May 5 Meeting of the Cook County Forest Preserve Commission

Chairman Stroger did not show up so Commissioner Reyes ran the meeting. It started with a break for the Finance Committee agenda where Commissioner Peraica questioned whether there is enough reporting. It was explained that much of the Forest Preserve spending is seasonal as are revenues and that Cash Flow reports do not reflect the overall financial picture for the Forest Preserve (which is quite healthy). There was general satisfaction that the Forest Preserve finances are in good financial shape.

After various other business there was some interesting discussion during the vote on payment to lawyers for the Shakman compliance work. Commissioner Silvestri and others concur that the Shakman compliance is taking too long and is expensive. Commissioner Collins expressed her desire not to try to meet the requirements inhouse but to change personnel to get into compliance, as the Sheriff's office did. Commissioner Sims thought it would be a good idea to go back to court -- perhaps to get a change in the decree?

There was a long report on the Bass Fishing Sectionals which were apparently very successful. Also an award was given to an exemplary CCFP Police Officer.

Cook County Board's Hot-button Topics

Despite all being present and on time, the May 4th meeting of the Cook County Board of Commissioners started 25 minutes late; at 11:00, after memorials, tributes, picture-taking, etc., the business portion of the meeting began. Last minute changes to the agenda were addressed first. It should be noted that many of these changes were distributed to the Board during the meeting and were not available to observers. This caused confusion, since it was not clear what exactly was being voting on.

Commissioners Reyes and Moreno presented a resolution to protest Arizona's recently passed immigration law by boycotting Arizona businesses and canceling Cook County contracts with Arizona companies. However this desire was cut short when some realized that minority businesses in Cook County could be hurt by this. No vote on the resolution was taken today and it was sent to the finance committee for further discussion.

Commissioner Goslin submitted a resolution (passed) regarding PC Power Management which should reduce electrical costs to the county.

The majority of time was spent on three ordinances (all passed by large majorities or unanimously) designed to keep closer watch on the expenditures of the county elected officials and departments, particularly President Stroger's office. Reports are to be submitted to the Board of Commissioners within 72 hours of any purchases and contracts over $750.00. Board approval is still necessary for all contracts of $25,000 or more. The Board also approved a requirement for departments to submit information regarding promotions and changes in salary and job titles. Third is a hiring freeze throughout the county. There was a lot of discussion on this last issue as some commissioners felt the county could not do its job with fewer people if some retired or left their positions.

Commissioner Daley requested that pay raises for grades 24 and up be put on board agendas for the necessary approval. This was an ordinance passed last December, but was not being followed by various county officials.

Commissioner Collins once again stated the county is not proceeding fast enough to comply with the Shakman Decrees regarding political-based hiring. Her resolution to create an ad hoc committee to analyze the cost of Shakman Compliance options was referred to the litigation committee. It was brought up that President Stroger has retained the law firm Sidley & Austin to represent him regarding Shakman. It was unclear why he required this.

Commissioner Sims presented an affirmative action hiring resolution which would have a personnel goal of 50% minority, 25% women, and 5% disabled.

This observer could not get a copy of this resolution/ordinance, so the specifics are not known to me.

CFO Jaye Williams spoke about the OPTIMA program which is designed to move from a paper to on-line methods for doing business. This will first be used for procurements and the tax process. Bid openings will also go on-line. This should make for more efficient and less costly procedures. Many commissioners were unaware of this program.

CCHHS Board Presented with Options in Delivery of Care

Cook County Health and Hospitals System Board Meeting

April 30, 2010 7:30 am to 4:00 pm

This was an all day meeting which covered regular Board agenda matters and a review of the Strategic Plan. The regular meeting spilled over its projected two hour time frame because of lengthy public comments, a protracted discussion of a contract for laundry linen services and a closed session regarding personnel matters. The current provider of laundry services was underbid by the GPO (Group Purchasing), a mechanism which had been approved several months ago to seek the lowest bidder for all services. Proponents of the current provider and losing bidder spoke of jobs lost by local residents to an out-of-state company. But Board members responded with arguments that the $2 million saving over 3 years of the contract could not be ignored. They recognized that use of GPOs represents change that may be hard on previous vendors and asked for a report on the efforts of the GPO to mentor small vendors to encourage their participation. The contract was approved with one negative vote.

The meeting resumed with a presentation of the current state of the Strategic Plan and the challenges inherent in it. Integrated Clinical Solutions, Inc., the consultant team, provided an in-depth assessment of community needs and related access factors, an overall evaluation of the System's current state, and key issues and a framework for the System to reach its goals. Four staff physicians then reported the progress of certain service lines whose development they are responsible for shepherding.

A few key issues drove the discussion: (1) There are significant unmet healthcare needs in Cook County. The community areas with the lowest health rankings – near south side, southland, east southland – have the least health resource coverage. Access to health care is a major issue in these communities. (2) System access points are not aligned geographically with patient populations having the greatest healthcare needs. There has been a significant geographic redistribution of the vulnerable population over the past 20+ years. (3) The current system configuration does not support a population/patient-centered approach to healthcare delivery. CCHHS is disproportionately skewed toward the provision of acute inpatient services, while evolving healthcare models are placing increased emphasis on primary care/prevention and comprehensive case management/care coordination. A greater proportion of CCHHS' traditional patients will have a choice in selecting their providers as national health care reforms. (4) CCHHS' current cost structure is not sustainable. Its cost per inpatient day is high, its losses are projected to increase; there is a significant opportunity to modify these by reallocating dollars.

Proposed scenarios would develop Regional Outpatient Centers that provide specialty services and are accessible to geographic areas with greatest needs – South, DT/West, and North, formalize partnerships with existing FQHCs (Federally Qualified health Centers) and other providers. The options include considerable detail regarding existing inpatient facilities, emergency services and long term care.

The final hour or so was devoted to four Service Lines which are considered critical to the Plan; Outpatient, Emergency, Maternal/Child Health and Surgical Services were scrutinized. The status and needs of each was detailed by the lead Physician especially as to how each fits into a long term plan.

The Board had many questions and will continue to peruse the mass of information that was provided. They hope to come to closure on a direction by their June meeting.

--Submitted by Observer Nancy Staunton

Health & Hospitals System Board Meeting March 26, 2010

A speaker in the public comment period related his bad experience which involved duplicate dental x-rays and a prolonged wait for dental services which in the end were not available, which information should have been known prior to referral. The Board recognized it as indicative of poor quality service and referred the issue to the Quality Committee.

Chairman Warren Batts reported on his visits to four Ambulatory & Community Health Network of Cook County ("ACHN") clinics. He found one adequate and the others very limited. Among deficiencies were few computers to expedite record keeping.

His remarks coincided with this month's Board Education, which was on the status of Information Technology. There has been progress, but equipment is still not adequate to implement Electronic Medical Records. The capital investment would be ~ $1.2 million. CCHHS would now have a rating of 4, having moved from a 1 in 2007; the ideal would be 6 to 7. About 50% of U.S. hospitals are below the ideal rate. December is the target date to eliminate paper documentation. Nursing is lagging and needs an advisory committee to expedite. With all hospitals now on one system, scheduling and billing should improve.

CEO William Foley discussed progress on leadership goals. There has been a delay in moving accounts payable and payroll functions to the CCHHS from the County. Using two different systems delays action, but a resolution appears near. Assessment of manager restructuring should be complete by July 1, leading to workforces changes. The goal is a reduction in costs of $106 million. He referenced the recently passed Health Care Reform legislation and noted one downside in its reduction in DSH allocations by the State. He also anticipates that public hospitals will have to compete with private hospitals for the increased number of Medicaid eligible patients. He projects a need to address clinics and primary care and a new demand for specialty care, better regional access, and the need to improve quality and manager accountability. The Strategic Plan continues to be refined.

In the Strategic Planning process, the consultant sees uncovered populations, more demand and a competitive marketplace. Overall goals continue to be accessible care, ease of entry, accountability, quality, continuity and cost-effectiveness. The big issues are potential re-configurations, ACHN clinics, Fantus Clinic, partnerships and community engagement. The next meeting of the Board on April 30 will be primarily a Retreat session to focus on the Strategic Plan.

With regard to partnerships, a joint consulting project with University of Chicago regarding use of Provident Hospital was discussed. Thus far a 5 week process has included a market assessment to determine the community need. It revealed a very fragmented market in the service area with more than 50% of inpatients out-migrating. Questions remain regarding the need for inpatient services at Provident. Both parties want to postpone furthur consideration until issues, including governance and capital improvements are resolved. The future of Provident Hospital is an important piece of the Strategic Plan.

Committee minutes were approved.

--Submitted by Observer Nancy Staunton