Health and Hospitals System Board Meeting April 24, 2015

CEO Dr. Jay Shannon commended CountyCare for the University of Illinois health researchers’ findings that the rollout of the Medicaid expansion achieved all stated goals: (1) to assist the state in enrolling 115,000 in Medicaid; (2) to quickly develop an inclusive, comprehensive network and deliver expanded access to Medicaid covered services including substance abuse and mental health services; and (3) to deliver necessary care to more than 2/3 of this population in the first six months, and more than 85% in the first 12 months.   

Dr. Shannon commended Dr. Raju and President Preckwinkle for getting the Medicaid waiver, and he spoke highly of the implementation team, especially Susan Green, Mary Sadak and Dr. Jennifer Smith in developing the patient-centered medical home, as well as Bill Baker for his success in negotiating contracts.  Dr. Shannon spoke of the rollout as an “entirely grassroots phenomenon”, with virtually no advertising.

COMMITTEE REPORTS

Quality and Patient Safety: Stroger and Provident Hospital still lag far behind in on-time surgery starts, owing to advance paperwork requirements, complexity of scheduling, and staff break times. Due to noise levels, lack of cleanliness, and long wait times, overall hospital patient satisfaction is only 63%, though improvement efforts are under way.  Patient satisfaction level is 68% for ambulatory clinics.

Managed Care: CountyCare membership now totals 179,000, ahead of goal and budget, roughly 50/50 male-female, average age early 30s, #2 in membership for the greater Chicago region as of February, a 33% growth in Cook County in March.  The pharmacy is moving to 90-day prescriptions to save cost. CountyCare’s primary challenges are (1) the Medicaid eligibility determination process is slow; (2) patients experience confusion regarding referrals and intake; and (3) patients need better understanding of the medical home assignment process.

Human Resources: The hiring process still requires 180 days, with a goal of 139 days.  Board member Lewis Collens pointed out, “Our competition can hire in 25-30 days!”   CCHHS is burdened by collective bargaining, the Shakman decree, and internal inefficiencies.

Finance: CountyCare is now turning a profit; fewer than 25% of CCHHS patients are uninsured. 

CIO Donna Hart spoke of the challenges of managing the health information services, with over 6,000 users logging onto the Cerner system, and 8,490 email mailboxes. Maintaining the Cerner system requires over $42m annually.  A challenge is that some sites use the EPIC platform, difficult to coordinate with the Cerner system.  A $5m contract to Chamberlin Edmonds & Assoc. for CountyCare eligibility/enrollment was approved, as well as a $3.5m contract for Superior Ambulance Services.  Contracts are moving toward competitive bid.

Dr. Shannon mentioned the Tribune article summarizing hospital ratings, allocating only 2 stars to Stroger, alluding to the hospital’s need for cleanliness, a functioning call center, appointment system, and the urgency of the need for change in this competitive environment.

Employment Officer Carrie Pramuk-Volk, Office of Compliance Administrator Mary Robinson, and Inspector General Patrick Blanchard helped the board understand how the Shakman decree has affected hiring in the past, how board members may make staff recommendations without violating the decree, and how the new employment plan compliance training may speed hiring and increase transparency in the future.

Submitted by Linda Christianson