Of the Meeting of the Board of Directors of the Cook County Health and Hospitals System (CCHHS) Held Friday, March 25, 2016 at the Hour of 9:00 A.M

Minutes of the Meeting of the Board of Directors of the Cook County Health and Hospitals System (CCHHS) held Friday, March 25, 2016 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 Chairman Collens called the meeting to order. He noted that Chairman Hammock was unable to attend the meeting due to an unexpected travel delay, and Vice Chairman Butler was also unable to attend the meeting.

Director Gugenheim, seconded by Director Wiese, moved to allow Director Collens to preside as Acting Chairman for this meeting, in the absence of Chairman Hammock. THE MOTION CARRIED UNANIMOUSLY.

Present: Acting Chairman Lewis M. Collens and Directors Ric Estrada, Ada Mary Gugenheim; Emilie N. Junge; Erica E. Marsh, MD, MSCI; Mary B. Richardson-Lowry; Carmen Velasquez; and Dorene P. Wiese (8)

Present Telephonically: Director Wayne M. Lerner, DPH, LFACHE (1)

Absent: Chairman M. Hill Hammock and Vice Chairman Hon. Jerry Butler (2)

Director Estrada, seconded by Director Gugenheim, moved to allow Director Lerner to participate as a voting member for the meeting telephonically. THE MOTION CARRIED UNANIMOUSLY.

Additional attendees and/or presenters were:

Cathy Bodnar – Chief Corporate Compliance and Privacy Gladys Lopez –Chief of Human Resources Officer Jeff McCutchan – Interim General Counsel Douglas Elwell – Deputy CEO of Finance and Strategy Suzet McKinney, DrPH, MPH – Illinois Medical District Claudia Fegan, MD – Executive Medical Deborah Santana – Secretary to the Board Director/Medical Director-Stroger John Jay Shannon, MD – Chief Executive Officer

II. Employee Recognition

Dr. John Jay Shannon, Chief Executive Officer, recognized employees for outstanding achievements. Details and further information is included in Attachment #9 - Report from the Chief Executive Officer.

III. Public Speakers

Acting Chairman Collens asked the Secretary to call upon the registered public speakers.

The Secretary called upon the following registered public speakers:

1. Dr. Marjorie Fujara Physician, John H. Stroger, Jr. Hospital of Cook County 2. George Blakemore Concerned Citizen

Page 1 of 108

Minutes of the Meeting of the CCHHS Board of Directors Friday, March 25, 2016 Page 2

IV. Board and Committee Reports

A. Minutes of the Board of Directors Meeting, February 26, 2016

Director Junge, seconded by Director Marsh, moved the approval of the Minutes of the Board of Directors Meeting of February 26, 2016. THE MOTION CARRIED UNANIMOUSLY.

B. Quality and Patient Safety Committee Meeting, March 15, 2016 i. Metrics (Attachment #1)

ii. Meeting Minutes, which include the following action items: • Medical Staff Appointments/Reappointments/Changes

Director Gugenheim presented the Meeting Minutes and reviewed the metrics. The Board reviewed and discussed the information.

Director Gugenheim, seconded by Director Lerner, moved the approval of the Minutes of the Quality and Patient Safety Committee Meeting of March 15, 2016. THE MOTION CARRIED UNANIMOUSLY.

C. Audit and Compliance Committee Meeting, March 17, 2016 i. Metrics (Attachment #2) ii. Meeting Minutes

Director Velasquez provided an overview of the Meeting Minutes, and Cathy Bodnar, Chief Corporate Compliance and Privacy Officer, reviewed the metrics. The Board discussed the information.

Director Velasquez, seconded by Director Junge, moved the approval of the Minutes of the Audit and Compliance Committee Meeting of March 17, 2016. THE MOTION CARRIED UNANIMOUSLY.

D. Managed Care Committee Meeting, March 17, 2016 i. Metrics (Attachment #3) ii. Meeting Minutes

Director Lerner reviewed the Meeting Minutes and Metrics with Douglas Elwell, Deputy CEO of Finance and Strategy. The Board reviewed and discussed the information.

Director Lerner, seconded by Director Marsh, moved the approval of the Minutes of the Meeting of the Finance Committee of March 17, 2016. THE MOTION CARRIED UNANIMOUSLY.

Page 2 of 108

Minutes of the Meeting of the CCHHS Board of Directors Friday, March 25, 2016 Page 3

IV. Board and Committee Reports (continued)

E. Human Resources Committee Meeting, March 18, 2016 i. Metrics (Attachment #4) ii. Meeting Minutes, which include the following action items: • Consideration of proposed FY2016 Executive Incentive Plan for CCHHS Chief Executive Officer • Approval of Proposed Collective Bargaining Agreements with: - House Staff Association of Cook County - International Union of Operating Engineers, Local 399

Director Wiese presented the Meeting Minutes and reviewed the metrics with Gladys Lopez, Chief of Human Resources. The Board reviewed and discussed the information.

Director Wiese, seconded by Director Velasquez, moved the approval of the Minutes of the Human Resources Committee Meeting of March 18, 2016. THE MOTION CARRIED UNANIMOUSLY.

F. Finance Committee Meeting, March 18, 2016 i. Metrics (Attachment #5) ii. Meeting Minutes, which include the following action items: • Contracts and Procurement Items (detail to be provided as an attachment to this Agenda)

Acting Chairman Collens provided an overview of the Meeting Minutes, and Mr. Elwell reviewed the metrics and contractual requests that were considered at the Finance Committee Meeting. The Board reviewed and discussed the information.

Director Estrada, seconded by Director Wiese, moved the approval of the Minutes of the Meeting of the Finance Committee of March 18, 2016. THE MOTION CARRIED UNANIMOUSLY.

V. Action Items

A. Contracts and Procurement Items

There were no Contracts and Procurement Items presented directly for the Board’s consideration.

B. Appointment of Stroger Hospital Department Chair(s) and Division Chair(s) (Attachment #6)

Director Velasquez, seconded by Director Estrada, moved the approval of the proposed Stroger Hospital Department Chair appointment. THE MOTION CARRIED UNANIMOUSLY.

C. Any items listed under Sections IV, V and IX

Page 3 of 108

Minutes of the Meeting of the CCHHS Board of Directors Friday, March 25, 2016 Page 4

VI. Recommendations, Discussion / Information Item

A. Strategic planning discussion (Attachment #7) Topics: Strategic Planning Framework, presented by Dr. John Jay Shannon Strategic Planning Discussion (includes Volumes), presented by Douglas Elwell

Dr. Shannon and Douglas Elwell provided an overview of the two (2) presentations regarding Strategic Planning. The Board reviewed and discussed the information.

VII. Report from Chairman of the Board

A. Quarterly report on Board and Committee meeting attendance by Directors and members of Committees (Attachment #8)

VIII. Report from Chief Executive Officer (Attachments #9 and #10)

Dr. Shannon provided an update on several subjects; detail is included in Attachment #9.

Dr. Shannon introduced and read into the record a Resolution (Attachment #10) that was recently approved by the Cook County Board in honor of Dr. Quentin Young, who recently passed away.

Director Gugenheim, seconded by Director Velasquez, moved to accept the Resolution in memory of Dr. Quentin Young. THE MOTION CARRIED UNANIMOUSLY.

IX. Closed Meeting Items

A. Audit and Compliance Committee Meeting Minutes, March 17, 2016 B. Human Resources Committee Meeting Minutes, March 18, 2016 C. Consideration of proposed FY2016 Executive Incentive Plan for CCHHS Chief Executive Officer D. Appointment of Stroger Hospital Department Chair(s) and Division Chair(s) E. Claims and Litigation F. Discussion of personnel matters

Director Lerner, seconded by Director Gugenheim, 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,” and 5 Page 4 of 108

Minutes of the Meeting of the CCHHS Board of Directors Friday, March 25, 2016 Page 5

IX. Closed Meeting Items (continued)

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 for a hospital, or other institution providing medical care, that is operated by the public body,” and 5 ILCS 120/2(c) (29), regarding “meetings between internal or external auditors and governmental audit committees, finance committees, and their equivalents, when the discussion involves internal control weaknesses, identification of potential fraud risk areas, known or suspected frauds, and fraud interviews conducted in accordance with generally accepted auditing standards of the United States of America.”

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: Acting Chairman Collens and Directors Estrada, Gugenheim, Junge, Lerner, Marsh, Richardson-Lowry, Velasquez and Wiese (9)

Nays: None (0)

Absent: Chairman Hammock and Vice Chairman Butler (2)

THE MOTION CARRIED UNANIMOUSLY and the Board convened into a closed meeting.

Acting Chairman Collens declared that the closed meeting was adjourned. The Board reconvened into the open meeting.

Director Gugenheim, seconded by Director Junge, moved to approve the proposed FY2016 Executive Incentive Plan for the CCHHS Chief Executive Officer. THE MOTION CARRIED UNANIMOUSLY.

X. Adjourn

As the agenda was exhausted, Acting Chairman Collens declared that the meeting was ADJOURNED.

Respectfully submitted, Board of Directors of the Cook County Health and Hospitals System

XXXXXXXXXXXXXXXXXXXXXXX Lewis M. Collens, Acting Chairman

Attest:

XXXXXXXXXXXXXXXXXXXXXXXXX Deborah Santana, Secretary Page 5 of 108 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #1

Page 6 of 108 COOK COUNTY HEALTH & HOSPITALS SYSTEM

CCHHS Board of Directors Quality Dashboard 25 March 2016

1 Page 7 of 108 CCHHS Board QPS Committee Board Quality Dashboard

2 Page 8 of 108 CCHHS Board QPS Committee Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #2

Page 9 of 108 CCHHS BOARD OF DIRECTORS

Corporate Compliance Metrics March 25, 2016

Page 10 of 108 Meeting Objectives

Dissemination of CountyCare Metrics for . General CountyCare Compliance Activity . Grievances and Appeals . Fraud, Waste, and Abuse

2 Page 11 of 108 Board of Directors I March 25, 2016 CountyCare Compliance Activities Metrics for Activities Initiated in Quarter 1 and 2 of State Fiscal Year 2016 (July 1, 2015 – December 31, 2015)

Activity Breakdown

Conflict of Interest

False Claims

Proactive Reactive HC Fraud & Abuse 30% 70% 13 Projects 31 Projects Privacy (HIPAA)

Contract, Policy, Regulation Review

3 Page 12 of 108 Board of Directors I March 25, 2016 Metrics for Grievances Comparison of State Fiscal Year 2015 to Quarter 1 & 2 2016

SFY 2015 SFY 2016

277 Q1 Q2 Total Grievance Categories 2016 2016 YTD

Transportation 205 78 283

Quality of Care 53 26 79 117 111 90 Access to Care 8 4 12 5 5… Other 11 9 20 Q1 Q2 Q3 Q4 Count 277 117 394 Grievances

Total Q1 2016 Q2 2016 Q3 2016 Q4 2016 Total Reported S-FY15 Jul - Sept Oct - Dec Jan - Mar Apr - Jun YTD

Identified 312 277 117 394

Activity Compared 0.05 - to Membership 0.16% 0.07% 0.06% (%)

4 Page 13 of 108 Board of Directors I March 25, 2016 Metrics for Appeals Comparison of State Fiscal Year 2015 to Quarter 1 & 2 2016

Appeals Expedited External Fair Appeals Independent Review Hearing

5 3 Appeals Q1 Q2 Total 1 Categories 2016 2016 YTD Medical 3 27 39 27 66 Necessity 1 12 3 Pharmacy 64 32 96 4 13 16 Other 0 3 3 18 Count 103 62 165 66 68 47 50 37

SFY15 Q1 SFY15 Q2 SFY15 Q3 SFY15 Q4 SFY16 Q1 SFY16 Q2 Total = 4 Total = 63 Total = 64 Total = 82 Total = 103 Total = 62

5 Page 14 of 108 Board of Directors I March 25, 2016 Metrics for Fraud, Waste, and Abuse Comparison of Issues1 Raised State Fiscal Year 2015 to Quarter 1 & 2 2016

SFY 2015 SFY 2016 Fraud, Waste, and Abuse Categories

14 Member Investigations Q1 Q2 Provider Investigations Q1 Q2 Billing Inconsistencies/ Identity Theft 2 7 4 Upcoding Unnecessary Pharmacy Fraud 1 1 8 Hospitalization 7 Quality of Care Concern 1 5

3 Overutilization 1 1 0 “Boilerplate” Billing 1

SFY15 Q1 SFY15 Q2 SFY15 Q3 SFY15 Q4 Kickback Scheme 2 Total = 0 Total = 5 Total = 3 Total = 8 CC Mbrs = 88,894 CC Mbrs = 96,618 CC Mbrs = 179,393 CC Mbrs = 172,873 1 Addressed through monthly CountyCare FWA SFY16 Q1 SFY16 Q2 and HFS OIG Committees. Total = 14 Total = 7 Referred to HFS OIG if indicative of FWA. CC Mbrs = 168,749 CC Mbrs =164,365

6 Page 15 of 108 Board of Directors I March 25, 2016 Questions?

7 Page 16 of 108 Board of Directors I March 25 2016 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #3

Page 17 of 108 CountyCare Metrics Prepared for: CCHHS Board of Directors, March Meeting

Steven Glass, Executive Director, Managed Care March 25, 2016

Page 18 of 108 CCHHS/Cook County Monthly Finance Meeting - CountyCare Dashboard Data as of 03/02/2016 % to % Change From FYTD'16 Budget Budget/ Key Measures Nov'15 Dec'15 Jan'16 Feb'16 Mar'16 Prior Month Trend or Goal Goal 1) QUALITY 1.1) Ambulatory Access - ACA & FHP Adults CountyCare Overall 68.7% 68.7% 68.7% 0.0% -- **% (50th %ile) CCHHS 66.3% 66.3% 66.3% 0.0% -- **% (50th %ile) MHN ACO 71.0% 70.9% 70.7% -0.3% -- **% (50th %ile) ACCESS 67.7% 67.7% 67.6% -0.1% -- **% (50th %ile) All Other 68.8% 68.8% 69.3% 0.7% -- **% (50th %ile) 2) RISK MANAGEMENT 2.1) Completed HRS/HRA (all populations, cum) Overall 52.0% 56.4% 55.1% -2.3%  100% 55.1% MHN ACO 73.2% 75.8% 75.5% -0.4% -- 100% 75.5% La Rabida Care Coordination (CSNs only) 64.2% 66.5% 3.6%  All Other 31.9% 37.8% 34.6% -8.5%  100% 34.6% 3) UTILIZATION 3.1) ER Utilization/1,000 ACA 944 939 965 924 -4.2%  1,017 94.9% FHP 743 747 848 727 -14.3%  ICP 1,315 1,322 1,391 1,372 -1.4%  3.3) Value of CCHHS "Paid" Claims (FYTD) $ 250,376,821 ($6,130,269) ($10,992,047) -44.2%  ($3,413,651) 322.0% 4) MEMBERSHIP 4.1) Monthly Membership 167,148 165,949 164,365 164,221 161,723 -0.1% -- 178,457 90.6% ACA 75,882 72,479 73,270 73,152 70,988 -0.2% -- 85,000 83.5% FHP 88,657 89,926 87,559 87,192 86,703 -0.4% -- 90,506 95.8% SPD 3,417 3,544 3,536 3,877 4,032 9.6%  2,951 136.6% Home/Community Waiver (incl DD) 596 581 617 655 678 6.2%  LTC 212 222 229 251 273 9.6%  4.2) FYTD Member Months 1,846,036 165,949 330,314 494,535 656,258 713,828 91.9% ACA 978,347 72,479 145,749 218,901 289,889 340,000 85.3% FHP 836,463 89,926 177,485 264,677 351,380 362,024 97.1% SPD 32,034 3,544 7,080 10,957 14,989 11,804 127.0% 5) OPERATIONS

FY'15 Q2 FY'15 Q3 FY'15 Q4 FY'16 Q1 Change from (Mar-May) (Jun-Aug) (Sep-Nov) (Dec-Feb) Prior Q # Days Goal Met 5.3) Claims Payment Turnaround Time (days) 39 33 42 35 -16.7%  < 35 Y

Page 19 of 108 CCHHS BOD | Mar 25, 2016 2 Data Charts Provided for Discussion Purposes Only

Page 20 of 108 Quality Metrics Provided for Discussion Purposes Only

% to % Change From FYTD'16 Budget Budget/ Key Measures Dec'15 Jan'16 Feb'16 Mar'16 Prior Month Trend or Goal Goal 1) QUALITY 1.1) Ambulatory Access - ACA & FHP Adults CountyCare Overall 68.7% 68.7% 0.0% -- **% (50th %ile) CCHHS 66.3% 66.3% 0.0% -- **% (50th %ile) MHN ACO 70.9% 70.7% -0.3% -- **% (50th %ile) ACCESS 67.7% 67.6% -0.1% -- **% (50th %ile) All Other 68.8% 69.3% 0.7% -- **% (50th %ile) 1.2) Ambulatory Access - ICP Adults CountyCare Overall 73.8% 74.3% 0.7% -- **% (75th %ile) CCHHS 76.3% 75.6% -0.9% -- **% (75th %ile) MHN ACO NA NA NA **% (75th %ile) ACCESS 69.5% 69.1% -0.6% -- **% (75th %ile) All Other 75.0% 76.1% 1.5%  **% (75th %ile) 1.3) CY'15 State P4P Measures (FHP & ACA) Inpatient Follow-Up 46.0% 45.9% -0.2% -- 60.0% 76.5% Well Child 15 Months - 6 Visits 6.7% 6.7% 0.0% -- **% (90th %ile) Well Child Visits, 3-6 years 63.6% 63.5% -0.2% -- **% (75th %ile) Immunization Status - Combo 3 0.0% 0.0% 0.0% -- **% (50th %ile) Developmental Screenings 37.9% 37.9% 0.0% -- 65.7% 57.7% Post Partum Care 42.6% 42.5% (<25th %ile) -0.2% -- 69% (75th %ile) 61.6% Prenatal Care 78.2% 78.1% (25th %ile) 0.0% -- 85% (75th %ile) 91.9%

@ or Within 5% > 5% From Key: Better of Goal Goal Than Goal

Page 21 of 108 CCHHS BOD | Mar 25, 2016 4 Risk Management & Utilization Metrics Provided for Discussion Purposes Only

% to % Change From FYTD'16 Budget Budget/ Key Measures Dec'15 Jan'16 Feb'16 Mar'16 Prior Month Trend or Goal Goal 2) RISK MANAGEMENT 2.1) Completed HRS/HRA (all populations, cum) Overall 56.4% 55.1% -2.3%  100% 55.1% MHN ACO 75.8% 75.5% -0.4% -- 100% 75.5% La Rabida Care Coordination (CSNs only) 64.2% 66.5% All Other 37.8% 34.6% -8.5%  100% 34.6% 2.2) High-Risk Stratification (all populations, cum) Overall 2.9% 2.8% -3.4%  3.0% 93.3% MHN ACO 4.6% 4.5% -2.2%  3.0% 150.0% La Rabida Care Coordination (CSNs only) 7.3% 7.1% All Other 1.2% 1.0% -16.7%  3.0% 33.3% 3) UTILIZATION 3.1) ER Utilization/1,000 ACA 939 965 924 -4.2%  1,017 94.9% FHP 747 848 727 -14.3%  ICP 1,322 1,391 1,372 -1.4%  3.2) Inpatient Utilization/1,000 ACA 158 169 161 -4.7%  168 100.6% FHP 93 98 93 -5.1%  ICP 367 375 389 3.7%  3.3) Value of CCHHS "Paid" Claims (FYTD) ($6,130,269) ($10,992,047) -44.2%  ($3,413,651) 322.0%

@ or Within 5% > 5% From Key: Better of Goal Goal Than Goal

Page 22 of 108 CCHHS BOD | Mar 25, 2016 5 Membership Metrics Provided for Discussion Purposes Only % to % Change From FYTD'16 Budget Budget/ Key Measures Dec'15 Jan'16 Feb'16 Mar'16 Prior Month Trend or Goal Goal 4) MEMBERSHIP 4.1) Monthly Membership 165,949 164,365 164,221 161,723 -0.1% -- 178,457 90.6% ACA 72,479 73,270 73,152 70,988 -0.2% -- 85,000 83.5% FHP 89,926 87,559 87,192 86,703 -0.4% -- 90,506 95.8% SPD 3,544 3,536 3,877 4,032 9.6%  2,951 136.6% Home/Community Waiver (incl DD) 581 617 655 678 6.2%  LTC 222 229 251 273 9.6%  4.2) FYTD Member Months 165,949 330,314 494,535 656,258 713,828 91.9% ACA 72,479 145,749 218,901 289,889 340,000 85.3% FHP 89,926 177,485 264,677 351,380 362,024 97.1% SPD 3,544 7,080 10,957 14,989 11,804 127.0% 4.3) Mbrs by Delegated Care Management Group CCHHS (ACHN, LTSS, non-MHN ACO) 84,609 84,378 85,976 1.9%  MHN ACO 81,340 79,987 78,245 -2.2%  La Rabida Care Coordination (CSNs only) 2,564 1,676 -34.6%  4.4) Members Lost to Medicaid Cancellation # Mbrs Due for Redetermination 5,470 3,775 7,362 95.0%  # Rede Cancellations 2,800 4,161 2,773 -33.4%  # Coverage Restored 1,379 772 838 8.5%  % Cancelled Due to Lack of Rede 26.0% 89.8% 26.3% -70.7%  < 22% 83.7% 4.5) Cook County Enrollment by Health Plan (rank order) Rank Aetna Better Health Inc. 73,523 96,824 31.7%  6th Blue Cross Blue Shield 154,507 196,826 27.4%  1st CountyCare 160,415 162,435 1.3%  2nd Family Health Network 151,001 150,893 -0.1% -- 3rd Data Not Yet Harmony Health Plan 105,418 104,628 -0.7% -- 5th Available IlliniCare Health Plan 87,366 106,503 21.9%  4th Meridian Health Plan 71,913 76,076 5.8%  8th Molina Health Care 77,862 7th Next Level Health Page 2319,460 of 108 CCHHS9th BOD | Mar 25, 2016 @ or Within 5% > 5% From Key: Better 6 of Goal Goal Than Goal Operations Metrics Provided for Discussion Purposes Only

% to % Change From FYTD'16 Budget Budget/ Key Measures Dec'15 Jan'16 Feb'16 Mar'16 Prior Month Trend or Goal Goal 5) OPERATIONS 5.1) Member & Provider Services Call Center Goal Goal Met Abandonment Rate 1.85% 3.95% 1.42% -64.1%  < 5% Y Hold Time 0:00:59 0:01:08 0:00:55 0:00:09  < :01:00 N Average Speed to Answer 0:00:18 0:00:31 0:00:15 0:00:13  < :00:45 Y 5.2) Claims/Encounters Acceptance Rate 24% 80.7% 80% 100.8% FY'15 Q2 FY'15 Q3 (Jun- FY'15 Q4 FY'16 Q1 Change from (Mar-May) Aug) (Sep-Nov) (Dec-Feb) Prior Q # Days Goal Met 5.3) Claims Payment Turnaround Time (days) 39 33 42 35 -16.7%  < 35 Y @ or Within 5% > 5% From Key: Better of Goal Goal Than Goal

Page 24 of 108 CCHHS BOD | Mar 25, 2016 7 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #4

Page 25 of 108 COOK COUNTY HEALTH & HOSPITALS SYSTEM

Human Resources Metrics for CCHHS Board Of Directors March 25, 2016

Gladys Lopez, Chief of Human Resources

Page 26 of 108 Hiring Waterfall & Snapshot (02/29/16) 533 Positions in process 700

600 38 39 105 500 8 17 400 62 20 93 300 151 200 Count of of Count positions 100 112 67

Shared Human Human Management Management Responsibility Resources Resources Human Resources

2 Page 27 of 108 CCHHS Human Resource Committee I 03/25/16 Human Resources Metrics Summary DATA THROUGH: 02/29/16 Gladys Lopez, Chief of Human Resources Goal: Continue to maintain open Fiscal Year 2016 vacancies at 750 or ≤ December 1, 2015 - November 30, 2016

1 VACANCIES FILLED FY15 TOTAL Quarter 1 Quarter 2 Quarter 3 Quarter 4 FY16 TOTAL CCHHS External 167 53 53 CCHHS Internal 88 14 14 Total CCHHS: 255 67 67

Nursing External 47 5 5 Nursing Internal 24 1 1 Total Nursing: 71 6 6

SEPARATIONS VARIANCE CCHHS Separations 206 143 143 -63  -31% Total Net New CCHHS: -39 -90 -90 -51  131%

Nursing Separations 61 39 39 -22  -36% Total Net New Nursing: -14 -34 -34 -20  143%

TURNOVER CCHHS FTEs 6,017 6,273 6,273 256  4% Total CCHHS Turnover: 3.4% 2.3% 2.3% -1.1%  -33%

CCHHS New Hire FTEs 167 52 52 -115  -69% CCHHS New Hire Separations 2 4 4 2 = 100% Total FY15 New Hire Turnover: 1% 8% 8% 6%  542%

OPEN VACANCIES Target Total CCHHS Vacant Positions: 750 767 846 846 79  10% Less Deleted Positions / PIDs 11 0 Total RTHs in HR (In Process): 744 533 533 -211  -28%

AVERAGE TIME TO HIRE Target Average Days to Hire (Month): 110 140 131 131 -9  -6%

Average Time to Hire Open Vacancies 135 131 Fill Time (YTD) Target (110) 900 130 125 846 Vacant Positions (YTD) Target (750) 850 120

115 800 110 110 750 105 750 100 95 700 Quarter 1 Quarter 2 Quarter 3 Quarter 4 Quarter 1 Quarter 2 Quarter 3 Quarter 4 3 1 Data thru 02/29/16 Page 28 of 108 CCHHS Board of Directors I 03/25/16 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #5

Page 29 of 108 COOK COUNTY HEALTH & HOSPITALS SYSTEM

CCHHS Board of Directors Finance Dashboard 25 March 2016

1 Page 30 of 108 Board Finance Dashboard Change FYTD’16 % to Key Measures 2013 2014 2015 2016 From Prior Budget or Budget or Period Goal Goal Days in Patient Accounts Receivable 48 37 33 52 57.6% 49.8 4.4% (Net)*

Days Cash on Hand 96 96 108 45 -58.3% 60 25.0%

Operating Margins as a %tage of Total -47.6% -11.7% -9.1% -12.9% -41.8% 2% Operating Revenue Overtime as %tage of 8.3% 8.3% 7.3% 9.5% 30.1% 5.0% -90.0% Gross Salary

2 Page 31 of 108 Board Finance Dashboard

3 Page 32 of 108 Volumes/Stats

4 Page 33 of 108 5 Page 34 of 108 6 Page 35 of 108 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #6

Page 36 of 108 Page 37 of 108 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #7

Page 38 of 108 Cook County Health & Hospitals System Strategic Planning Framework

CCHHS Board of Directors March 25, 2016

Page 39 of 108 Strategic Planning Objectives

Objectively assess CCHHS's market, clinical, quality, operational, facility, and financial performance

Articulate a clear, compelling, and shared vision and strategy for CCHHS

Identify the strategic initiatives required to position CCHHS for growth

Determine the resources required to implement the strategic initiatives

Establish a set of relevant goals and associated metrics

Page 40 of 108 2 Strategic Planning Activities By Phase

Initiate Assess Design Finalize • Organize launch • Profile industry trends • Summarize CCHHS • Draft implementation • Identify data available • Evaluate market Strengths and plan • Assemble and charter dynamics Weaknesses • Prepare final strategic teams • Benchmark operational • Identify options plan document • Identify key issues performance • Conduct scenario • Present strategy • Elicit stakeholder analysis feedback • Establish strategic direction • Identify Areas of Focus • Incorporate feedback

Page 41 of 108 3 Strategic Planning Framework Guidelines

Tactics Improve Health Focus Area Tactics Equity Strategies Tactics Building a high quality, safe, Tactics reliable, patient- Provide high quality, Focus Area Tactics safe and reliable care Strategies centered, integrated Tactics health system that maximizes resources Demonstrate value, Tactics to ensure the adopt performance FocusStrategies Area Tactics greatest benefit for benchmarking Tactics the patients and communities we Tactics Develop human Focus Area serve capital Strategies Tactics Tactics

Lead in Medical Education and Clinical Tactics Investigation relevant FocusStrategies Area Tactics to vulnerable Tactics populations

Actions and Major areas of focus that Plan of action to initiatives that define the “big buckets of achieve the focus support each work” required to achieve area goals strategy the vision Page 42 of 108 4 Strategic Planning Activities By Key Date Date Activity February March April May June Initiate Assess/Design/Feedback Finalize Feb. 26 Launch Strategic Planning Process March 8 Brief Stroger Medical Staff March 15 ACHN Quarterly Meeting/Physicians Leadership Meeting March 16 Leadership Forum/Nursing Leadership Meeting March 17 Managed Care Committee Meeting March 18 Human Resources Committee Meeting March 18 Finance Committee Meeting March 25 CCHHS Board March 28 Labor Management April 2 Stroger Medical Staff April 13 Provident Medical Staff/Cook County Board of Commissioners April 19 Quality Committee/Physicians Leadership Meeting April 20 Leadership Forum/Nursing Leadership Meeting April 21 Audit and Compliance Committee April 22 Human Resources Committee/Finance Committee Meeting April 28 Labor Management April 29 CCHHS Board May TBD Civic Groups and Organizations May 10 Stroger Medical Staff May 17 Quality Committee May 18 Physician’s Leadership Meeting May 19 Leadership Forum/Nursing Leadership Meeting May 19 Managed Care Committee/Audit and Compliance Committee May 20 Human Resources Committee/Finance Committee Meeting May 23 Labor Management May 27 CCHHS Board – Draft Strategy Issued for Public Review June 14 Quality Committee June 14 Stroger Medical Staff/Physician’s Leadership Meeting June 15 Leadership Forum/Nursing Leadership Meeting June 16 Audit and Compliance Committee June 17 Human Resources Committee/Finance/Managed Care June 21 Quarterly ACHN Meeting • Seek approval for Strategy at June 24 CCHHS Board meeting • Seek approval for Strategy at later date Cook PageCounty 43 Board of 108 of Commissioners 5 April/May Committee Meetings: Assess, Develop

The goal: The facilitator will lead the Board in a discussion of strategies that can be implemented to achieve success in the Key Area of Focus.

Proposed Topics are areas previously identified at Board meetings and elsewhere that can help direct discussion.

Key Area of Focus Proposed Topics

• Nursing Strategy • Comparison Data/Inpatient Data • Provide high quality, safe and reliable care • Continuum of Care • Improve Health Equity • Correctional Health Services • Health Equity

• Develop human capital • Human Capital • Lead in Medical Education and Clinical • Graduate Medical Education Investigation relevant to vulnerable populations • Research

• Financial Outlook • Compliance • Demonstrate value • Medical Practice Plan Strategy • Adopt performance benchmarking • Medicaid Managed Care • Technology

Page 44 of 108 6 Strategy Discussions March 25, 2016 Doug Elwell Deputy CEO of Finance and Operations

1 Page 45 of 108 Strategic Discussion March 25, 2016 Strategic Issues

• Investment in Ambulatory facilities • Investment in Primary Care • Investment in high tech equipment • Investment in clinical lines including partnerships – Maternal/Child – Laboratory Services – Oncology – Post Acute • Ability to finance investments

2 Page 46 of 108 Strategic Discussion March 25, 2016 • CCHHS Volume Summary

• Revenue

3 Page 47 of 108 Strategic Discussion March 25, 20142016 Inpatient & Observation

4 Page 48 of 108 Strategic Discussion March 25, 2016 Inpatient & Observation Patient Days

12,000

6% decrease since 2013

10,000

8,000

6,000

4,000

31% increase since 2013

2,000

- 1/1/2013 2/1/2013 3/1/2013 4/1/2013 5/1/2013 6/1/2013 7/1/2013 8/1/2013 9/1/2013 1/1/2014 2/1/2014 3/1/2014 4/1/2014 5/1/2014 6/1/2014 7/1/2014 8/1/2014 9/1/2014 1/1/2015 2/1/2015 3/1/2015 4/1/2015 5/1/2015 6/1/2015 7/1/2015 8/1/2015 9/1/2015 1/1/2016 2/1/2016 10/1/2013 11/1/2013 12/1/2013 10/1/2014 11/1/2014 12/1/2014 10/1/2015 11/1/2015 12/1/2015

Inpatient Observation

5 Page 49 of 108 Strategic Discussion March 25, 2016 Emergency Services

6 Page 50 of 108 Strategic Discussion March 25, 2016 Emergency- Stroger

14,000

12,000

10,000

8,000

6,000

12% decrease since 2013 4,000

2,000

0 Jul-13 Jul-14 Jul-15 Jan-13 Jan-14 Jan-15 Jan-16 Jun-13 Jun-14 Jun-15 Oct-13 Oct-14 Oct-15 Feb-13 Apr-13 Feb-14 Apr-14 Feb-15 Apr-15 Sep-13 Sep-14 Sep-15 Dec-13 Dec-14 Dec-15 Aug-13 Aug-14 Aug-15 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 May-13 May-14 May-15

7 Page 51 of 108 Strategic Discussion March 25, 2016 Trauma- Stroger

800

700

600

500

400

300 11% increase since 2013 200

100

- Jul-13 Jul-14 Jul-15 Jan-13 Jan-14 Jan-15 Jan-16 Jun-13 Jun-14 Jun-15 Oct-13 Oct-14 Oct-15 Feb-13 Apr-13 Feb-14 Apr-14 Feb-15 Apr-15 Sep-13 Sep-14 Sep-15 Dec-13 Dec-14 Dec-15 Aug-13 Aug-14 Aug-15 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 May-13 May-14 May-15

8 Page 52 of 108 Strategic Discussion March 25, 2016 Emergency- Provident

3,500

3,000

2,500

2,000 20% decrease since 2013

1,500

1,000

500

9 Page 53 of 108 Strategic Discussion March 25, 2016 Ambulatory Care

10 Page 54 of 108 Strategic Discussion March 25, 2016 Total Provider Visits

60,000

50,000

40,000

7% decrease since 2013 30,000

20,000

10,000

0 Jul-13 Jul-14 Jul-15 Jan-13 Jan-14 Jan-15 Jan-16 Jun-13 Jun-14 Jun-15 Oct-13 Oct-14 Oct-15 Feb-13 Apr-13 Feb-14 Apr-14 Feb-15 Apr-15 Feb-16 Sep-13 Sep-14 Sep-15 Dec-12 Dec-13 Dec-14 Dec-15 Aug-13 Aug-14 Aug-15 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 May-13 May-14 May-15

11 Page 55 of 108 Strategic Discussion March 25, 2016 Urgent Care

4,000

3,500 18% decrease since 2013 3,000

2,500

2,000

1,500 14% decrease since 2013

1,000

500

0 Jul-13 Jul-14 Jul-15 Jan-13 Jan-14 Jan-15 Jan-16 Jun-13 Jun-14 Jun-15 Oct-13 Oct-14 Oct-15 Feb-13 Apr-13 Feb-14 Apr-14 Feb-15 Apr-15 Feb-16 Sep-13 Sep-14 Sep-15 Dec-13 Dec-14 Dec-15 Aug-13 Aug-14 Aug-15 Nov-13 Nov-14 Nov-15 Mar-13 Mar-14 Mar-15 May-13 May-14 May-15 ASC ICC

12 Page 56 of 108 Strategic Discussion March 25, 2016 Ambulatory Provider Visit Summary

300,000

250,000

200,000

150,000

100,000

50,000

0 Primary Specialty Other

FY2013 FY2014 FY2015

13 Page 57 of 108 Strategic Discussion March 25, 2016 Specialty Care Provider Visits- Total

140,000

120,000

2% decrease since 2013

100,000

80,000

60,000

40,000

20,000

0 Cicero CORE Fantus Morton East OFHC Sengstacke SHCC Clinics Specialty Care

FY2013 FY2014 FY2015

14 Page 58 of 108 Strategic Discussion March 25, 2016 Specialty Care Provider Visits- Adults

140,000

120,000 2% decrease since 2013

100,000

80,000

60,000

40,000

20,000

0 CORE Fantus OFHC Sengstacke SHCC Clinics Specialty Care

FY2013 FY2014 FY2015

15 Page 59 of 108 Strategic Discussion March 25, 2016 Specialty Care Provider Visits- Peds

7,000

6,000

8% increase since 2013 5,000

4,000

3,000

2,000

1,000

0 Cicero Fantus Morton East SHCC Clinics Specialty Care

FY2013 FY2014 FY2015

16 Page 60 of 108 Strategic Discussion March 25, 2016 Primary Care Provider Visits- Total

60,000

50,000

9% decrease since 2013 40,000

30,000

20,000

10,000

FY2013 FY2014 FY2015

17 Page 61 of 108 Strategic Discussion March 25, 2016 Primary Care Provider Visits- Adults 60,000

50,000

40,000

8% decrease since 2013 30,000

20,000

10,000

FY2013 FY2014 FY2015

18 Page 62 of 108 Strategic Discussion March 25, 2016 Primary Care Provider Visits- Peds

7,000

6,000

18% decrease since 2013 5,000

4,000

3,000

2,000

1,000

0 Child Advocacy Cicero CORE Fantus Logan Square Morton East Sengstacke Vista

FY2013 FY2014 FY2015

19 Page 63 of 108 Strategic Discussion March 25, 2016 Diagnostics & Lab

20 Page 64 of 108 Strategic Discussion March 25, 2016 Radiology- Total 35,000

30,000

25,000

20,000 4% decrease since 2013

15,000

10,000

5,000

21 Page 65 of 108 Strategic Discussion March 25, 2016 Radiology- CT Scans

6,000

5,000

4,000

3,000

1% increase since 2013 2,000

1,000

22 Page 66 of 108 Strategic Discussion March 25, 2016 Radiology- Diagnostic

25,000

20,000

15,000

10,000

10% decrease since 2013 5,000

23 Page 67 of 108 Strategic Discussion March 25, 2016 Radiology- Interventional

250

200

150 36% increase since 2013

100

24 Page 68 of 108 Strategic Discussion March 25, 2016 Radiology- MRI

900

800

700

600 27% increase since 2013 500

400

300

200

100

25 Page 69 of 108 Strategic Discussion March 25, 2016 Radiology- Mammography 1,400

1,200

1,000

800

5% increase since 2013 600

400

200

26 Page 70 of 108 Strategic Discussion March 25, 2016 Radiology- Nuclear Medicine

700

600

500

400 <1% increase since 2013

300

200

100

27 Page 71 of 108 Strategic Discussion March 25, 2016 Radiology- Ultrasound 3,500

3,000

2,500

2,000

17% increase since 2013 1,500

1,000

500

28 Page 72 of 108 Strategic Discussion March 25, 2016 Laboratory 300,000

250,000

200,000

150,000 2% decrease since 2013

100,000

50,000

29 Page 73 of 108 Strategic Discussion March 25, 2016 Surgery

30 Page 74 of 108 Strategic Discussion March 25, 2016 Surgery

1,000 19% increase since 2013 900

800

700

600

500

400 8% increase since 2013 300

200

100

Inpatient Outpatient

31 Page 75 of 108 Strategic Discussion March 25, 2016 Deliveries

32 Page 76 of 108 Strategic Discussion March 25, 2016 Deliveries

1000

900

800

700

600

500

400

300

200

100

0 2012 2013 2014 2015

33 Page 77 of 108 Strategic Discussion March 25, 2016 Radiology Summary • Number of linear accelerator treatments increased nearly 500% from 2014 • Interventional radiology has increased 37% since 2013 • Mammography has increased 5% since 2013 with an expected increase in demand through partnership with City of Chicago • Ultrasound volume has increased 17%

34 Page 78 of 108 Strategic Discussion March 25, 2016 External Data

35 Page 79 of 108 Strategic Discussion March 25, 2016 State of Illinois: Outpatient Hospital Spending

36 Page 80 of 108 Strategic Discussion March 25, 2016 State of Illinois: Inpatient Spending

37 Page 81 of 108 Strategic Discussion March 25, 2016 State of Illinois: Medical Programs Spending

38 Page 82 of 108 Strategic Discussion March 25, 2016 United States Hospital Utilization

39 Page 83 of 108 Strategic Discussion March 25, 2016 Milliman Medical Index: Components of Healthcare Spending

40 Page 84 of 108 Strategic Discussion March 25, 2016 Milliman Medical Index: Annual Rate of Increase

41 Page 85 of 108 Strategic Discussion March 25, 2016 National Health Expenditures

42 Page 86 of 108 Strategic Discussion March 25, 2016 National Acute Care Hospital Expenditures

Strategic Discussion March 25, 2014

43 Page 87 of 108 Strategic Discussion March 25, 2016 Revenue

44 Page 88 of 108 Strategic Discussion March 25, 2016 Revenue

• Most Medicaid monies including Disproportionate Share Hospital (DSH) payments, Medicaid Fee for Service (FFS), Benefits Improvement and Protection Act (BIPA) Funds are based on cost • They are also based on Cook County Health and Hospitals System paying the state share of the cost • Medicaid managed care capitation payments are based on actuarial soundness • Medicaid managed care payments to providers are primarily based on fee schedules • Accountable Care Act funding was game changer, but still has challenges

45 Page 89 of 108 Strategic Discussion March 25, 2016 Revenue

• Historically the combination of County funding and the 50% of cost from federal sources worked • As the County funding shrinks, the challenge increases • ACA, Medicare, Commercial, and Medicaid MCO patients become key to future success

Page 90 of 108 46 Strategic Discussion March 25, 2016 Revenue • Breakdown of cash receipts (in millions) Payor 2014 2015 Budget 2016 BIPA $101 $139 $131 DSH $170 $158 $162 CC $728 $847 $952 MC $72 $68 $70 FFS $160 $161 $41 MCO $0 $31 $92 Phys $11 $15 $18 Other $34 $66 $62 Total $1,276 $1,485 $1,529

47 Page 91 of 108 Strategic Discussion March 25, 2016 Risk and Opportunities

• BIPA • DSH • CC • MC • FFS • MCO • Phys • ACA • Exchange • Research/Grants

Page 92 of 108 48 Strategic Discussion March 25, 2016 • Post-inpatient care continuum of care services: Nursing Homes, Rehabilitation Facilities, Home Care, Home Infusion, Inpatient Meals-On-Wheels, etc.

Procedures and Tests

Ambulatory Specialty Care

Ambulatory Primary Care

49 Page 93 of 108 Strategic Discussion March 25, 2016 Discussion

50 Page 94 of 108 Strategic Discussion March 25, 2016 Previews

• Expenses • Staff to Volumes • Debt • Pension • CART – Clinical – Administrative – Research – Teaching

51 Page 95 of 108 Strategic Discussion March 25, 2016 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #8

Page 96 of 108 Cook County Health and Hospitals System Board Attendance - 2016 Board 2015-2016 18-Dec 29-Jan 26-Feb

Hammock, Chr X X X Butler X X X Collens X X Estrada X X Gugenheim X X X Junge X X X Lerner X X phone Marsh X X X Richardson-Lowry X X X Velasquez X X Wiese X X X

Finance Committee: 11-Dec 22-Jan 19-Feb

Collens, Chr X X Butler X X X Estrada X X X Richardson-Lowry X X X Wiese X X X

Scheer X X

Hammock phone X X Gugenheim X X X Junge X X X Velasquez X X

Human Resources 11-Dec 22-Jan 19-Feb Committee: Wiese, Chr X X X Collens X X Richardson-Lowry X X X

Non- Board Member

Hammock phone X X Butler X X X Estrada X Gugenheim X X X Junge X X X Velasquez X X

1st Quarter FY2016 Presented at 3/25/16Page Board97 of of108 Directors Meeting 1 Cook County Health and Hospitals System Board Attendance - 2016

Quality & Patient 8-Dec 19-Jan 16-Feb Safety Committee:

Gugenheim X X X Lerner X X phone Marsh X X

Merryweather X X X Driscoll X X phone

Hammock phone X X Butler X Junge X

Audit & Compliance Dec. 19-Jan 18-Feb Committee: no meeting scheduled Velasquez, Chair X X Gugenheim X X Junge X

Bauman phone X

Hammock X X

Managed Care Dec. 21-Jan Feb. Committee: no meeting no meeting scheduled scheduled Lerner, Chair X Junge X Velasquez

Non- Board Member

Hammock X

Gugenheim X

1st Quarter FY2016 Presented at 3/25/16Page Board98 of of108 Directors Meeting 2 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #9

Page 99 of 108

JOHN JAY SHANNON, MD CHIEF EXECUTIVE OFFICER COOK COUNTY HEALTH & HOSPITALS SYSTEM REPORT TO THE BOARD OF DIRECTORS March 25, 2016

Recognition

Suzet McKinney, DrPH, MPH, was named Executive Director of the Illinois Medical District Commission (IMDC) in August 2015. Among other responsibilities, Dr. McKinney is charged with execution of the IMDC’s strategic plan, and has recently released the 2016 Illinois Medical District (IMD) Master Plan. The IMDC priorities include the development of approximately 45 acres of land, fostering translational research, promoting community health, and managing and leveraging clinical data. Prior to joining the IMDC, Dr. McKinney has served as Deputy Commissioner of the Bureau of Public Health Preparedness & Emergency Response and the Division of Women & Children’s Health at the Chicago Department of Public Health.

CCHHS’ Annual Resident Education Day took place on Thursday, March 11, 2016. This year’s winners include:

Outstanding Clinical Vignette • First Place - Sharad Khurana: Platypnea-Orthodeoxia Due To Bleomycin-Induced Intrapulmonary Shunt • Second Place - Hemant Mutneja: Choledochal Cyst With Autosomal Dominant Polycystic Kidney Disease: It is far more rare than you think! • Third Place - Anas Almoghrabi: An Unusual Case of Dysphagia

Outstanding Original Research Poster • First Place - Hemant Mutneja: Mesalamine in Prevention of Recurrent Diverticulitis: A Systematic Review • Second Place - Christopher Chung: Development and Evaluation of a Pharmacist-led Vancomycin Monitoring Service for High Risk Patients at a Tertiary Care Teaching Hospital with Limited Clinical Pharmacy Staff

Best QI Poster Presentation • Muriel Go: Don’t Give Me This Shot - Demographics, Reasons and Solutions to Influenza Vaccine Refusals at CCHHS

Best Clinical Vignette Presentation • Yuchen Wang: Hypertriglyceridemia Induced Acute Pancreatitis in Diabetic Ketoacidosis: Chicken or the Egg

Best Clinical Vignette - Clinical Significance • Sharad Khurana: Platypnea-Orthodeoxia Due To Bleomycin-Induced Intrapulmonary Shunt

Best Clinical Vignette – Visual Presentation • Aswathi Chandran: Dilemmas In Managing Warfarin Induced Major Bleed With Mechanical Heart Valve

Best Oral Presentation Clinical Vignette • Ashish Angl: Is the patient having myocardial ischemia after ablation?

Best Oral Presentation QI Category • Muhammad Mushtaq: From their own perspective: Attributes and Perceptions of Medical Patients Regarding Readmission at an Urban County Hospital

Page 100 of 108

Best Oral Presentation Original Research Category • Muhammad Mushtaq: Lab indicators of Iron Level in Bone Marrow Aspirate of Patients Diagnosed with Multiple Myeloma

Best Oral Presentation: Special Mention For A Very Interesting Topic • Ayla Pelleg: Stealth Assassins: Healthcare Professionals Serial Killers

Stroger Hospital’s Trauma Unit was pleased to host the re-enlistment ceremony of United States Navy Hospital Corpsman Second Class Jose Tamez on March 12th. Corpsman Tamez is participating in the U.S. Navy/Stroger training program that provides ongoing trauma training to active duty members of the U.S. Navy. We were honored to have Senator Richard Durbin join us for the ceremony. Following the ceremony, Senator Durbin toured the trauma unit and met with the Navy personnel and our trauma team to discuss the program and the impact it has had on both teams. Chicago Sun Times columnist Mark Brown attended the event. His story (attached) ran on Sunday, March 20th.

Patient Experience Recognition

The difference between CountyCare and other Medicaid managed care plans can be seen very clearly from this story as told by Rachel Reichlin, Manager of Care Management, CountyCare.

A CountyCare patient was notified that his therapy would be discontinued because his Medicaid benefits were being terminated as a result of not completing the redetermination process. The patient and facility reached out to Latonja Simmons-Holmes at the CountyCare Call Center. Ms. Simmons-Holmes was able to connect him with Rachel Reichlin, Manager of Care Management, CountyCare. The patient was also provided with contact information for Heather Holberg, Enrollment Manager, CountyCare and Michelle Graham-Brown, Clinical Case Manager, CountyCare. Although he initially understood that his rede paperwork could be processed in 24hrs, he later learned that it could take 7-10 days. He informed me (Ms. Reichlin) that the facility would discontinue his PT/OT because his insurance had expired. Then he met with Daniel, an administrator at the facility. The patient stated, “There are no chiefs and Indians here, he wanted me to call him Daniel.” The patient informed our team that Daniel was going to reinstate the PT/OT and the care that he needed. He did inform him that if, for some reason he wasn’t reinstated in Medicaid, the patient would get a bill. Our patient understood stating, “I know, they have to get paid.” He confirmed that he had no increase or change in income since his medical condition occurred last year. Ms. Reichlin reinforced Daniel’s message that it was very unlikely that he wouldn’t be reinstated, though no guarantees. As soon as he is redetermined, it would be retroactive to 3/1 and the care would be covered. The patient sighed and stated, “you don’t know how much it means to me that you called, thank you.” He spoke of the mental burden for somebody in his situation to carry the potential of incurring great debt and the instability in the midst of a health crisis/need.

He went on to say that the staff at the facility he has been receiving care at is really different. They are all passionate and dedicated and really care. He said, “I’m going to be writing complimentary letters, you should know about the good ones!” Between the social worker at the facility, the providers, Daniel and Latonja in the call center, he expressed a lot of gratitude.

This story is indicative of the commitment of the CountyCare team in making the health of our members the first priority. Few, if any, other managed care plans would go to these lengths to ensure continuity of care regardless of the member’s insurance status. Rather they likely would have dropped this patient from coverage leaving the individual with significant medical bills.

2 | Page

Page 101 of 108

Activities and Announcements

• The Joint Commission completed its follow-up survey of Stroger Hospital March 11 and 12, 2016. Stroger Hospital’s three year accreditation is effective March 12, 2016.

• The nation’s first blood bank opened at Cook County Hospital on March 15, 1937. The blood bank was founded by Dr. Bernard Fantus, an inventive Cook County Hospital physician. The cost to open the blood bank was $1,500 and it helped facilitate 1,354 blood transfusions in its first year. The ability to store and transfuse blood has made modern surgery and resuscitation in critical care, trauma and obstetrics possible.

Today, the blood bank at Stroger Hospital supports more than 15,000 transfusions a year, including over 100 massive (large volume) transfusions for patients with traumatic injuries or hemorrhagic shock from other causes.

Through the Decades, a daily time capsule of significant events on Decades Network featured the blood bank last week. View the video here: http://www.decades.com/videos/view/first-blood-bank

• The new CCHHS Patient Support Center officially opened last week. The new PSC is located on the first floor of the administration building and has allowed for the entire PSC staff to be centrally located. The PSC is currently taking more than 2,000 calls daily. Board members are encouraged to join us for a quick visit to the PSC following today’s board meeting.

• On Monday, March 7, CCHHS/CountyCare hosted its 4th redetermination event for CountyCare members at the Lawndale Christian Health Center located at 3860 W. Ogden Avenue in Chicago. More than 50 CountyCare members attended the event for assistance with redetermination paperwork and other enrollment questions. Most of the attendees utilize the health centers within the Central Chicago geographical area which included the CCHHS Fantus and Prieto Health Centers, Lawndale Christian, Esperanza, Access and Alivio Health Centers. About half of the people who attended were Spanish speakers. Overall, we received extremely positive feedback from the CountyCare members, with one member who said that her “County” doctors are awesome and that “..she and her children were born there and it’s a great place”. Our next redetermination event will take place on Wednesday, April 27th at the CCHHS Cottage Grove Health Center in Ford Heights. In addition, we are reaching out to Alivio to host an event in April at their Berwyn site.

• The second issue of the CCHHS community newsletter was sent on March 18th. The distribution list has grown to approximately 2,400 individuals and organizations.

• Upcoming Events: o Monday, April 4: Dr. Shannon will participate on a panel discussion on Medicaid expansion as a critical structural achievement for low income persons with mental illnesses. The event is sponsored by the Civic Federation and the Federal Reserve Bank of Chicago. o Tuesday, April 12: GFCD Fresh Food Truck at Cottage Grove Health Center o Saturday, April 4: “Men Only” Health Fair at Provident o Wednesday, April 27: Redetermination Event at the Cottage Grove Health Center

3 | Page

Page 102 of 108 Legislative Update

State • In April, Illinois will begin its 10th month without a comprehensive state budget in place. Despite the lack of a budget, the state is on pace to spend well over projected revenues. Earlier this month, the Illinois Comptroller said that the state’s bill backlog could be at $10 billion by June 2016.

• The Illinois Department of Human Services (IDHS) reported to a Senate committee that 800 entities contracted with IDHS are owed more than $168M for services provided since July 1, 2015. Institutions of higher education have also not been paid since July 1, 2015 and many have announced layoffs and mandatory furlough days in an effort to keep their doors open.

• The Illinois Senate passed a $3.8B appropriations bill (SB2059) that would authorize spending for higher education, MAP grants, and human services programs. SB2059 includes no new revenue. The bill now goes to the House for consideration.

• The House will return to Springfield on April 4, 2016 and the Senate returns on April 5, 2016. The General Assembly is scheduled to adjourn May 31, 2016.

Federal • In late February, Cook County Board President Toni Preckwinkle and Letitia Close, Executive Director of Governmental Affairs, CCHHS, attended the National Association of County Organizations (NACo) Legislative Conference in Washington, D.C. Cook County presented two Resolutions on behalf of CCHHS to NACo’s Health Steering Committee.

The first Resolution pertains to Section 1905 of the Social Security Act which prohibits Medicaid from paying for detainees’ health care when in county facilities even while they are pre-trial and presumed innocent. The Resolution urges the Centers for Medicare and Medicaid Services (CMS) to utilize all necessary measures, including waivers, to enhance flexibility within the Medicaid program to improve the continuity of health care for justice-involved individuals.

The second Resolution pertains to a proposed regulation on Medicaid Managed Care. Federal limitations on supplemental payments as described in the proposed rule would inhibit counties’ ability to serve as safety net providers and provide access to critical health services to their residents. The Resolution urges CMS to consider modifying the proposed rule to preserve the ability of states to provide supplemental support to targeted local government providers for services provided to Medicaid managed care enrollees.

NACo’s Health Steering Committee unanimously approved both Resolutions. The Resolutions have been presented to NACo’s Policy Committee and will be considered for inclusion in NACo’s National Policy Platform at the Annual Conference in July 2016.

• Last month President Obama released his 2017 budget proposals which contained no cuts to Medicaid or key public health programs. Congress will soon release a budget resolution which will serve as a blueprint for future Congressional action on the FY2017 budget.

On March 15, 2016 the House Committee on Budget released their budget proposal which would cut close to $7 trillion off the federal deficit over next decade. The proposal repeals Obamacare including Medicaid expansion and supports a work requirement for Medicaid. The Freedom Caucus has announced their opposition to the proposal and which is unlikely to pass the House.

4 | Page

Page 103 of 108 • The House Committee on Energy & Commerce Subcommittee on Health held a hearing earlier this month. The purpose of the hearing was to discuss the Administration’s Health and Human Services (HHS) budget; however, members of Congress used the hearing as an opportunity to questions HHS Secretary Burwell on a wide range of health related matters. Questions focused on the Patient Protection and Affordable Care Act (ACA)and Medicaid expansion in particular. Secretary Burwell mentioned repeatedly that Medicaid expansion saves money as people are now getting primary and preventative care and emergency rooms use is dropping. A number of members spoke of the need to innovate, but no specific ideas were shared.

Protection of Medicaid remains a key priority for CCHHS at both the State and Federal level.

Community Outreach

April 2 CCHHS and CountyCare promotion at the Move for Life! ¡Vive tu Vida! hosted by The West Humboldt Park Development Council and the Diabetes Empowerment Center at their Humboldt Park located at California and Division Avenue in Chicago. Registered Dietitian and Certified Diabetes Educator Lilia Herrera from the Fantus Health Center and the Endocrinology Department will speak to attendees about diabetes and nutrition.

April 2 CountyCare promotion at the Prevent. Educate. Empower Health Fair hosted by National Kidney Foundation of Illinois and State Representative Lisa Hernandez at MacNeal Hospital located at 3249 S. Oak Park Ave in Berwyn.

April 7 Presentation on CCHHS and CountyCare to the 2nd District Chicago Area Police Ministerial Meeting at the Holy Temple Church located at 5541 S. State in Chicago. Staff will specifically promote Provident Hospital and the Sengstacke Health Center services provided and will encourage attendees to mention the upcoming 4 Men Only Health Fair to their parishioners.

April 7 CCHHS and CountyCare promotion at the Summit of Hope which is hosted by the Illinois Department of Corrections at Proviso East High School located at 807 S. 1st Ave. in Maywood. The Summit of Hope a community expo, bringing together local service providers to create a "one-stop" environment for parolees and probationers to obtain necessary assistance to move past barriers. Many of the over 5000 attendees are in need of health insurance. At this year’s first Summit of Hope in Riis Park in Chicago, CCHHS/CountyCare staff spoke to over 300 participants who were in need of medical homes and health insurance.

April 8-10 CCHHS and CountyCare promotion at the Black Women’s Expo at McCormick Place located at 2301 S. Lake Shore Dr. in Chicago. Over 25,000 people attend this 3 day event and competing health plans and hospitals systems will be exhibiting at the Expo.

April 9 CCHHS and CountyCare promotion at the South Cook McKinney-Vento Resource Fair hosted by South Cook Intermediate Service Center at Bloom High School located at 101 W. 10th St. in Chicago Heights. The South Cook Intermediate Service Center sponsors this event to bring resources and information to homeless families in Bloom Township.

April 9 CCHHS and CountyCare promotion at Cook County Commissioner Richard R. Boykin’s Youth Career, Health, and Resource Expo at the Columbus Park Refectory located at 5701 W. Jackson Blvd. in Chicago.

April 12 CCHHS and CountyCare promotion at the Cottage Grove Health Center Fresh Truck Event hosted by Greater Chicago Food Depository and CCHHS at the Cottage Grove Health Center 5 | Page

Page 104 of 108 located, at 1645 Cottage Grove Ave in Ford Heights. This third Fresh Food Truck event with GCFD seeks to resolve Food Security and Nutrition issues which are part of our Food is Medicine initiative.

April 12 CCHHS and CountyCare promotion at the Brighton Park Neighborhood Council’s 4th Annual Health Fair at the Kelly High School located at4136 S. California in Chicago.

April 13 CCHHS and CountyCare promotion at the Young Child Community Expo hosted by National Association for the Education of Young Children at the Forest View Educational Center located at 2121 S. Goebbert Road in Arlington Heights.

April 14 CCHHS and CountyCare promotion at the Celebration of the Young Child Resource Fair hosted by the All our Kids Early Childhood Committee and the Cicero Community Center at the center located at 2250 S. 49th Avenue in Cicero. Cicero Health Center staff will also participate to promote their new initiatives.

April 16 CCHHS’ Provident Hospital and Sengstacke Health Center host the annual 4 Men Only Health and Wellness Fair which provides health screening including eye, blood pressure, HIV and hearing tests, to over 400 men who attend the event. Last year, over 75 men enrolled into CountyCare after visiting the event. The event takes place at Provident Hospital located at 500 E. 52st Street in Chicago.

April 18 CCHHS and CountyCare promotion at Congresswoman Robin Kelly’s 3rd Annual Youth Job & Resource Expo at Thornton Township High School located at 15001 Broadway Avenue in Harvey.

April 22 CCHHS and CountyCare promotion at the Chicago Business Opportunity Fair hosted by the Chicago Minority Development Council at the Hyatt Regency Hotel located at 151 E. Wacker Drive in Chicago.

April 23 CCHHS and CountyCare promotion at the 15th Annual Orland Park Sportsplex Health Fair hosted by the Village of Orland Park which will take place at the Orland Park Sportsplex located at 11351 W. 159th Street in Orland Park.

April 26 CCHHS and CountyCare promotion at the Walk A Day In My Shoes hosted by Peer Plus Education & Training Advocates at the DFSS Community Service Centers located at 4314 S. Cottage Grove Avenue in Chicago.

April 27 The CountyCare Redetermination event will take place at the Cottage Grove Health Center located, at 1645 Cottage Grove Ave in Ford Heights. This fifth “Rede” event seeks to help CountyCare members maintain their Medicaid coverage by helping them submit their re- enrollment materials in a timely manner. About 2500 CountyCare members from the South Suburban Cook County area will receive invites to this event.

April 29 CCHHS and CountyCare promotion at the "Swing into Spring" Senior Expo hosted by the Maine Township MaineStreamers at the Golf Mills Shopping Center located at 239 W. Golf Road in Niles.

April 30 CCHHS and CountyCare promotion at the Palos Area Chamber of Commerce Health & Business Expo hosted by Palos Area Chamber of Commerce at the Alan B. Shepherd High School located at 13049 S. Ridgeland Avenue in Palos Hills.

6 | Page

Page 105 of 108 CCHHS and CountyCare promotion continues at the different campuses of the City Colleges of Chicago. We will keep up this type of outreach to their students by participating in monthly fairs at the different colleges. To date, we have confirmed the following dates and locations for April: • April 6 – Harold Washington College – 30 East Lake Street, Chicago • April 12 – Malcolm X College – 1900 West Van Buren, Chicago • April 13 – Wright College – 4300 North Narragansett, Chicago • April 20 – Truman College – 1145 West Wilson, Chicago • April 26 – Olive Harvey College – 10001 South Woodland, Chicago

7 | Page

Page 106 of 108 Cook County Health and Hospitals System Board of Directors Meeting Minutes March 25, 2016

ATTACHMENT #10

Page 107 of 108 DRAFT

CCHHS BOARD RESOLUTION Honoring the Life of Dr. Quentin Young

WHEREAS, Dr. Quentin Young, a champion of civil rights and public health died on March 7, 2016 at the age of 92; and

WHEREAS, Quentin Young, the son of immigrants, grew up on the South Side of Chicago, graduated from Hyde Park High School and attended the University of Chicago; and

WHEREAS, despite his studies being interrupted by his Army service during World War II, Quentin Young received his medical degree in 1947 from Northwestern University; and

WHEREAS, Dr. Young began his medical training at Cook County Hospital before leaving for Michael Reese Hospital in 1952; and

WHEREAS, Dr. Quentin Young eventually returned to Cook County Hospital as the “Chairman of Medicine” in 1972, a role he retained until 1981; and,

WHEREAS, while at Cook County Hospital Dr. Young worked tirelessly to improve the County’s public healthcare system and its ability to help the poor and underserved; and

WHEREAS, in addition to leadership positions within Cook County, Dr. Young served as President of the Chicago Board of Health and the American Public Health Association; and

WHEREAS, Dr. Quentin Young co-founded the Health and Medicine Policy Research Group; and helped to found Physicians for a National Health Program; and

WHEREAS, Dr. Quentin Young was most proud of his work with the Committee to End Discrimination in Chicago’s Medical Institutions; and

WHEREAS, Dr. Young was also busy agitating and fighting for social change. He volunteered to register black voters during Mississippi’s Freedom Summer in 1964; and marched from Selma, Alabama to Montgomery, Alabama in 1965; and

WHEREAS, Dr. Young provided medical care to Martin Luther King Jr. during his stops in Chicago, as well as to campaign volunteers, civil rights workers, and anti-war protesters as founder of the Medical Committee for Human Rights; and

WHEREAS, Dr. Young is survived by two sons: Michael and Ethan; three daughters: Nancy, Polly, and Barbara; and two stepchildren: William and Karen Weaver. His wife, Ruth, passed away in 2007.

NOW, THEREFORE, BE IT RESOLVED, that the President and the Cook County Board of Commissioners, on behalf of the residents of Cook County, do extend their deepest condolences and most heartfelt sympathy to the family as well as to the many friends and loved ones of Dr. Quentin Young; and

NOW, THEREFORE, BE IT FURTHER RESOLVED, that a suitable copy of this Resolution be tendered to the loved ones of Dr. Quentin Young as a means of communicating our deep respect for Dr. Young’s fight for civil rights for all, and his contributions to the Cook County public healthcare system.

Page 108 of 108