I. Attendance/Call to Order Acting Chair Richardson-Lowry called the meeting to order.

Transcription

1 Minutes of the Meeting of the Board of Directors of the Cook County Health and Hospitals System (CCHHS) held Friday, August 31, 2018 at the hour of 9:00 A.M. at 1900 West Polk Street, in the Second Floor Conference Room, Chicago, Illinois. I. Attendance/Call to Order Acting Chair Richardson-Lowry called the meeting to order. Present: Acting Chair Mary B. Richardson-Lowry and Directors Mary Driscoll, RN, MPH; Ada Mary Gugenheim; David Ernesto Munar; Robert G. Reiter, Jr.; and Sidney A. Thomas, MSW (6) Present Telephonically: Chair M. Hill Hammock and Director Layla P. Suleiman Gonzalez, PhD, JD (2) Absent: Vice Chair Hon. Jerry Butler and Director Emilie N. Junge (2) Additional attendees and/or presenters were: Ekerete Akpan Chief Financial Officer Douglas Elwell Deputy Chief Executive Officer, Finance and Strategy Marcelino Garcia - Director of Community Affairs, Strategy & External Affairs Sharon Goss Cook County Bureau of Human Resources Charles Jones Chief Procurement Officer James Kiamos Chief Executive Officer, CountyCare Jeff McCutchan General Counsel Carrie Pramuk-Volk CCHHS Employment Plan Officer Barbara Pryor Interim Chief Human Resources Officer Kent Ray Associate General Counsel Deborah Santana Secretary to the Board John Jay Shannon, MD Chief Executive Officer Ronald Wyatt, MD Chief Quality Officer Director Munar, seconded by Director Gugenheim, moved to allow Board Chair Hammock and Director Suleiman Gonzalez to telephonically participate in the meeting as voting members. THE MOTION CARRIED UNANIMOUSLY. II. Employee Recognition Dr. John Jay Shannon, Chief Executive Officer, recognized employees for outstanding achievements. Details and further information is included in Attachment #6 - Report from the Chief Executive Officer. III. Public Speakers Acting Chair Richardson-Lowry asked the Secretary to call upon the registered public speakers. The Secretary called upon the following registered public speakers: 1. Kaitlyn Quigley Representative, LAF 2. Esperanza Villalobos CCHHS Patient 3. Andi Garcia Brown Representative, Greater Chicago Food Depository 4. Carmen Vergara Esperanza Health Center 5. Aloyce Hill CCHHS Patient 6. George Blakemore Concerned Citizen

2 Minutes of the Meeting of the Board of Directors Friday, August 31, 2018 Page 2 IV. Board and Committee Reports A. Minutes of the Board of Directors Annual Meeting, July 27, 2018 Director Thomas, seconded by Director Driscoll, moved the approval of the Minutes of the Board of Directors Meeting of July 27, THE MOTION CARRIED UNANIMOUSLY. B. Human Resources Committee Meeting, August 23, 2018 i. Metrics (Attachment #1) ii. Meeting Minutes, which include the following action item: Proposed Collective Bargaining Agreement with Teamsters Local 743 Acting Chair Richardson-Lowry and Barbara Pryor, Interim Chief Human Resources Officer, provided an overview of the metrics and meeting minutes. The Board reviewed and discussed the information. The Board took action on this item following the adjournment of the closed meeting. Director Thomas, seconded by Director Driscoll, moved the approval of the Minutes of the Human Resources Committee Meeting of August 23, THE MOTION CARRIED. With regard to the Collective Bargaining Agreement (CBA) with Teamsters Local 743, which is an action item recommended for approval by the Human Resources Committee and contained within the minutes, Director Reiter stated for the record that, as a member of this Board, he will continue to weigh in on issues regarding labor, however he is recusing himself from the vote on that particular item, as Teamsters 743 is an affiliate of the Chicago Federation of Labor (CFL), and he is the President of the CFL. C. Managed Care Committee Meeting, August 23, 2018 i. Metrics (Attachment #2) ii. Meeting Minutes James Kiamos, Executive Director of Managed Care, reviewed the metrics. The Board reviewed and discussed the information. Director Thomas, seconded by Director Munar, moved the approval of the Minutes of the Managed Care Committee Meeting of August 23, THE MOTION CARRIED UNANIMOUSLY. D. Quality and Patient Safety Committee Meeting, August 24, 2018 i. Metrics (Attachment #3) ii. Meeting Minutes, which included the following action items and report: Proposed initial appointments of two (2) Stroger Hospital Division Chairs Medical Staff Appointments/Reappointments/Changes Director Gugenheim and Dr. Ronald Wyatt, Chief Quality Officer, provided an overview of the metrics and meeting minutes. Director Gugenheim, seconded by Director Reiter, moved the approval of the Minutes of the Quality and Patient Safety Committee Meeting of August 24, THE MOTION CARRIED UNANIMOUSLY.

3 Minutes of the Meeting of the Board of Directors Friday, August 31, 2018 Page 3 IV. Board and Committee Reports (continued) E. Finance Committee Meeting, August 24, 2018 i. Metrics (Attachment #4) ii. Meeting Minutes, which included the following action items and report: Contracts and Procurement Items (detail was provided as an attachment to this Agenda) Proposed Transfers of Funds Proposed Resolution amending the CCHHS capital asset threshold Proposed CCHHS FY2019 Preliminary Budget Proposed request to negotiate and execute an agreement for the acquisition of property to be utilized by CCHHS for medical and dental offices Director Reiter presented the Meeting Minutes for the Board s consideration. Ekerete Akpan, Chief Financial Officer, reviewed the Metrics, and Charles Jones, Chief Procurement Officer, provided a brief overview of the contractual requests that were considered at the Finance Committee Meeting. It was noted that there are no requests pending review by Contract Compliance. Director Reiter, seconded by Director Driscoll, moved the approval of the Minutes of the Meeting of the Finance Committee of August 24, THE MOTION CARRIED UNANIMOUSLY. V. Action Items A. Approval of proposed CCHHS FY2019 Preliminary Budget (Attachment #5) Presented to Finance Committee on August 24, 2018 Public Hearings August 28, 2018 at 9:00 A.M. and August 29, 2018 at 6:00 P.M. Mr. Akpan reviewed the presentation on the proposed CCHHS FY2019 Preliminary Budget, which included information on the following items: FY2018 Accomplishments FY2019 Proposed Budget Executive Summary FY2019 Initiatives FY2019 Proposed Budget Revenue Drivers FY2019 Proposed Budget Expense Drivers FY2018 Volume FY Budget FY2019 Proposed CountyCare Financial Summary FY2019 Proposed External Revenue by Source Cook County Pension, Debt Service and Operating Allocation CCHHS Uncompensated Care Full Time Equivalent Position Count FY2019 Proposed Budget Key Take-Aways FY Budget Projections FY2019 Budget Calendar

4 Minutes of the Meeting of the Board of Directors Friday, August 31, 2018 Page 4 V. Action Items A. Approval of proposed CCHHS FY2019 Preliminary Budget (continued) Director Reiter commented that he has reviewed this presentation a number of times and chaired two (2) public hearings on it, and believes that it is remarkable what this organization accomplishes in fulfilling its mission. An attendee of one of the public hearings who has an extensive background in public policy offered a comment to him after the hearing about how they were amazed at the work that is done here; this type of effort is not seen anywhere else in the country. This health system that includes public hospitals, a network of clinics, a correctional health facility and a public health department is running successfully with less and less money coming in directly from the County. He fully stands behind this budget, and he commits himself as a Director and Finance Chair to pass this today and get it integrated into the County s proposed budget. Director Thomas stated that he will vote for the budget; however, he expressed his interest in receiving more detail. He stated that it is great to grow the CountyCare membership, but the Board does not have a projection of the number of CountyCare members to keep in this System to make it profitable for the System it would be good to consider what is the goal for keeping folks in the System for their primary care. Additionally, he referenced the progress being made with updating some of the clinics; he believes that some of the south side clinics need some loving care and new facilities. With regard to the information on slide 14, pertaining to FY2019 Proposed External Revenue by Source, Director Gugenheim inquired regarding the figure of $494 million in patient fees; she asked what percentage of that figure is Medicare? Mr. Akpan responded that he estimates it to be approximately 12-15%, but he can provide the exact amount following the meeting. Dr. Shannon stated that he believes that it amounts to approximately 14%; he offered to follow up with a deep dive review on the subject in the future. Director Gugenheim noted that the slide would be improved if percentages are included. Chair Hammock noted for the record that he supports the budget; there are always difficult choices to be made, but he thinks the organization is moving in the right direction. Director Munar remarked that, because the architecture of the budget is so fragile, and so much depends on enrollments and reimbursement rates, the Board will have to carefully monitor the projections and assumptions in the outlier years. Director Reiter, seconded by Director Thomas, moved the approval of the proposed CCHHS FY2019 Preliminary Budget. THE MOTION CARRIED UNANIMOUSLY. B. Contracts and Procurement Items There were no contracts presented directly for the Board s consideration. C. Any items listed under Sections IV, V and VIII VI. Report from Chair of the Board There was no report presented at this time.

5 Minutes of the Meeting of the Board of Directors Friday, August 31, 2018 Page 5 VII. Report from Chief Executive Officer (Attachment #6) Dr. Shannon provided an update on several subjects; detail is included in Attachment #6. VIII. Closed Meeting Items A. Claims and Litigation B. Discussion of personnel matters C. Minutes of the Human Resources Committee Meeting, August 23, 2018 Proposed Collective Bargaining Agreement with Teamsters Local 743 Director Gugenheim, seconded by Director Thomas, moved to recess the open meeting and convene into a closed meeting, pursuant to the following exceptions to the Illinois Open Meetings Act: 5 ILCS 120/2(c)(1), regarding the appointment, employment, compensation, discipline, performance, or dismissal of specific employees of the public body or legal counsel for the public body, including hearing testimony on a complaint lodged against an employee of the public body or against legal counsel for the public body to determine its validity, 5 ILCS 120/2(c)(2), regarding collective negotiating matters between the public body and its employees or their representatives, or deliberations concerning salary schedules for one or more classes of employees, 5 ILCS 120/2(c)(11), regarding litigation, when an action against, affecting or on behalf of the particular body has been filed and is pending before a court or administrative tribunal, or when the public body finds that an action is probable or imminent, in which case the basis for the finding shall be recorded and entered into the minutes of the closed meeting, 5 ILCS 120/2(c)(12), regarding the establishment of reserves or settlement of claims as provided in the Local Governmental and Governmental Employees Tort Immunity Act, if otherwise the disposition of a claim or potential claim might be prejudiced, or the review or discussion of claims, loss or risk management information, records, data, advice or communications from or with respect to any insurer of the public body or any intergovernmental risk management association or self insurance pool of which the public body is a member, and 5 ILCS 120/2(c)(17), regarding the recruitment, credentialing, discipline or formal peer review of physicians or other health care professionals, or for the discussion of matters protected under the federal Patient Safety and Quality Improvement Act of 2005, and the regulations promulgated thereunder, including 42 C.F.R. Part 3 (73 FR 70732), or the federal Health Insurance Portability and Accountability Act of 1996, and the regulations promulgated thereunder, including 45 C.F.R. Parts 160, 162, and 164, by a hospital, or other institution providing medical care, that is operated by the public body. On the motion to recess the open meeting and convene into a closed meeting, a roll call was taken, the votes of yeas and nays being as follows: Yeas: Nays: None (0) Acting Chair Richardson Lowry, Chair Hammock and Directors Driscoll, Gugenheim, Munar, Reiter, Suleiman Gonzalez and Thomas (8) Absent: Vice Chair Butler and Director Junge (2) THE MOTION CARRIED UNANIMOUSLY and the Board convened into a closed meeting. Acting Chair Richardson-Lowry declared that the closed meeting was adjourned. The Board reconvened into the open meeting.

6 Minutes of the Meeting of the Board of Directors Friday, August 31, 2018 Page 6 IX. Adjourn As the agenda was exhausted, Acting Chair Richardson-Lowry declared that the meeting was ADJOURNED. Respectfully submitted, Board of Directors of the Cook County Health and Hospitals System XXXXXXXXXXXXXXXXXXXXXXX Mary B. Richardson-Lowry, Acting Chair Attest: XXXXXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary Requests/Follow-up: Follow-up: Slide 14 of the budget presentation information to be provided on patient fees and percentage of Medicare. A future deep dive on the subject will be planned. Page 4

7 ATTACHMENT #1 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

8 COOK$COUNTY$HEALTH$$ &$HOSPITALS$SYSTEM!! Human$Resources$Metrics$for$ CCHHS$Board$Of$Directors$ August$31,$2018$ Barbara$Pryor$ Interim$Chief$Human$Resources$Officer$

9 QUARTERLY$METRICS$ CCHHS!Board!of!Directors!I!!08/31/2018!

10 CCHHS$HR$Activity$Report$0$Open$Vacancies DATA THROUGH: 07/31/18 Goal:&Continue&to&maintain&open& vacancies&at&750&or& Our!goal!is!to!maintain!our!total!vacancies!equal!to!or!below!750.! Description Dec Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Vacancy Number: Add Separations: Less External Vacancies Filled: FY18 TOTAL: Net New Open Vacancies Vacant Positions (YTD) Target (750) Quarter 1 Quarter 2 Quarter 3 Quarter 4 FY17:!Thru!!!07/31/2017!SeparaAons!(316)!&!External!Hires!(350)!=!!!!!34!Net!New! FY18:!Thru!!!07/31/2018!SeparaAons!(321)!&!External!Hires!(287)!=!!!!O34!Net!New! 3! FY18!data!is!through!07/31/2018! CCHHS!Board!of!Directors!I!!08/31/2018!

11 CCHHS!HR!AcAvity!Report!!Vacancies!Filled! 250! 221$ CCHHS$FILLED$ FY!2017!Filled!(515)! FY!2018!Filled!(424)! Thru$07/31/2018! 70! 65$ 60! NURSING$FILLED$ FY!2017!Filled!(163)! FY!2018!Filled!(94)! 56$ 200! 169$ 173$ 50! 150! 100! 142$ 125$ 109$ 40! 30! 38$ 33$ 42$ 23$ 20! 50! 10! 0! 0! 4! FY18!data!is!through!07/31/2018! Does!not!include!Consultants,!Registry!and!House!Staff!! CCHHS!Board!of!Directors!I!!08/31/2018!

12 CCHHS!HR!AcAvity!Report!!SeparaAons! CCHHS$SEPARATIONS$ 2017!SeparaAons!(316)! 2018!SeparaAons!(321)! Thru$07/31/2018! NURSING$SEPARATIONS$ 2017!SeparaAons!(71)! 2018!SeparaAons!(58)! 165! 145! 146$ 154$ 60! 50! 125! 105! 85! 65! 92$ 98$ 78$ 69$ 40! 30! 20! 36$ 29$ 19$ 20$ 16$ 45! 10! 9$ 25! 0! FY17:!Thru!!!07/31/2017!SeparaAons!(316)!&!External!Hires!(350)!=!!!!!34!Net!New! FY18:!Thru!!!07/31/2018!SeparaAons!(321)!&!External!Hires!(287)!=!!!!O34!!Net!New! FY17:!Thru!!!07/31/2017!SeparaAons!(71)!&!External!Hires!(95)!=!!!!24!Net!New! FY18:!Thru!!!07/31/2018!SeparaAons!(58)!&!External!Hires!(46)!=!!!!V12$Net!New! 5! FY18!data!is!through!07/31/2018! Does!not!include!Consultants,!Registry!and!House!Staff!! CCHHS!Board!of!Directors!I!!08/31/2018!

13 CCHHS!HR!AcAvity!Report!!Turnover! 9.0% CCHHS'TURNOVER 8.0% Turnover'YearPtoPDate 7.0% 6.0% Head'Count:'6, % 4.0% 3.0% 2.0% 1.0% 0.0% YTD'CumulaVve'Totals: Quarter'1 Quarter'2 Quarter'3 Quarter'4 FY18'CCHHS'Turnover 2.5% 4.0% 5.1% FY17'CCHHS'Turnover 2.3% 3.8% 4.9% FY17'U.S.'IL'Health'&'Hospital'Assoc.' Turnover'Data NURSING'TURNOVER Turnover'YearPtoPDate Head'Count:'1,395 YTD'CumulaVve'Totals: 9.0% 8.0% 7.0% 6.0% 5.0% 4.0% 3.0% 2.0% 1.0% 0.0% Quarter'1 Quarter'2 Quarter'3 Quarter'4 FY18'Nursing'Turnover 2.1% 3.5% 4.2% FY17'Nursing'Turnover 2.9% 4.7% 5.4% FY17'U.S.'IL'Health'&'Hospital'Assoc.' Turnover'Data 3.7% 4.0% 4.5% FY18'U.S.'Dept.'of'Labor'Turnover'Data 3.7% 3.6% 3.7% 3.8% 6.0% 4.7% 6! FY18!data!is!through!07/31/2018! Include!Consultants,!Registry!and!House!Staff!! CCHHS!Board!of!Directors!I!!08/31/2018!

14 250! Impact!2020!!CCHHS!HR!Strategies! Improve/Reduce$Average$Time$to$Hire! Average!Time!to!Fill! (Without!CredenAaled 1)! 200! 203$ 150! 100! 139$ 140$ 110$ 108$ 95.9$ 95$ 90$ 93.7$ 50! 0! 0$ FY14! FY15! FY16! FY17! FY18! Goal! Actual! 7! 1 Creden'aled*Posi'ons:*Physicians,*Psychologist,*Physician*Assistant*I*and*Advanced*Prac'ce*Nurses.* CCHHS!Human!Resource!Commi^ee!I!08/23/!2018!

15 CCHHS!HR!AcAvity!Report!!Hiring!Snapshot! 1,400 Clinical!PosiAons!!409!/!71%! NonOClinical!PosiAons!!166!/!29%! Thru$07/31/$2018! $575$Posi]ons$in$process$ Count of positions 1,200 1, ClassificaVon'&' CompensaVon'(27) 16% Budget'Processing'(43) 25% Labor'(3) 2% PosiVon'Control'(92) 53% $($65$%)$of$the$posi]ons$in$process$ are$in$the$postvvalida]on$phase$ ! Hiring'Manager'(7) 4% Shared Responsibility Human Resources Management Human Resources Management Human Resources 8! CCHHS!Board!of!Directors!I!!08/31/2018!

16 HR!AcAvity!Report!!Licensed!Nurses!Hiring!Snapshot! /87%$of$166$$Posi]ons$in$ process$are$invpa]ent$ Thru$07/31/$2018! $166$Nursing$Posi]ons$in$process$ Count of positions ClassificaVon'&' CompensaVon'(9) 28% Budget'Processing'(6) 19% PosiVon'Control'(17) 53% $($70$%)$of$the$posi]ons$in$process$ are$in$the$postvvalida]on$phase$ ! Shared Responsibility Human Resources Management Human Resources Management Human Resources 9! CCHHS!Board!of!Directors!I!!08/31/2018!

17 Count of positions HR!AcAvity!Report!!Revenue!Cycle!Hiring!Snapshot! 8 ClassificaVon'&' CompensaVon'(2) 25% Budget'Processing'(1) 12% 3 Hiring'Manager'(1) 13% PosiVon'Control'(4) 50% 7 Thru$07/31/$2018! $44$Revenue$Cycle$Posi]ons$in$process$ 1 33$($75$%)$of$the$posi]ons$in$process$ are$in$the$postvvalida]on$phase$ Shared Responsibility Human Resources Management Human Resources Management Human Resources 10! CCHHS!Board!of!Directors!I!!08/31/2018!

18 CCHHS$HR$In$Focus:$ Employment$Plan$Update$ Employment!Plan!Office:!SemiOAnnual!Report!! August!2018! Carrie$PramukVVolk,$$ Employment$Plan$Officer$ CCHHS!Board!of!Directors!I!!08/31/2018!

19 Employment Plan Office: Semi- Annual Report August$ th $SemiVAnnual$Report$ January$16VJuly$16,$2018$ What s!new?! O Modified!the!Discipline!Policy! O Grade!24!Salary!DeterminaAon!Policy! O Grade!24!Salary!Adjustment!Policy! Monitoring!update! InvesAgaAons!update.! SubstanAal!Compliance!update:! 1. Hiring!Processes! 2. Discipline!Process! Closed!18!addiAonal!files;!! 3!sustained!findings! Employment!Plan!Amendments! Hearing!tentaAvely!scheduled! 12! CCHHS!Board!of!Directors!I!!08/31/2018!

20 What s'new? Grade$24$Salary$Determina]ons$ Starts!with!a!request!to!create!a!new!Grade!24!PosiAon! HR!CompensaAon!Team!performs!market!analysis! Final!determinaAon!by!Chief!Human!Resource!Officer!(CHRO)! Grade$24$Salary$Adjustments$ Starts!with!a!request!from!a!Deputy!CEO!to!modify!an!exisAng!Grade!24!salary! HR!CompensaAon!team!evaluates!job!descripAon!and!performs!market!analysis! CHRO!reviews!and!makes!recommendaAon!to!CEO! CEO!makes!final!determinaAon! Discipline$Policy$amended$ Policy!amended!twice!to!accommodate!loss!of!CCHHS!Labor!Team! Clarify!what!approval!is!required!for!suspensions!and!terminaAons!(HR*approval)! Require!management!to!send!completed!discipline!to!HR!within!5!days!! Direct$Appointment$&$Ac]vely$Recruited$Posi]on$Lists$revised$ Direct!Appointment!List!amended!May!2018:! Direct!Appointment!List!amended!July!2018:! AcAvely!Recruited!List!amended!March!2018:!!added!21;!modified!24!!added!1!!added!28! 13! CCHHS!Board!of!Directors!I!!08/31/2018!

21 Monitoring!Processes! 120! 100! 80! 60! 40! 20! 0! Hiring$ EPO$REPORTING$ (MONITORED!~49%!OF!REQUISITIONS*)! 67! 49! 52! 19! 29! 6! 2! 8! 10! 15! 3! 0! PosAng! ValidaAon!Interviews! SelecAon! DTH! ACP! MeeAngs! RequisiAons!without!Errors! Total$Requisi]ons:$ ~530$ RequisiAons!with!at!least!One!Issue! 8th! Report! 7th! Report! 6th! Report! Disciplinary$Ac]on$Overview$ (Percentage!of!Compliance!Noted)! 135! 157! 204! 714! 875! 925! 0! 200! 400! 600! 800! 1000! Total!DAFs!to!HR! Discipline$ 78%! DAFs!Returned!for!CorrecAons! 77%! 85%! *!This!percentage!reflects!various,!but!not!all,!stages!of!the!hiring!process.! 14! CCHHS!Board!of!Directors!I!!08/31/2018!

22 InvesAgaAons!of!NonOCompliance! Closed$Files$ $18*$ Transfer! 7%! Discipline! 7%! Incident$Report:$Issues$ Pay! 7%! OverAme! 7%! Hiring! 33%! Closed,!no! InvesAgaAo n! 33%! Incident$Reports:$Findings$ Sustained! 17%! Sustained!Issues:! Hiring!O3! OverAme!!1! CBA! 13%! Unauthoriz ed!contact! 13%! Layoff! 7%! Conflict!of! Interest! 6%! Not! Sustained! 50%! Sustained! Not!Sustained! Closed,!no!InvesAgaAon! **Report*iden'fies*19* *one*was*issued*during*the*7 th *Report*Period,*but*HR*Response*received*during*this*(8 th )*Report*Period.* 15! CCHHS!Board!of!Directors!I!!08/31/2018!

23 SubstanAal!Compliance! NEXT!STEPS:! O Work!on!updates/amendments!to!the!Employment!Plan!to!file!at! Compliance!Hearing! O Shakman!parAes!to!file!Agreed!MoAon!by!end!of!August! O Hearing!tentaAvely!scheduled!for!October!31,!2018! 16! CCHHS!Board!of!Directors!I!!08/31/2018!

24 APPENDIX$ Provided(for(Informa.onal(Purposes( CCHHS!Board!of!Directors!I!!08/31/2018!

25 45! 40! CCHHS!HR!AcAvity!Report!! Other! Hiring!Snapshot! Nurse (166) 29% Other!!281!In!Process! 40! 35! 30! 25! 20! 15! 10! 5! 2! 3! HIS (3) 0% Finance (44) 8% Physician (68) 12% 4! 4! Pharmacy (13) 2% 5! 7! Other (281) 49% 10! 10! 10! 11! 11! 12! 12! 19! 20! 20! 23! 26! 32! 0! 18! FY18!data!is!through!!07/31/18! Data!does!not!include!Consultants,!Registry!and!House!Staff!! CCHHS!Board!of!Directors!I!!08/31/2018!

26 ATTACHMENT #2 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

27 CountyCare*Update* Prepared'for:'CCHHS'Board'of'Directors' James*Kiamos* CEO,*CountyCare* August*31,*2018* *

28 Current*Membership* Monthly membership as of August 9, 2018 Category) Total)Members) ACHN)Members) %)ACHN) FHP) 224,024* 27,547* 12.3%* ACA) 75,964* 18,871* 24.8%* ICP) 30,075* 7,137* 23.7%* MLTSS) 5,135* N/A* N/A* Total) 335,198) 53,555) 16.0%) 2

29 Cook*County*Managed*Medicaid*Market* Membership in Cook County as of May 18, 2018 MCO) Membership) CountyCare* ************************************331,051** Blue*Cross*Blue*Shield* ************************************292,648** Meridian* ************************************143,396** IlliniCare* **************************************96,677** Harmony*(WellCare)* **************************************85,247** Molina* **************************************69,290** Next*Level* **************************************61,257** Total) ))))))))))))))))))))))))))))))))1,079,566)) WellCare'+'Meridian' '''''''''''''''''''''''''''''''''''228,643'' Source: IL HFS May Numbers 3

30 Monthly*Membership*Trend* *336,000** Monthly*Membership*Trend* *334,000** *332,000** Linear trend *330,000** *328,000** *326,000** *324,000** AprY18* MayY18* JunY18* JulY18* AugY18* Overall positive trend from 4/1/2018 (end of open enrollment period) 2018 Membership Budget is 225,000 4

31 2018*OperaZons*Metrics:*Call*Center*&* Encounter*Rate* Performance) Key)Metrics) State)Goal) May) Jun) Member)&)Provider)Services)Call)Center)Metrics) Abandonment*Rate) <*5%) 1.29%* 0.64%* Hold*Time*(minutes)* 1:00* 0:19* 0:04* %*Calls*Answered*<*30*seconds* >*80%* 88.02%* 96.83%* Claims/Encounters*Acceptance*Rate* 95%* 95.23%* 95.23%* 5

32 2018*OperaZons*Metrics:*Claims*Payment* Performance) Key)Metrics) State)Goal) May) Jun) Claims)Payment)Turnaround)Time) %*of*clean*claims*adjudicated*<* 30*days) 90%) 95.1%* 94.4%* %*of*claims*paid*<*30*days* 90%* 23.7%* 45.3%* 6

33 2018*OperaZons*Metrics:*Care* Management*HRS/HRA* Performance) Key)Metrics) Membership) Market)%) Apr) May) Jun) Completed)HRS/HRA)(all)populaRons)) Overall) 328,563) 40%) 48.5%) 49.9%) 51.8%) 7

34 2018*OperaZons*Metrics:*Care* Management*High*Risk*Members* Performance) Key)Metrics) Members) Market)%) Apr) May) Jun) Completed)Care)Plans)on)High)Risk)Members) Overall) 9,890) 65%) 62.7%) 50.1%) 43.0%) 8

35 How*We*Match*Up** 9

36 10 QuesZons?*

37 ATTACHMENT #3 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

38 COOK COUNTY HEALTH & HOSPITALS SYSTEM CCHHS Board of Directors Meeting Quality and Patient Safety Committee Dashboard Overview 31 August 2018 Ronald Wyatt, MD, Chief Quality Officer 1

39 2 Board Quality Dashboard

40 ATTACHMENT #4 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

41 Cook County Health & Hospitals System Full Board Committee Meeting August 2018 Ekerete Akpan CFO 1 Full Board Meeting : August 2018

42 2 Income Statement for the Seven Months ending June 2018(in thousands) Year-To-Date Variance Actual Budget $ % Operating Revenue 1,442,913 1,149, ,460 26% Operating Expenses Salaries & Benefits 364, ,200 23,330 6% Overtime 25,714 21,129 (4,586) -22% Pension* 141, , % Supplies 44,414 30,810 (13,604) -44% Pharmaceutical Supplies 56,657 48,270 (8,387) -17% Purch. Svs., Rental, Oth. 154, ,699 (15,119) -11% External Claims Expense 844, ,596 (302,937) -56% Insurance Expense 13,047 15,359 2,312 15% Depreciation 20,077 20, % Utilities 5,440 6,800 1,360 20% Total Operating Exp 1,671,532 1,353,902 (317,630) -23% Operating Margin (228,620) (204,449) (24,170) 12% Operating Margin % -16% -18% 2% #DIV/0! -11% Non Operating Revenue 148, ,752 - #DIV/0! 0% Net Income/(Loss) (79,868) (55,698) (24,170) 43% *Year to Date (7 months) Pension Liability per GASB Full Board Meeting : August 2018 Unaudited Financial Statement

43 Observations Operating Margin - challenging to budget but drivers to watch vs. same time FY17 Primary Care visits down 1% while Specialty Care visits up 7% Surgical Cases up 4% and slightly above FY 2018 Target Inpatient Discharges down 12% and LOS 11% higher Emergency Department visits up 1% Deliveries down 3%. System-wide uninsured numbers, captured by visit held 42% (Provident 34%, ACHN 42%, Stroger 44%) System wide Financial /Revenue Cycle ratios are indicating progress as well as challenges CountyCare retained over 328,000 members as of end June-2018 and contributed $121M to CCHHS 3 Full Board Meeting : August 2018

44 Financial Metrics Metric As of end June-16/YTD As of end June 17/YTD As of end June-18/YTD Target Days Cash On Hand** days* Operating Margin*** -14% -25.7% -6.0% -24.2% Overtime as Percentage of Gross Salary 7.6% 7.7% 7.6% 5.0%* Average Age of Plant (Years) *Days Cash on Hand - CCHHS target 60 days, Moody's 198 days *Overtime as percentage of Gross Salary CCHHS target 5%, Moody's 2% ** Days Cash in Hand Point in time i.e. as of end June for each year ***Excludes Pension Expense-Target based on compare group consisting of like health systems : Alameda Health System, Harris Health Systems, Nebraska Medical Center, Parkland Health & Hospital System, and UI Health Full Board Meeting : August 2018 Unaudited Financial Statement

45 Metric Average Days in Accounts Receivable (lower is better) Discharged Not Finally Billed Days (lower is better) Claims Initial Denials Percentage (lower is better) Revenue Cycle - Metrics Dec-17 Jan-18 Feb-18 Mar-18 Apr-18 May-18 June % 40% 42% 23% 36% 26% 22% Definitions: Average Days in Accounts Receivable: Total accounts receivable over average daily revenue Discharged Not Finally Billed Days: Total charges of discharge not finally billed over average daily revenue Claims Initial Denials Percentage: Percentage of claims denied initially compared to total claims submitted. 5 Full Board Meeting : August 2018 Unaudited Financial Statement

46 ATTACHMENT #5 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

47 COOK COUNTY HEALTH & HOSPITALS SYSTEM FY2019 Proposed Budget and Financial Plan August, 2018 Dr. Jay Shannon, CEO Doug Elwell, Deputy CEO for Finance & Strategy Ekerete Akpan, CFO

48 2 FY2018 Accomplishments

49 FY2018 Major Accomplishments Transition of more than 200,000 new members into CountyCare. U.S. District Court dissolved the 2010 Consent Decree involving Cermak Health Services. Stroger Hospital re-designated as a Level III Perinatal Center. Stroger Hospital s Burn Unit reaccredited by the American Burn Association. U.S. News and World Report recognized Stroger Hospital with its highest rating for heart failure care in their annual Best Hospital ranking. CCHHS hospitals and outpatient centers achieved Health Information Management Systems Society (HIMSS) Stage 7 in Only 6.4% of providers in the US have reached Stage 7. Stroger Hospital recertified as Advanced Primary Stroke Center by The Joint Commission. 3

50 FY2018 Major Accomplishments Notable capital equipment, clinical, revenue cycle and facility improvements investments* include; o $17.9M in medical equipment o $9.6M in Health Information Technology equipment and upgrades o $8.7M for fixtures & buildouts of new professional office building o $0.4M in safety and communications equipment at Cermak Health Services o $8.7M in revenue cycle systems and technology upgrades 4 *Capital /equipment and facility improvement investment amounts represent full assets values already financed or in advanced planning stages for financing by end of FY2018 through leases and other mechanisms which typically requires a 3 to 5 year payment period

51 5 FY2019 Proposed Budget

52 FY2019 Proposed Budget Executive Summary The FY2019 annual budget proposal moves CCHHS into the final year of Impact The FY2019 budget: Reflects organizational focus on quality improvements, patient satisfaction and regulatory compliance; Continues the strategic development of service lines to grow and compete while meeting healthcare needs of Cook County residents; Continues efforts to build and integrate clinical and managed care capacity across all care settings; and Supports organizational capacity to improve clinical documentation, billing, coding, collections and other revenue cycle activities. 6

53 7 FY2019 Initiatives Deliver High Quality Care Establish outpatient dialysis services at Provident Increase surgery services at Stroger and Provident Grow outpatient services by maximizing health center access Expand community-based dental services Invest in care coordination to improve patient outcomes and health Establish mental health services at Juvenile Temporary Detention Center and for court-involved youth Grow to Serve and Compete Sustain and grow CountyCare membership by 3% Increase CountyCare members use of CCHHS services Opening of new/renovated facilities will increase capacity to drive volumes Expand services offered in community centers for women and children Continue building behavioral health services/capacity Foster Fiscal Stewardship Sustain financial position including level tax allocation at $101.9M Invest in care coordination to improve patient care and better control costs Continually improve billing and collection processes Conduct operational reviews for efficiencies Reduce overtime and registry usage Monitor critical contracts Prioritize strategic initiatives Build on success in securing grant resources

54 FY2019 Initiatives Invest in Resources Replace aging capital equipment Improve employee engagement through training investments, leadership rounding, annual performance evaluation Partner with labor, developing shared vision for organizational success with a patient-centered focus Leverage Valuable Assets Leverage systems such as Time and Attendance to improve management Impact Social Determinants of Health Expand Food as Medicine and Women, Infants and Children (WIC) services at community health centers Supportive housing for medically-at-risk populations Expand evidence-based practices and innovations in addressing substance use disorders Advocate for Patients Provide improved health care for the uninsured and justice-involved population Protect critical federal/state programs including the Affordable Care Act, 340B Drug Discount Program, Medicaid coverage and rates 8

55 FY2019 Proposed Budget Revenue Drivers Increase in CountyCare membership to 345,000 Increases due to initiatives in the following areas: o Dialysis services o Surgery at Provident and Stroger o New larger primary care clinics in the community o Professional Office Building on Central Campus o Specialists physicians in the community o Provident services o Care Coordination Professional and facility billing improvements 9

56 Expense Drivers FY2019 Proposed Budget Increase in CountyCare membership Insourcing where costs can be reduced and quality enhanced Wage increases, driven by negotiated salary changes Mental health services at the Juvenile Temporary Detention Center Pharmacy and medical supplies usage and inflation Health Information Technology investments Investments in revenue cycle Moving from Oak Forest campus assumed by end of 1 st quarter

57 FY 2018 Volume Monthly Average Monthly Projection Difference Visit Type FY 2016 FY 2017 FY 2018 * FY 2019 FY19 v. FY18 Surgical Cases 1,238 1,233 1,245 1,320 6% Emergency Visits 12,901 12,074 12,037 12,750 6% Primary Care Visits 18,436 18,482 18,144 19,051 5% Specialty Care Visits 20,230 20,143 21,325 22,391 5% Deliveries % 11 *based on actuals for first 7 months of FY2018

58 12 FY Budget ( in Millions) *Cook County Allocation is $101.9M total, $29.2 million of which goes to pension contribution FY 2018 Adj. App. FY 2018 Proj. YE NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences. FY 2019 Proposed Revenues CCHHS Revenue $2,478 $2,479 $2,619 Cook County Allocation $102 $102 $102 County Pension Contribution $129 $129 $129 Total Available Funds $2,708 $2,709 $2,849 Expenses Hospital-Based Services $909 $924 $1,023 CountyCare $1,531 $1,531 $1,572 Health Administration $79 $76 $68 Ambulatory Services $175 $168 $165 Correctional Health Services $119 $115 $125 Public Health Services $16 $16 $17 Total Expenditures $2,829 $2,830 $2,970 Accrual Basis Net Surplus/ (Deficit) ($120) ($120) ($120) Non-Cash Expenditures Pension $86 $86 $86 Depreciation $34 $34 $34 Self Insurance $0 $0 $0 Cash Basis Net Surplus/ (Deficit) ($0) $0 ($0) Finance Committee I August 25, 2017

59 FY2019 Proposed CountyCare Financial Summary (in millions) ACA Adult FHP SPD MLTSS/LTSS /IMD TOTAL Projected 2019 Membership 82, ,000 31,000 10, ,000 Revenue (in millions) $517 $505 $511 $288 $1,822 Medical Expense (CCHHS) Medical Expense (Network) ,455 Administrative Expense Total Expenses (in millions) $517 $505 $511 $284 $1,817 Profit/(Loss) $0 $0 $1 $4 $5 Total CCHHS Contribution $137 $25 $118 $3.7 $ NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences.

60 FY2019 Proposed External Revenue by Source (in millions) Patient Fees BIPA DSH CountyCare Others 14 DSH: Disproportionate Share Hospital Payments BIPA: Benefits Improvement and Protection Act Payments NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences.

61 Cook County Pension, Debt Service & Operating Allocation (in millions) The FY18 tax allocation toward CCHHS operations is $102M. The CCHHS FY19 budget will anticipate a level tax allocation from the County of $102M. CCHHS does not anticipate requesting additional County taxpayer support for operating funds in FY * Operating Tax Allocation, Pension and Debt Service assumed at FY2018 level; Pension includes statutory and legacy pension payments NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences.

62 CCHHS Uncompensated Care* (in millions) FY2013 FY2014 FY2015 FY2016 FY2017 FY2018** FY2019** Charity Care Cost Bad Debt Cost 16 * Uncompensated Care is Charity Care + Bad Debt at cost ** FY2018 projected **FY2019 projected NOTE: Some numbers are rounded to nearest million for display purposes and could result in small arithmetical differences.

63 Insurance Status by Unique Patients 48% 52% 40% 60% 65% 66% 35% 34% 39% 61% FY2013 FY2014 FY2015 FY2016 FY2017 Uninsured Insured 17

64 Full Time Equivalent Position Count 2018 Adopted 2019 Proposed FY2019 vs FY2018 Percent Change Health Fund Ambulatory Services % Correctional Health Services % CountyCare and Integrated Care % Health Administration % Hospital-Based Services 4, , % Public Health Services % Grand Total 6, , % 18 NOTE: Some numbers are rounded for display purposes and could result in small arithmetical differences.

65 FY2019 Proposed Budget Key Take-Aways The FY 2019 annual budget proposal aligns with Impact 2020, however, success will depend on: Growth in key volume indicators; Internal capture of CountyCare and other Managed Care business; Improvement in revenue cycle; Flexible staffing and management of overtime and registry utilization; CountyCare membership retention within the plan and state capitation rates. 19

66 20 FY Projections

67 21 FY Budget Projections (in Millions) FY 2018 Proj. YE FY 2019 Proposed FY 2020 Projected FY 2021 Projected Revenues CCHHS Revenue $2,479 $2,619 $2,697 $2,778 Cook County Allocation $102 $102 $102 $102 County Pension Contribution $129 $129 $102 $92 Total Available Funds $2,709 $2,849 $2,901 $2,972 Expenses Hospital-Based Services $924 $1,023 $1,057 $1,070 CountyCare $1,531 $1,572 $1,566 $1,610 Health Administration $76 $68 $70 $72 Ambulatory Services $168 $165 $180 $190 Correctional Health Services $115 $125 $128 $130 Public Health Services $16 $17 $18 $19 Total Expenditures $2,830 $2,970 $3,019 $3,090 Accrual Basis Net Surplus/ (Deficit) ($120) ($120) ($118) ($118) Non-Cash Expenditures Pension $86 $86 $86 $86 Depreciation $34 $34 $34 $34 Self Insurance $0 $0 $0 $0 Cash Basis Net Surplus/ (Deficit) $0 ($0) $2 $2 NOTE: Some numbers are rounded for display purposes and could result in small arithmetical differences.

68 Budget Calendar June 19, 2018 President s FY2018/2019 Preliminary Budget Forecast Released July 12, 2018 July 20, 2018 July 23 25, 2018 August 24, 2018 August 28-29, 2018 August 31, 2018 President s Preliminary Forecast Public Hearing CCHHS Finance Committee Meeting Budget Framework Introduced Cook County Finance Committee Meeting Mid-Year Budget Hearings CCHHS Finance Committee Meeting FY2019 Budget Request for Approval CCHHS Budget Public Hearings CCHHS Board Meeting FY2019 Budget Request for Approval September 12, 2018 Cook County Board Meeting CCHHS FY2019 Proposed Preliminary Budget Introduced & Approved* (for inclusion in Executive Budget Recommendation) October, 2018 Oct/Nov, 2018 President s FY2019 Executive Budget Recommendation Introduced Cook County Public Hearings, Agency & Department Budget Review Meetings Proposed Amendments, Annual Appropriation Bill Adopted 22

69 23 Questions?

70 APPENDIX

71 Insurance Status By Charges 54% 46% 63% 65% 63% 62% 61% 37% 35% 37% 38% 39% FY2013 FY2014 FY2015 FY2016 FY2017 FY2018* Insured Uninsured 25 FY2013 thru FY2017 based on audited financials statement's * FY2018 Unaudited and projected based on first 7 months of Fiscal year.

72 ATTACHMENT #6 Cook County Health and Hospitals System Minutes of the Board of Directors Meeting August 31, 2018

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