1 cook county health & hospitals system: strategic planning stakeholders forum november 14, 2008...

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Cook County Health & Hospitals System: Strategic Planning Stakeholders Forum

November 14, 2008

UIC Student Center West

828 South Wolcott, 3:00 p.m.

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Cook County Health & Hospitals System

Cook County President

&Commissioners

Reserved powers

CCHHS Independent

Board of Directors

CCHHS Central Offices

Hospitals

Clinics

CCDPH dfksdfskldj

Cermak

Core Center

PROVIDENT

STROGER

OAK FOREST

2008 Cook County Health & Hospitals System

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Mission Statement

To provide a Comprehensive Program of Quality Health

Care, with Respect and Dignity, to the Residents of Cook County, regardless of

their ability to pay.


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Today’s Goals

• An overview of the strategic planning process and objectives.

• An overview of our preliminary findings on the current environment.


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Strategic Goals

• Securing the operational stability of the CCHHS.

• Developing more specific long term goals (in spite of immediate challenges).

Planning Process


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First Steps

• Gathering, analyzing and interpreting data from the external environment.

• Community participation in the planning process to solicit feedback and ensure transparency.

Planning Process


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• Changes in the surrounding community-population shifts, economic changes, birth rates

• Changes in Cook County Health & Hospitals System (CCHHS)

• Changing external forces will affect the future.

• Existing internal forces will affect the future.

Initial Findings


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Changes in Population

•Total county population declining, but growth in Suburban Cook County partially offsetting decline in Chicago population.•Hispanic and non-white population growing—Suburban Hispanic population grew 34%, more than 100,000 individuals.

Demographic Characteristics and Patterns of Change in Suburban Cook County and Chicago

Population

Suburban Cook County City of Chicago

2000 20062006 from 2000

2000 20062006 from

2000

Total Populati

on2,480,725 2,539,372 2.4% 2,896,016 2,749,283 -5.1%

Nonwhite

Population

670,280 856,049 27.7% 1,680,701 1,744,523 3.8%

Hispanic or Latino

318,096 426,915 34.2% 753,644 774,042 2.7%

Source: Census Bureau for County and City; Suburban Cook estimated; Note that “Nonwhite” includes “more than one race” and “two or more races” categories;


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Growth in Poverty

Demographic Characteristics and Patterns of Change in Cook County and Chicago

Economics

Cook County City of Chicago

2000 2006%

Change 2000 2006%

Change

2006 from 2000

2006 from 2000

Median Household Income

$45,922

$50,691

10.4%$38,6

25$43,22

311.9%

% Persons below Poverty

13.5% 15.3% 13.3% 19.6% 21.2% 8.2%

Source: Census Bureau

•Income grew faster in Chicago than in suburbs.•Portion of population below poverty line grew faster in Suburban Cook County.


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The Uninsured

Selected Statistics for Numbers and Rates of Uninsurance

Year CategorySuburban

Cook County

City of Chicago

Metro Area (8

counties)Illinois

2000Number of Uninsured

< 65162,932 690,000 1,260,000

1,623,382

2005Number of Uninsured

< 65233,367 536,224 1,197,374

1,710,451

Sources:1. Data are drawn from the U.S. Census Bureau and from the published analyses of the Gilead Center; Uninsurance estimates for Chicago and for the "Metro" area are from Gilead; Cook County estimates are from the Census Bureau;

•Overall decline in uninsured between 2000 and 2005—but preliminary data suggests increases since 2005.•Metro and Chicago decline in uninsured.•All decline in Chicago—number of uninsured in Suburban Cook County increased by 43% (although still smaller than in Chicago).


233,367

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Births Declining – Faster in Chicago

Number of Live Births by Place and Township

Place of ResidenceYEAR

2002 2005% Change 2002-2005

Cook County 81,567 77,891 -4.51%

Chicago 47,958 45,218 -5.71%

Suburban Cook 33,609 32,673 -2.78%Source: Cook County Department of Public Health

•Births are declining everywhere in the County•More slowly in Suburban Cook County


12Note: There are 43 zip codes in Stroger’s Primary Service Area (PSA) that account for 18,902 or 80% of the hospital’s 23,548 total discharges. The top 3 zips, 60612 (West Town), 60623 (Lawndale) and 60608 (Pilsen) account for 13% of PSA discharges.

Where do Stroger patients live?

FY 2007


*Total discharges exclude normal newborns

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Note: There are 44 zip codes in Oak Forest’s PSA that account for 2,258 or 80% of the hospital’s 2,813 total discharges. The top 3 zips, 60426 (Harvey), 60628 (Roseland) and 60411 (Chicago Heights) account for 18% of PSA discharges.

Where do Oak Forest patients live?

FY 2007



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Note: There are 10 zip codes in Provident’s PSA that account for 4,802 or 80% of the hospital’s 5,944 total discharges. The top 3 zips, 60615 (Kenwood-Hyde Park), 60653 (Kenwood-Oakland) and 60609 (Bridgeport) account for 33% of PSA discharges.

Where do Provident patients live?

FY 2007



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System Hospitals: Average Daily Census by Hospital, 2004 thru 2007

Source: IDPH Data, 2004-2007

Average Daily Census, 2004-2007

0

50

100

150

200

250

300

350

400

450

2004 2005 2006 2007

Ave

rage D

aily

Censu

s

Stroger

Oak Forest

Oak Forest(w/o LongTerm Care)Provident


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System Hospitals: Admission Trends, 2004-2007

CCHHS Aggregate Hospital Data, Selected Admissions Indicators, 2004-2007

0

5,000

10,000

15,000

20,000

25,000

30,000

Medical/Surgical OB/GYN Deliveries Pediatric

Admission Type

# o

f A

dm

issi

ons

2004200520062007

Source: IDPH Data, 2004-2007


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ACHN Clinic Locations


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Visits: Ambulatory Community Health Network Clinic Visits by LocationFY2005 - 2008

Ambulatory Community Health Network Clinic Visits by Location

FY2005 - 2008

STROGER CAMPUS

COMMUNITY CLINICS PROVIDENT CAMPUS

OAK FOREST CAMPUS

0

100

200

300

400

500

600

700

800

900

In T

housa

nds

OAK FOREST CAMPUS 25,915 23,793 21,397 19,297

PROVIDENT CAMPUS 33,089 27,650 25,069 28,805

COMMUNITY CLINICS 192,849 186,083 153,051 134,823

STROGER CAMPUS 511,883 508,880 444,732 398,923

2005 2006 2007 2008(Projected)

Source: ACHN Manual Counts 2008 Cook County Health & Hospitals System

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CCHHS Financing: Summary

1.66 Bill

2.02 Bill 1.88 Bill 1.74 Bill 1.79 Bill 1.71 Bill

Source: Audited Financial Statements, FY 04-08; Management estimate for FY 08-FY 09

$312 M$357 M $318 M

$290 M$271 M$309 M

$431 M$431 M$275 M$245 M

$187 M$204 M

$137 M

$141 M$183 M$259 M

$244 M

$131 M

$0

$100

$200

$300

$400

$500

$600

$700

$800

$900

FY 2004 FY 2005 FY 2006 FY 2007 FY 2008Estimate

FY 2009Estimate

IGT/BIPARevenue

Tax Revenue

Patient FeeRevenue

CCHHS Sources of SupportFY04 - FY09 ($M)


Source: Audited statements and internal documents;

20Source and Notes: County’s Health Care System Lost $120.5 Million in “Supplemental” Medicaid Revenues Between FY05 and FY08; Slide provided by the Center for Budget and Tax Accountability (CTBA);

$143.6

$52.1

$115.5

$131.3

$131.3 $131.3

$7.3$9.5$0

$50

$100

$150

$200

$250

$300

FY05 FY06 FY07 FY08

Main IGT/UPL BIPA

$259.1M

$183.4 M

$140.8M $138.6M

$

IGT/BIPA Funds Declining Over Time


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$61.6$94.2 $115.5 $131.3 $131.3

$114.4

$174.9

$214.5$243.8 $243.8

$5.3 $9.8

$0

$50

$100

$150

$200

$250

$300

$350

$400

FY02 FY03 FY04 FY05 FY06 FY07

Amount of Sec. 701(d) BIPA funds distributed to Cook County Amount of Sec. 701(d) BIPA funds retained by the State

$375M $375M$330M

$269M

$176M

$15M

Source and Notes: "BIPA" refers to the (federal) Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act of 2000 ; The federal payments under Sec. 701(d)

of BIPA were ramped up between FY02 and FY06 to an annual maximum of $375 million in FY06 and each fiscal year thereafter; . Slide prov ided by CTBA:

BIPA Funding Shared with State


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Cook County Health & Hospitals SystemFY 2008-FY2009 Budget Comparison

Category FY2008 FY2009 Difference

Operating $822M $867M +$45M

Capital $31M $63M +$32M

Total $853M $930M +$77M

Source: Audited Financial Statements, FY 2008-2009


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Adopted Appropriations: Health Fund

Health Fund Total, Adopted AppropriationFY 04-FY07, ($M)

$-

$200

$400

$600

$800

$1,000

FY 2004 Adopted

Appropriation

FY 2005 Adopted

Appropriation

FY 2006 Adopted

Appropriation

FY 2007 Adopted

Appropriation


Notes and Sources: * IN FY 2004 and FY 2005 Department 899-Special Purpose Funds were included in the total for the Bureau of Health Appropriation; Data retrieved from the Annual Appropriation Bill for each fiscal year;

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Adopted Appropriations: Capital

Capital, Adopted Appropriation, FY 04-07, ($ M)

$0

$2

$4

$6

$8

$10

$12

FY 2004 Adopted

Appropriation

FY 2005 Adopted

Appropriation

FY 2006 Adopted

Appropriation

FY 2007 Adopted

Appropriation


Notes and Sources: * IN FY 2004 and FY 2005 Department 899-Special Purpose Funds included in the total for the Bureau of Health Appropriation; Data retrieved from the Annual Appropriation Bill for each fiscal year;

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CCHHS Patient Payor Mix

Cook County Health and Hospital Systems: Patient Mix

Payor

Year Estimated Projected

FY 2006 FY 2007 FY 2008 FY 2009

Self-Pay 52% 57% 56% 56%

Medicaid 31% 28% 28% 28%

Medicare 11% 11% 11% 11%

Other 6% 4% 5% 5%

Source: Audited Financial Statements, FY 06-07; Management estimate for FY08 and FY09;


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Public Hospital Subsidy

Subsidy per Capita for a Sampling of Public Hospitals and Systems

Hospital County2006

Population

2006 State/Local Subsidies

Per Capita

Subsidy

Subsidy as %of Net Patient

Care Revenues

Parkland Dallas 2,345,815 $345,139,836 $147 42%

GradyFulton & DeKalb

1,683,611 n/a n/a n/a

Jackson Memorial

Miami 2,402,208 $353,775,130 $147 28%

Cook County

Cook 5,288,655$244,727,1

14$46 49%

Wishard Marion 865,504 $83,505,375 $96 23%

Harris County

Harris 3,886,207 $393,831,000 $101 48%

Los Angeles County

Los Angeles

9,948,081 $834,937,007 $84 39%

Denver Health

Denver 566,974 $27,720,000 $49 7%

Maricopa Maricopa 3,768,123 $0 $0 0%

Hennepin County

Hennepin 1,122,093 $20,333,603 $18 4% 2008 Cook County Health & Hospitals System

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Policy Issues

•National healthcare reform.

•Charity care as government policy.

•Patient Safety and Quality Measurement/Pay for Performance structures.

•Proposed regulations that may constrain providers of healthcare to the poor.


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Regional/National Trends

• Shifting City/County Demographics• ongoing city gentrification, inflow of uninsured

immigrants.

• Increasing out-of-pocket expenses.• Public Hospital financing issues in the U.S. • Insufficiency of specialty care access and resources for the poor.• Anticipated shifts/trends in healthcare delivery.• The overall economic downturn that threatens tax revenue shortages.


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Existing Internal Forces

•Weakened infrastructure in IT and revenue cycle throughout the institution threatens our ability to move forward.

•Tumultuous changes led to the loss of many critical human resources that need to be rebuilt in order to move forward.

•Customer service scores display a gap that will keep us from succeeding.


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Positive Developments

• Support from the County Board President and Commissioners for the creation of an independent CCHHS Board, and the opening up of the governance decision-making process.

• The opening of the new John H. Stroger hospital facility.

• The preliminary acceptance of the CCHHS’ recommended 2009 Budget.

• Reduction of costs through the use of a Group Purchasing Organization (GPO).

• The work with the Revenue Cycle consultants is showing progress and positive returns.


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Next Steps – Your Input

What are the Hard Decisions? You tell us. What are the three most important services

CCHHS delivers to the people of Cook County?

What are the three services you are willing to give up in order to assure the most important services?

What questions do we need to answer in order to develop an actionable Strategic Plan?


32 2008 Cook County Health & Hospitals System

Questions?

1 cook county health & hospitals system: strategic planning stakeholders forum november 14, 2008...

Documents

residents of cook county

system hospitals

gilead cook county estimates

cook county81

city suburban cook

total population

total discharges

chicago decline