Health & Hospitals Systems Board Meeting April 25, 2014

Commmittee Reports:  Board member Lewis Collens reported that TB patients formerly treated by the city are now cared for at CCHHS clinics, with a chargeback from CCHHS to the city to pay for their care. He also reported that though immunization of CCHHS employees is mandatory, only 61% of Stroger employees, 58% of Provident employees, and 84% of Cermak clinic employees were immunized.  Chairman David Carvalho commented, "That employees can expose their patients to preventable, communicable diseases in appalling."

The board approved a recommendation that the Cook County Board exercise an option to purchase a currently-leased property at 2424 S. Pulaski which houseds CCHHS' Dr. Jorge Prieto Health Center.

Chairman Carvalho reported the the CEO search is moving ahead: candidates are to be reviewed in May, with interviews to begin in June.

Interim CEO Dr. Jay Shannon reported:

• the Stroger cafeteria has been updated;
• the 2015 budget is in development with some planned capital equipment additions;
• there are now more than 95,000 CountyCare patients;
• CCHHS has received an extension to October 2015 to comply with the ICD (International Classification of Diseases) 10 disease coding, a complex coding system increasing the ICD9 codes from 14,000 to iDC 10, 70,000 codes, providing greater specificity for improvemeng diagnoses and for assessing the true cost of care, particularly in anesthesia and orthopedics.

The meeting adjourned to closed session at 9:45.

Submitted by Linda Christianson

April 9, 2014 Cook County Board & Committee Meetings

CC Board Restricts Sources of Pets Sold at Pet Stores

 

Note:  As mentioned by other League Observers, there continue to be issues regarding transparency of Board actions.  At this meeting, there was no WiFi available in the Board room for accessing the Board and Commission agendas, and no paper copies were available until finally, after the Committee meetings and an hour and a half into the Board meeting, citizen George Blakemore came in and started passing copies of the Board agenda to audience members.  However, at that point, a second amended proposed ordinance to amend the Animal and Consumer Protection Ordinance was being discussed.  Board members had received this second amended version earlier that morning, but it was not available to audience members at the meeting, nor was it available online on either the Secretary to the Board’s or the Clerk of the Board’s web sites during or after the meeting.  Commissioner Fritchey, who was the chief sponsor of the second amended and original proposed amendment to the Ordinance did identify the changes from what appeared in the agenda, but this observer has not been able to verify that all the changes were identified since this second amended version is still not posted as of the end of April 9.  The 3 New Agenda items were also not available online or at the meeting. Reports of Board Committee meetings from April 8 were approved by the Board during the Board Meeting on April 9, but since these Reports are not available, this Observer does not know what items or how those items that were on the Committee agendas were dealt with at the Committee meetings and consequently what the Board votes accepting the Reports actually mean. However, all items dealt with on the agenda, other than the Committee Reports, were briefly summarized for those watching the meeting, which is appreciated.

After about an hour of public comment from supporters of and those expressing concern over the proposed restrictions to the sources of pets for pet stores, the Board voted unanimously to approve the second amended version of an Amendment to the Cook County Companion Animal and Consumer Protection Ordinance.  Under the version that appeared in the agenda, retailers may only offer for sale cats, dogs, and rabbits that are obtained from a government-operated facility or from a humane society or rescue organization.  However, Commissioner Fritchey stated that under the second amended version that was passed, retailers may also obtain these animals from someone that has 5 or fewer breeding animals.  Further, any municipality that has Home Rule powers may opt out from this ordinance.  Finally, this second amended version provides for an effective date of October 1, 2014, rather than the originally proposed July 1. Commissioner Fritchey said that he would be happy to talk with those who expressed concern over the amendment to see whether any further changes should be proposed to the Board.

Prior to the vote, Commissioner Goslin questioned why the Board was considering this proposed amendment at all, as opposed to referring it to a Board Committee, as is the usual practice.  Commissioner Gorman then moved to refer it to the Legislative Committee so that there would be time for all the written testimony and other information presented to the Board during the public comment period to be reviewed and considered. That motion was voted down, with only Commissioners Gorman, Goslin, Murphy, Schneider, and Suffredin supporting it.  Commissioner Goslin did say that he would look at all the testimony presented and would consider whether he would offer amendments at future Board meetings.

The Board received for filing the Human Resources Biweekly Activity Reports for January 12 through February 8. Commissioner Gainer questioned the large raises/promotions ($35,000 to $50,000) given to several employees at the Juvenile Temporary Detention Center (JTDC) within just a few weeks of the budget being passed. Transitional Administrator of the JTDC sent an employee with a letter to the Board which stated that the Administrator would respond in writing to any written questions the Board had and the employee said that he had been instructed not to respond to any Commissioner questions during the meeting. Several Commissioners expressed their dissatisfaction with what they perceived to be a lack of respect for the Board. Commissioner Suffredin said that Chief Judge Evans had expressed the belief that the hand-off from the Transitional Administrator (appointed by the Federal Court) to the Chief Judge (and therefore from Federal Court to County control) would take place by June or July. 

New Agenda item 14-2448 was passed which apparently (the text of this item was not available to the public) amends the Board’s appointment process to cover the appointment of members of a Juvenile Temporary Detention Center Advisory Council once the JTDC is under the Chief Judge’s supervision.

The 1^st Quarter Report of the Veterans Assistance Commission was received and filed.  The budget for this Commission had been a hot topic during last fall’s budget hearings, and the Board at that time ended up increasing the budget by $100,000 even though the Commission spent far less than had been budgeted in the past.  Per this Report, the Commission has spent $37,000 vs. the $78,000 the Budget Department would have expected, but what was spent is slightly over what had been spent at this time the prior year.

Finance Committee Meeting (prior to the Board Meeting):  Commissioner Suffredin moved to defer the proposed Ordinance to Create a Municipal or Special District Inspector General to the next Board meeting in order to give the Cook County Sheriff and State Comptroller time to work out an acceptable deal with Harvey regarding turning over records. The Committee received the Revenue Report through February for filing.  Revenues from the Clerk of the Court and the Recorder of Deeds were down from what had been projected, but the revenues from the Health & Hospitals System (HHS) for the Health Fund are well above projections. Upon questioning from Commissioner Gainer and others, the Chief Financial Officer for HHS said that most of the excess revenues are coming from the Medicaid Expansion:  the budget anticipated that there would be 56,000 under County Care throughout the year under the expansion, while currently 86,000 have been approved, though some of these may opt for other providers later in 2014; further, some of the revenues received in 2014 are for services provided in 2013.  Commissioner Gainer asked that HHS provide the Board with an estimate of sustainable increase in income.

--reported by Priscilla Mims

Health and Hospital Systems Board Meeting March 28, 2014

Once committee reports were approved, all without disagreement, most of the meeting consisted of a presentation by Steven Glass, Executive Director, Managed Care, on the board approval request for services by IlliniCare Health Plan, Inc. to provide third party administrative services, managed care, and clinical services for CountyCare at a cost not to exceed $1,795,970,071.00 over the five year contract term.  Dr. Raju prefaced the presentation by explaining that CCHHS anticipates having more than 100,000 patients enrolled in CountyCare, but lacks the expertise to manage this population.  The funding will come from the federal government, and 88% of funds will be used for patient care, rather than administration.  Already 567,000 claims have been validated for CountyCare services.

In his presentation, Glass explained that, under this contract, IlliniCare Health Plan, Inc. will provide managed care expertise and services as well as business support for the operations of CountyCare. The contract consolidates and transitions three existing contracts for: claims processing and payment, provider and member services; behavioral health benefits management services; and pharmacy benefits management services into one.  Since optometry is now a Medicaid approved service, optometry benefits management is also included in this contract.  The four pieces of the contract are:

1.  Administrative services, including claims adjudication, processing and payment; financial reporting and support; provider and member services.  These and similar services total 11.8% or an estimated $212,744,000 over the 5-year contract term, calculated on a per member per month (PMPM) assuming 115,000 CountyCare members.
2. Managed Care Services and Support. As CountyCare's TPA (Third Party Administrator), IlliniCare will provide care coordination and case management, nurse hotline, quality assurance, and utilization management, totaling 14.4% or an estimated $257,646,000 over the 5-year contract term, again assuming a PMPM payment basis for 115,000 CountyCare members.
3. IlliniCare subcontracted benefits management services: IlliniCare will subcontract for benefits management services for pharmacy, behavioral health and optometry through the existing subsidiaries' management networks of IlliniCare's parent company, Centene Corp.  These services total 7.2% or an estimated $129,168,000 over the 5-year contract term.
4. Payments to CountyCare network providers and approved out-of-network  providers.  IlliniCare will transmit payments owed by CountyCare to network providers, including contracted FQHCs, participating hospitals, ancillary providers, pharmacies, as well as to approved out-of-network providers.  These costs represent 66.6% or an estimated $1,195,850,842 over the 5-year contract term.

Once board member questions were addressed, the approval request was unanimously approved.  During the second quarter of 2014 CountyCare will transition to a Managed Care Community Network (MCCN), and additional contract and procurement item requests were approved without disagreement to process claims payments and provide managed care services through June 30, 2014. 

Currently, 147,000 CountyCare applications have been initiated, 118,000 submitted, and 87,000 approved.  CountyCare is compensated at a per member payment rate of $632.48 x 87,000 current members = approximately $70,000,000 per month to cover all services.  CountyCare has 138 primary care sites and 38 hospitals in its network

Currently: 43+% of care provided by CCHHS is uncompensated; 22+% is covered by Medicaid; 20+% by CountyCare, and 11+% by Medicare.

Dr. Raju, departing now for his new position as CEO of New York City's health and hospital system, spoke movingly of his experience with CCHHS as the "greatest job of my professional career" and acknowledged the board for its support in maintaining the CCHHS mission of service while getting its financial house in order.  Chairman Carvalho introduced a resolution of appreciation to Dr. Raju, as board members affirmed Dr. Raju's transformation of CCHHS in his 2 1/2 years and warmly applauded his contribution.  Dr. Raju received a rousing standing ovation by all meeting attendees before the meeting adjourned to closed session at 10:30.

submitted by Linda Christianson

CCHHS Quality Assurance and Patient Safety Committee Meeting March 26, 2014

Attending:  Chairman Collens, Directors Lerner, Guggenheim and Hammock; and a new non-Board member of the Committee, Patrick Driscoll.

Cook County's Public Health Department was accredited for the next five years by the Public Health Accreditation Board.

Surveyors from the Joint Commission made a surprise visit to the Ambulatory Care Center and, though the report is not final, issued only 10 citations (of need for correction) out of 1000 standards.  They made a point of telling the staff the visit had been "excellent."

CCHHS Chief Operating Officer Daniels reported on the system's new Capacity Management Project. The Project is focused on four areas: patient flow through the Emergency Department, bed management, the discharge process and patient acuity. The first is most important because CCHHS gets 72% of its patients through the ED, vs. an industry standard of 50-60%. It’s hoped that under the Affordable Care Act fewer patients will use the ED for primary care, but meanwhile the ED divides its patients into 5 levels of acuity, with 1 being the most serious. 1s are seen "within minutes," 2s and 3s are in the ED appropriately, and 4s and 5s should receive urgent care in another setting. For the moment, the ED has created its own "Doctor Quick" section to treat 4s and 5s.

Some internal goals have already been met: a 20% improvement over FY2013 3rd Quarter; only 6% of patients left without being seen; patients are treated and released within 4 hours or treated and admitted within 8 hours. National goals (3%, 3 hours and 6 hours respectively) will now be adopted.

Daniels credited the improvements to collaboration among all the departments, especially nursing initiatives coupledwith IT analysis which identified bottlenecks and administrative fixes which eliminated them. The next step is a "pilot program in Six-Sigma and Lean," two corporate-based programs which use detailed data simulations to map and fix all processes involved in a system (here, a patient’s progress through stages of care). Daniels acknowledged they’ve "hit a plateau and must push through it" to improve further. The goal is to integrate flow in and out of the ED with the System’s overall care strategy. They’ve already decided to create a "Bed Czar" position to improve bed turnover and availability, and are considering a Short Stay and Observation Unit to "decompress the ED."

Chairman Collens urged dissemination of these metrics to all doctors and nurses, and was assured they’d be widely distributed; they’re apparently already displayed at certain nursing stations. Director Lerner congratulation Daniels but urged him to consider using outside advice and to set higher goals "insiders create fewer stretch goals." He added, "Our benchmarks can’t be public hospitals or people will go elsewhere [now that they can]." Collens expressed concern that the Dr. Quick service would encourage patients to continue to receive primary care in the Emergency Department. Stroger’s Dr. Uchowa responded that only by providing patients with a good experience in their new "medical homes" will they be willing to remain in them.

Provident reported that its medical staff had identified patient registration as a bottleneck, so they’re working with Daniels to figure out how to provide bedside registration. Provident’s lab and pathology departments have just been re-accredited for two years. Provident is not in the program of intensive oversight and weekly meetings.

Submitted by Kelly Kleiman