitals System Board Meeting February 28, 2014

Committee Reports 
The Quality and Patient Safety committee requested that inpatient operational efficiency at Stroger and Provident be measured.  

The board discussed concerns that financial statements for CountyCare have not been published.  CFO John Cookinham explained that though $70 million in costs were incurred in 2013, the funds are not refunded by the federal government until 2014, in irregular block amounts, resulting in misleading accounting.  Dr. Raju reassured the board that CountyCare is still in its infancy, and once it becomes an HMO this will work itself out.  Board member Wayne Lerner: "This problem should have been part of the planning up front...revenue and expenses are just an estimate, but do we know what we're expending?  Let's get this in shape so we have confidence in the reports coming in." Chairman Carvalho said the finance committee needs a review of what resources we have and don't have, and what needs to be done.  Auditing is on an accrual basis, CountyCare must be coordinated similarly.

Action Items

John Daley and Dr. Robert Weinstein were approved as reappointments, and Dr. Jay Shannon as a new appointment to the CORE Foundation board, as proposed by President Preckwinkle.

The Chicago Consultants Studio, Inc. presented a request to develop a program for the enhancement and value creation of the Stroger Campus, incorporating (a) revenue generating opportunities and (b) clinical components.  The request must be approved by the County Board, and calls for 90 days to develop a strategic plan for a 12-14 month project overall.  Board member Wayne Lerner cautioned that we're already running 2 organizations, provider and payer, this will be a big change; the clinical portion of the RFP must be carefully vetted. The hope is that there will be minimal cost to CCHHS.  The plan was approved to go forward to the County Board.

Olenik Consulting was approved to receive $641,250 to provide ICD (International Classification of Diseases) training, including Web-based training, and education for a nine month period, with project management included.  There are now 17,000 codes and diagnoses, a big job for coders.  "Do we have the capacity to be trained?" Chairman Carvalho asked.  Often trainers come in, realize staff don't have capacity to acquire skills, and wind up doing the work themselves. Cookinham responded that new coders are being hired so the bulk of them are CCHHS staff.  

Chairman's Report

The Cerner system has been updated so that new patients can present data to determine their eligibility for charity care, for which they are eligible if they are at 200% of poverty - $23,340 for a single person.  Illinois state law makes these persons eligible regardless of where they live, so, as Carvalho pointed out, Illinois may become a "medical tourism" destination.  The hope is to enroll eligible residents in CountyCare or Carelink.

CEO Raju Report  

1. The 1115 Medicaid waiver was extended for 90 days to the end of March 2014, allowing CountyCare enrollment to continue. Currently there are 141,000 CountyCare applications, 113,000 turned over to the state for approval, 81,000 applications approved. The 2013 goal was 56,000, so the goal was exceeded.
2. As an outcome of a survey on patient safety, senior leaders will now make periodic rounds to find out what patients safety issues they've encountered, then understand and correct them.
3. A preliminary public health January site visit found CCHHS fully compliant on 77 measures and largely compliant on an additional 20 measures, for accreditation by the national board.
4. The Stroger Hospital cafeteria will be updated to include a famer's market beginning this spring.
5. Cook County University has now trained 35 senior managers on what works, what doesn't work, and how to manage.  All middle managers are now to be trained. 
6. At mycookcountyhealth.com,CCHHS patients can create their own portal and have access to their health records which they will be able to take with them from one caregiver to another. 
7. A feature on Stroger Hospital's trauma center will be shown on CNN on March 6 at 9 am. 
8. Dr. Courtney Hollowell was honored for his participation in the men's health forum at Trinity Church, featured on ABC news. 
9. The state of Illinois is seeking a 1115 waiver from the federal government to provide funds to bring the state healthcare infrastructure up to date to accommodate new Medicaid patients and to provide for care coordination, including community health workers, educators, substance abuse counselors, psychotherapy and counseling.  If approved, the state will receive funds to build health care capacity statewide,  including a specific request for $200,000,000 annually to expand training of health professionals at Stroger and U of I hospitals. The proposal calls for funds for CCHHS to collaborate with the UIC nursing curriculum to offer specialized nursing education and training to address CCHHS competency and nursing shortages.  Also, CountyCare will introduce population screening to identify and treat patients with mild to moderate depression and behavior disorders. To address continuity of care for Cook County jail detainees, the 7500 jail detainees now enrolled in CountyCare, and new enrollees, will be assisted in obtaining health benefits and in coordinating their healthcare once they are released.

The meeting adjourned to closed session at 10 a.m.

submitted by Linda Christianson