COOK COUNTY HEALTH
& HOSPITALS SYSTEM
CCHHS Board of Directors
Quality Dashboard Overview
26 February 2016
Krishna Das, MD, Chief Quality Officer
1
CCHHS Board QPS Committee
Board Quality Dashboard
2
CCHHS Board QPS Committee
COOK COUNTY HEALTH
& HOSPITALS SYSTEM
CCHHS Board of Directors
Stroger Hospital Quality Plan Summary
26 February 2016
Krishna Das, MD, Chief Quality Officer
Goals of a Quality Program
• To comply with law and regulations which govern
quality management in the healthcare setting
• To continually improve quality processes and
outcomes
• To improve patient safety and to comply with
laws regarding safety event evaluation and
reporting
• To assure successful accreditation and
certification
• To create value for the organization
4
Quality Plan 2016 Overview
Regulatory Standards: CMS
Conditions of Participation: 42 CFR 482.21
• The hospital must develop, implement, and
maintain an effective ongoing, hospital-wide,
data-driven quality assessment and
performance improvement program
(a) Program scope:
• To show measurable improvement in indicators with
evidence that it will improve health outcomes and
identify and reduce medical errors
• Track indicators including adverse patient events …to
assess care, hospital service and operations
5
Quality Plan 2016 Overview
Regulatory Standards: CMS
Conditions of Participation: 42 CFR 482.21
(b) Program data
• Incorporate quality data
• Use the data to monitor the effectiveness and safety of
services and identify opportunities for improvement
• The frequency and detail of data collection must be
specified by the hospitals governing body
(c) Program activities
• Set priorities for performance improvement
• Track medical errors
• Implement performance improvement activities,
measure success and track improvement
6
Quality Plan 2016 Overview
Regulatory Standards: CMS
Conditions of Participation: 42 CFR 482.21
(d) Performance improvement projects
• Hospital conducts performance improvement projects
• Projects must be proportional to the scope and
complexity of the hospital’s services and operations
(e) Executive responsibilities
• Leaders – governing body, hospital administration and
medical staff, ensure that a Quality Assessment and
Performance Improvement plan is created and reviewed
annually
• Assures resources for assessing and improving
performance
7
Quality Plan 2016 Overview
Joint Commission Standards
Leadership
LEADERSHIP– Quality and Safety
– Quality, safety and performance improvement planning is
hospital wide.
– Work processes are designed to focus individuals on quality and
safety issues
– Leaders set priorities for performance improvement activities and
patient health outcomes
– Leaders give priority to high-volume, high-risk or problem prone
processes
– Leaders implement a hospital wide safety program
– An individual or a multidisciplinary group manages the safety
program
– The scope of the safety programs ranges from potential or no
harm errors (near misses or close calls) to hazardous conditions
and sentinel events
8
Quality Plan 2016 Overview
Joint Commission Standards
Performance Improvement
PERFORMANCE IMPROVEMENT
• The hospital collects data to monitor its performance
– Leaders set priorities for data collection
• Hospital compiles and analyzes the data
– Presents data in usable forms; tracks and trends
– Benchmarks data to external sources
– Uses data to identify improvement opportunities
• Hospital improves performance on an ongoing basis
– Prioritizes improvement opportunities
– Takes action on improvement priorities
– Evaluates actions to confirm that they resulted in
improvements
9
Quality Plan 2016 Overview
Current Challenges
• Quality projects often performed in ‘silos’
• Quality management efforts are not widely
disseminated
• Front line staff are not engaged in quality/PI
• Event reporting is good but PI efforts/
feedback loops must be completed
• Regulatory compliance – manager education
and accountability
10
Quality Plan 2016 Overview
Accountability for Quality
Management and Reporting
• Existing departmental and committee structures are used for
reporting data and provide governance
– Use concept of ‘reporting groups’ to align reporting efforts and support
robust discussion
• Regulatory readiness efforts are aligned with existing structure
– Incorporate readiness challenges into reporting group dashboards
• Local leaders report on local performance and lead improvement
efforts
– Support leaders with quality data specific to their areas of authorityenhance reports
– Support leaders with guidance on performance improvement methods
• Continue to develop patient safety initiatives for areas which are high
risk, high volume or problem prone.
11
Quality Plan 2016 Overview
Hospital Quality Innovations
• Nursing Quality and Safety Committee and
Nursing Quality Council planned
– Align nursing indicators with National Database
for Nursing Quality Indicators (NDNQI)
– Nursing oversight reconfigured
• Environment of care committee reporting
redesign
– Combine life safety, clinical engineering, EOC,
emergency management
12
Quality Plan 2016 Overview
Quality Committee
General
Med-Surg
ED
Services
Infection
Control
Critical
Care &
Emergency
Response
Diagnostic
Imaging
Record of
Care
Behaviora
l Health
Hospital Quality
Improvement and
Patient Safety
Committee ‘HQuIPS’
Nursing
Care
Diagnostic
Testing
Patient
Experienc
e of Care
Periop
Services
Med
Mgmt
Maternal
Child
Environ of
Care
13
Medical
Education
Quality Plan 2016 Overview
Overview of Reporting Groups
14
Reporting Group
Departments or
Divisions
Committees or
Workgroups
Joint Commission
Chapter
Perioperative
Surgery, Anesthesia
OR, PI team
Medication
Management
Pharmacy
Drug & Formulary,
Med safety, DUE
Medication
Management
Environment of Care
Environmental, Police,
B&G, CE
Environment of Care
EOC, Life Safety,
Emergency
Management
Infection Control
Infection Control,
OR/SPD, Nursing
Infection Control
Infection Control
Critical Care/
Critical Care (various),
Emergency Response Palliative Care
Critical Care,
Resuscitation,
Bioethics
Provision of Care
General Med-Surg
Family Medicine,
Medicine, Surgery,
Case Management
Stroke, Diabetes,
Immunization,
UM/CM, NSQIP
Provision of Care
Emergency Services
EM, Trauma/Burn,
Nursing
Capacity
Management
Provision of Care
Quality Plan 2016 Overview
Overview of Reporting Groups
15
Reporting Group
Departments or
Divisions
Committees or
Workgroups
Joint Commission
Chapter
Maternal Child
Pediatrics, Ob-Gyne
Perinatal Network
Provision of Care
Behavioral Health
Psychiatry, Nursing
Bioethics
Provision of Care,
Patient Rights
Diagnostic Testing
Pathology
SFRC, IT Committees
Radiology/ Radiation Radiology
Safety
Radiation Safety
Nursing Services
Nursing
Nursing Quality
Nursing, Provision
of Care
Hospital Information
Management
HIM
HIM, IT Committees
Record of Care
and Information
Management
Patient Experience
of Care
Patient Experience,
Patient Relations
Patient Experience
Council
Patient Rights
Medical Education
GME
GMEC
Quality Plan 2016 Overview
HQuIPS Reporting, cont’d.
16
Reporting Group
Frequency
All Reporting Groups listed
Quarterly
Cancer Committee
Annual
Contract Compliance
Annual
Correctional Health
Annual
Food/Nutrition
Quarterly
Human Resources
Monthly, then Quarterly
Oral Health
Semi-annual
Patient Safety Council and Oversight
Functions
Monthly
Transfusion Committee
Annually
Quality Plan 2016 Overview
Reporting Group Dashboards
• Core measures referable to a reporting group
• Departmental indicators:
–
–
–
–
–
Process measures (eg VTE prophylaxis)
Preventive measure (eg immunization)
Patient safety measure (time outs, HAI)
Documentation measures (H&P or Op notes)
Efficiency measures (clinic follow up or readmissions)
• Patient safety events – hospital acquired events, sentinel events,
medication safety events, procedural complications
• PI activity related to patient safety events
• PI activity related to ongoing regulatory readiness
• Patient experience data and patient complaints
• Dashboards are updated at least monthly
17
Quality Plan 2016 Overview
Key Performance Indicators
18
Hospital Indicator1
Baseline
Q3 2015
Target
50th %ile2
90th %ile
Operating Room:
OR on-time starts (%)
47
80
64
88
Quarterly
Operating Room:
OR room turnaround
time (minutes)
47 min
35 min
29
23
Quarterly
Core Measure:
VTE Prophylaxis
General Care
89
99
88
99
Quarterly
Prevention:
Influenza Vaccination
75
90
93
100
Quarterly
Patient Satisfaction:
Recommend the
Hospital
69
84.7
72.4
84.7
Quarterly
Patient Satisfaction:
Communication with
Nurses is ‘good’
69
85.7
79.5
85.7
Quarterly
Fall rate/ falls with
injury
0.6
-
-
Quarterly
Hospital Acquired
Pressure Ulcers
0.6
25%
reduction
25%
reduction
-
-
Quarterly
Reporting
Interval
Quality Plan 2016 Overview
Focus Areas- High Risk, High Volume,
Problem Prone
• High Risk
– Emergency department wait times and throughput
– Operating room start times and throughput
• High Volume
– VTE (venous thromboembolism) prevention
– Vaccinations
• Problem Prone*
–
–
–
–
Procedural safety (time outs)
Medication safety
Alarm management
Cognitive or psychiatric impairments in patients
*Related to Joint Commission Safety Goals
19
Quality Plan 2016 Overview
Next Steps
• Approve plan
• Build out detailed dashboards in conjunction with
reporting groups
• Work closely with BI team to automate and distribute
dashboard data
• Work closely with Nursing quality to develop unit
based performance improvement
• Train and deploy quality staff to coach performance
improvement efforts in all departments
• Develop safety priorities and safety plan
20
Quality Plan 2016 Overview
COOK COUNTY HEALTH
& HOSPITALS SYSTEM
Human Resources Metrics for
CCHHS Board Of Directors
February 26, 2016
Gladys Lopez, Chief of Human Resources
1
CCHHS Human Resource Committee I 02/19/16
CCHHS Employment Plan: Overview
CCHHS Employment Plan (Plan) is an employment policy governing hiring and
other employment actions which is required by a 2007 Court Order as one of the
conditions to achieving substantial compliance with the Shakman Consent
Decrees. Its key objectives are: transparency, consistency and equal opportunity.
2
External Oversight:
Court Compliance Administrator (CA)
& Inspector General (IG)
Internal Oversight & Implementation:
Employment Plan Officer (EPO)
& Human Resources (HR)
EMPLOYMENT PLAN …
• Approved by the Court on 10/23/2014
• Roadmap for hiring
• Requires the creation of a Policy Manual
to set out procedures for other
employment actions
• Requires annual training on the Plan
provisions
• Requires decision makers to sign an NPCC
(No Political Consideration Certificate)
• Allows for real time monitoring of
processes
• Requires that Employees report violations
of the Plan to the EPO; report Political
Discrimination/Contacts to the IG
SUBSTANTIAL COMPLIANCE …
o Create Employment Plan (Y)
o Hire EPO (Y)
o Train all staff on Plan (Y)
o Create Policy Manual (N)
o Train supervisors/managers on Manual (N)
o Complete Implementation of Plan
provisions (3/4)
o Monitoring by CA after implementation of
Plan & Policies (1/2)
o Demonstrate ability to implement Plan &
Manual consistently
o CA recommendation to Court
CCHHS Human
Resource
I 02/19/16
CCHHS
BoardCommittee
of Directors
I 02/26/16
CCHHS Employment Plan: Training Update
Employment Plan requires that all New Hires attend Employment Plan Training within 90 days of their start date.
3
CCHHS Human Resource Committee I 02/19/16
CCHHS Employment Plan Office: Investigation Update
4
CCHHS Human Resource Committee I 02/19/16
CCHHS Employment Plan Office: 2015 Incident Report Update
Issue Breakdown
Sustained vs. Not Sustained
Findings
(7 Reports Issued)
5
CCHHS Human Resource Committee I 02/19/16
Employment Plan: Hiring Process – Advanced Clinical Position (ACP)
Exceptions to the General Hiring Process
Solicit Recommendations
General
Hiring
Actively
Recruited
Direct
Appointment
Advanced
Clinical
Position
Direct Contact
Departmental Tours
Candidate Interaction
An ACP is a clinical position requiring licensure that qualifies an Employee to make independent decisions
concerning diagnosis and/or treatment of patients.
An ACP pilot program was implemented at Cermak Health Services on November 19, 2015
Job Classifications that Qualify as ACP
•
Advanced Practice Nurse
•
Physician Assistant
•
Medical Doctors
•
Doctor of Dentistry
ACP Comparison
•
Job Submittals:
(applicants)
•
Fill Time:
FY15
63 within 1 year
302 days
FY16
36 within 3 months
174 days
Advance Clinical Process Benefits
•
Decrease time from Request to Hire packet in HR to Decision to Hire/Selection in HR.
•
Increase job submittals
•
The ease for Applicants to submit their resume via e-mail
•
More competitive with competitors
•
Applicant engagement
6
CCHHS Human
Resource
I 02/19/16
CCHHS
BoardCommittee
of Directors
I 02/26/16
Comparison of Hiring Processes
General
Hiring
Actively
Recruited
Advanced
Clinical
Position
√
√
√
Training is required before a Hiring Manager can proceed
√
√
√
Candidates and management must execute a No Political Consideration
Certification (NPCC)
√
√
√
The entire process is monitored in Taleo
√
√
The position is subject to randomization
√
The number of candidates is limited per PID
√
48 Hour Advance Notice is Required Prior to Interviews, Tours, Candidate
selection meetings, Application Review meetings, etc.
√
√
All candidate contact is monitored
√
√
Description
The candidate must meet the minimum qualifications listed in the job
description and posting
Hiring Manager is able to see all candidates who applied
7
√
√
Candidates may submit their CV / Resume to an identified CCHHS email
address
√
The Hiring Manager is able to interview candidates during the posting
period
√
The Hiring Manager is able to interview one on one
√
The Hiring Manager must complete and maintain a Candidate Contact Log
√
CCHHS Human Resource Committee I 02/19/16
Human Resources Metrics Summary
DATA THROUGH:
01/31/16
Goal: Continue to maintain open
Gladys Lopez, Chief of Human Resources
vacancies at 750 or
Fiscal Year 2016
≤
December 1, 2015 - November 30, 2016
VACANCIES FILLED
CCHHS External
CCHHS Internal
Total CCHHS:
1
FY15 TOTAL
114
Quarter 1
56
7
170
41
34
Nursing External
37
3
Nursing Internal
17
1
Total Nursing:
54
4
CCHHS Separations
176
103
Total Net New CCHHS:
-62
-69
Quarter 2
Quarter 3
Quarter 4
FY16 TOTAL
34
7
41
3
1
4
SEPARATIONS
VARIANCE
Nursing Separations
58
27
Total Net New Nursing:
-21
-24
CCHHS FTEs
6,017
6,316
Total CCHHS Turnover:
2.9%
1.6%
CCHHS New Hire FTEs
CCHHS New Hire Separations
114
34
2
2
Total FY15 New Hire Turnover:
2%
103
-69
-73
27
-24
-31
-7
-3


-41%


-53%
11%
14%
TURNOVER
OPEN VACANCIES
Total CCHHS Vacant Positions:
750
Total RTHs in HR (In Process):
Average Days to Hire (Month):
8
1 Data
thru 1/31/16
299
-1.3%


5%
-44%
-80
6%
34
2
6%
0
4%

=

235%
767
823
823
56

7%
11
744
0
463
463
-281

-38%
203
117
117
-86

-42%
-70%
0%
Target
Less Deleted Positions / PIDs
AVERAGE TIME TO HIRE
6,316
1.6%
Target
110
CCHHS Human
Resource
I 02/19/16
CCHHS
BoardCommittee
of Directors
I 02/26/16
Cook County Health & Hospitals
System
Finance Committee : December 2015 Financials
Finance Committee Meeting: February 2016
1
Income Statement : Dec-15 vs. Dec-14 (in thousands)
Operating Revenue
Acute Care
Dec-14
Dec-15
78,595
63,843
CountyCare
Dec-15
Dec-14
52,582
72,198
Cermak
Public Health
Eliminations
Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14
(13,628) (18,268)
-
Total
Dec-15
Dec-14
122,413 112,909
Operating Expenses
276
6,293
4,950
734
4,274
77
738
11
939
29
47,992
368
-
586
185
16
-
105
140
20
46
32
1
63
35
2
78,353
54,929
6,471
4,616
828
1,068
(6,155)
-9%
(2,347)
-4%
Salaries & Benefits
Supplies
Purchased Services,
Rental / Other
Insurance Expense
Depreciation
Utilities
Total Operating
Expenses
48,006
9,864
44,271
13,935
167
7,731
1,771
2,223
129
13,828
1,456
2,777
78,186
69,725
76,267
Operating Margin
Operating Margin %
(5,882)
-9%
2,328
3%
5,911
12,109
29
14,437
Non Operating
Net Income/(Loss)
-
(6,155)
53,861
10,609
49,760
19,666
(13,628) (17,599)
72,921
1,988
2,240
129
44,388
1,998
2,799
-
(13,628) (18,268)
141,749
118,611
(0)
(19,336)
-16%
(5,702)
-5%
10,461
18,403
(8,875)
12,701
(668)
-
(6,471) (4,616)
0%
0%
(828) (1,068)
0%
0%
-
23
4,399
5,894
151
377
-
(2,324)
(2,072)
1,278
(677)
(691)
-
Finance Committee Meeting: February 2016
(0)
2
Balance Sheet Summary (in thousands)
Category
Total cash & cash equivalent
Total property taxes rec
Total receivables
Inventories
TOTAL CURRENT ASSETS
Depreciable assets - net
TOTAL ASSETS
Dec-15
358,521
165,511
132,120
5,206
661,358
386,937
1,048,295
Finance Committee Meeting: February 2016
3
Balance Sheet Summary (in thousands)
Category
Dec-15
Accounts payable
Third-party settlements
Claims Payable
Other Liabilities
TOTAL CURRENT LIABILITIES
LONG-TERM LIABILITIES:
TOTAL LIABILITIES
TOTAL NET POSITION
TOTAL LIAB & NET POSITION
Finance Committee Meeting: February 2016
154,741
112,000
92,714
126,354
485,809
47,030
532,839
515,455
1,048,295
4
Finance Committee Meeting: February 2016
5
Finance Committee Meeting: February 2016
6
Finance Committee Meeting: February 2016
7
Finance Committee Meeting: February 2016
8
Finance Committee Meeting: February 2016
9
Metrics Summary: Membership
• (--) 164,221 members; -0.1% from month prior, 8.0% below
budget
Population
Membership
Change from
Month Prior
Comp to
Budget
ACA
73,152
(--) 0.1%
() -13.9%
FHP
87,192
(--) -0.2%
() -3.7%
ICP
3,877
() 9.6%
() 31.4%
– FYTD total membership below budget in similar proportions to
monthly
• ( ) 89.8% of Medicaid cancellations at DHS Hoyne St. Office
due to lack of timely redetermination
– Up from 26.0% last month
• CountyCare is 2nd largest health plan serving Cook County
beneficiaries; BCBS took 1st post-ACE acquisitions
Finance Cte | Feb 19, 2016
10
Financial Highlights
• () Dec’15 Financials
– Net Income = $1.4 million; ($3.6 million) after IGT
for FHP & ICP PMPM
– CCHHS-generated revenue = $15.4 million
– 40% under budget of $25.8 million
• PMPM payments current for ACA only
– No FHP or ICP payments since October’15
• CY’16 rates setting meeting 2/19
Finance Cte | Feb 19, 2016
11
CountyCare Metrics
Prepared for: CCHHS Board of Directors
Doug Elwell, Deputy CEO, Strategy & Finance
February 26, 2016
BOD Managed Care Metrics
Data as of 2/2/2016
Key Measures
1) QUALITY
1.1) Ambulatory Access - ACA & FHP Adults
CountyCare Overall
CCHHS
MHN ACO
ACCESS
All Other
2) RISK MANAGEMENT
2.1) Completed HRS/HRA (all populations, cum)
Overall
MHN ACO
La Rabida Care Coordination (CSNs only)
All Other
3) UTILIZATION
3.1) ER Utilization/1,000
ACA
FHP
ICP
3.3) Value of CCHHS "Paid" Claims (FYTD)
4) MEMBERSHIP
4.1) Monthly Membership
ACA
FHP
SPD
Home/Community Waiver (incl DD)
LTC
4.2) FYTD Member Months
ACA
FHP
SPD
5) OPERATIONS
5.3) Claims Payment Turnaround Time (days)
2
Nov'15
Dec'15
Jan'16
68.7%
66.3%
71.0%
67.7%
68.8%
68.7%
66.3%
70.9%
67.7%
68.8%
52.0%
73.2%
31.9%
56.4%
75.8%
64.2%
37.8%
944
743
1,315
$ 250,376,821
939
747
1,322
$15,414,501
965
848
1391
167,148
75,882
88,657
3,417
596
212
1,846,036
978,347
836,463
32,034
165,949
72,479
89,926
3,544
581
222
165,949
72,479
89,926
3,544
164,365
73,270
87,559
3,536
617
229
330,314
145,749
177,485
7,080
FY'15 Q2
FY'15 Q3
36
31
Feb'16
68.7%
66.3%
70.7%
67.6%
69.3%
164,221
73,152
87,192
3,877
655
251
494,535
403,466
264,677
10,957
% Change From
Prior Month
Trend
FYTD'16
Budget or
Goal
% to
Budget/
Goal
0.0%
0.0%
-0.3%
-0.1%
0.7%
------
8.5%
3.6%


100%
100%
52.0%
73.2%
18.5%

100%
31.9%
2.8%
13.5%
5.2%



1,017
92.3%
$25,511,681
60.4%
-0.1%
-0.2%
-0.4%
9.6%
6.2%
9.6%
---


178,457
85,000
90,506
2,951
92.1%
86.2%
96.7%
119.8%
356,914
170,000
181,012
5,902
92.5%
85.7%
98.1%
120.0%
Change from
Prior Q
-13.9%
TBD
# Days

Goal Met
CCHHS
< 35 BODY | Feb 26, 2016
Data Charts
Provided For Discussion Purposes Only
3
Quality Metrics
Provided for Discussion Purposes Only
Key Measures
1) QUALITY
1.1) Ambulatory Access - ACA & FHP Adults
CountyCare Overall
CCHHS
MHN ACO
ACCESS
All Other
1.2) Ambulatory Access - ICP Adults
CountyCare Overall
CCHHS
MHN ACO
ACCESS
All Other
1.3) CY'15 State P4P Measures (FHP & ACA)
Inpatient Follow-Up
Well Child 15 Months - 6 Visits
Well Child Visits, 3-6 years
Immunization Status - Combo 3
Developmental Screenings
Post Partum Care
Prenatal Care
Oct'15
Nov'15
Dec'15
Jan'16
Feb'16
% Change From
Prior Month
Trend
66.7%
64.6%
68.8%
65.8%
66.6%
68.7%
66.3%
71.0%
67.7%
68.8%
68.7%
66.3%
70.9%
67.7%
68.8%
68.7%
66.3%
70.7%
67.6%
69.3%
0.0%
0.0%
-0.3%
-0.1%
0.7%
------
72.0%
72.3%
NA
66.8%
74.3%
73.3%
74.1%
NA
67.6%
75.6%
73.8%
76.3%
NA
69.5%
75.0%
74.3%
75.6%
NA
69.1%
76.1%
0.7%
-0.9%
NA
-0.6%
1.5%
---
46.9%
7.1%
58.8%
0.0%
37.4%
40.1%
78.7%
46.0%
6.7%
63.6%
0.0%
37.9%
42.6%
78.2%
46.0%
6.7%
63.6%
0.0%
37.9%
42.6%
78.2%
45.9%
6.7%
63.5%
0.0%
37.9%
42.5%
78.1%
-0.2%
0.0%
-0.2%
0.0%
0.0%
-0.2%
-0.1%
--------
FYTD'16
Budget or
Goal
% to
Budget/
Goal
TBD
TBD
TBD
Comments:
• ‘Chart chasing’ to begin March’16
• Goals as set by HFS provided as percentiles, working to get actual scores
• Continued discussion with HFS on goal
CCHHS BOD | Feb 26, 2016
4
Risk Management Metrics
Provided for Discussion Purposes Only
Key Measures
2) RISK MANAGEMENT
2.1) Completed HRS/HRA (all populations, cum)
Overall
MHN ACO
La Rabida Care Coordination (CSNs only)
All Other
2.2) High-Risk Stratification (all populations, cum)
Overall
MHN ACO
La Rabida Care Coordination (CSNs only)
All Other
Oct'15
Nov'15
51.7%
72.1%
52.0%
73.2%
32.1%
31.9%
3.2%
5.0%
3.0%
4.8%
1.4%
1.2%
Dec'15
56.4%
75.8%
64.2%
37.8%
2.9%
4.6%
7.3%
1.2%
Jan'16
Feb'16
% Change From
Prior Month
Trend
FYTD'16
Budget or
Goal
% to
Budget/
Goal
8.5%
3.6%


100%
100%
56.4%
75.8%
18.5%

100%
37.8%
-3.3%
-4.2%


3.0%
3.0%
96.7%
153.3%
0.0%
--
3.0%
40.0%
Comments:
• Completion of risk screens (HRS) and risk assessments (HRA) up overall
• Change in delegation from TPA to CCHHS Centralized Care Coordination
Unit on-schedule for April 1 start.
CCHHS BOD | Feb 26, 2016
5
Utilization Metrics
Provided for Discussion Purposes Only
Key Measures
3) UTILIZATION
3.1) ER Utilization/1,000
ACA
FHP
ICP
3.2) Inpatient Utilization/1,000
ACA
FHP
ICP
3.3) Value of CCHHS "Paid" Claims (FYTD)
Oct'15
Nov'15
Dec'15
Jan'16
Feb'16
% Change From
Trend
Prior Month
FYTD'16
Budget or
Goal
% to
Budget/
Goal
944
743
1,315
939
747
1,322
965
848
1391
2.8%
13.5%
5.2%



1,017
94.9%
170
151
111
91
361
348
$ 167,298,969 $ 250,376,821
158
93
367
$15,414,501
169
98
375
7.0%
5.4%
2.2%



168
100.6%
$25,511,681
60.4%
957
744
1,288
Comments:
• ED and Inpatient utilization increased in all populations from prior month;
Now two-month trend of increases
• Most likely seasonal in nature
• Will continue to monitor for other trends
• Paid claims to CCHHS $10 million below budget
• Overall contribution to CCHHS bottom line under budget by $28 million
CCHHS BOD | Feb 26, 2016
6
Membership Metrics
Provided for Discussion Purposes Only
Key Measures
4) MEMBERSHIP
4.1) Monthly Membership
ACA
FHP
SPD
Home/Community Waiver (incl DD)
LTC
4.2) FYTD Member Months
ACA
FHP
SPD
4.3) Mbrs by Delegated Care Management Group
CCHHS (ACHN, LTSS, non-MHN ACO)
MHN ACO
La Rabida Care Coordination (CSNs only)
4.4) Members Lost to Medicaid Cancellation
# Mbrs Due for Redetermination
# Rede Cancellations
# Coverage Restored
% Cancelled Due to Lack of Rede
4.5) Cook County Enrollment by Health Plan (rank order)
Aetna Better Health Inc.
Blue Cross Blue Shield
CountyCare
Family Health Network
Harmony Health Plan
IlliniCare Health Plan
Meridian Health Plan
Molina Health Care
Next Level Health
Oct'15
Nov'15
Dec'15
Jan'16
Feb'16
% Change From
Prior Month
Trend
168,749
76,910
88,538
3,301
593
201
1,678,888
902,465
747,806
28,617
167,148
75,882
88,657
3,417
596
212
1,846,036
978,347
836,463
32,034
165,949
72,479
89,926
3,544
581
222
165,949
72,479
89,926
3,544
164,365
73,270
87,559
3,536
617
229
330,314
145,749
177,485
7,080
164,221
73,152
87,192
3,877
655
251
494,535
218,901
264,677
10,957
-0.1%
-0.2%
-0.4%
9.6%
6.2%
9.6%
85,335
83,414
2,561
84,539
82,609
2,563
84,609
81,340
2,564
84,378
79,987
85,976
78,245
1.9%
-2.2%


5,208
3,580
879
51.9%
5,493
2,368
1,285
19.7%
5,470
2,800
1,379
26.0%
3,775
4,161
772
89.8%
7,362
95.0%
48.6%
-44.0%
245.6%




72,893
122,123
163,375
150,885
107,853
89,805
73,784
94,684
130,494
165,518
151,137
106,683
108,446
77,376
73,523
154,507
160,415
151,001
105,418
87,366
71,913
96,824
196,826
162,435
150,893
104,628
106,503
76,076
77,862
19,460
0.9%
26.5%
-1.8%
0.1%
-2.3%
-2.7%
-2.5%
-

-


Comments:
• Membership down slightly from prior month (0.1%); With ICP membership continuing to grow.
• Members assigned to CCHHS Care Management up
• Medicaid cancellations due to redetermination up, while restorations of coverage are down
• CountyCare is 2nd largest plan serving Cook County beneficiaries; BCBS has taken top position
7
---


FYTD'16
Budget or
Goal
% to
Budget/
Goal
178,457
85,000
90,506
2,951
92.0%
86.1%
96.3%
131.4%
535,371
255,000
271,518
8,853
92.4%
85.8%
97.5%
123.8%
< 22%
Rank
6th
1st
2nd
3rd
5th
4th
8th
7th
9th
CCHHS BOD | Feb 26, 2016
Operations Metrics
Provided for Discussion Purposes Only
Key Measures
5) OPERATIONS
5.1) Member & Provider Services Call Center
Abandonment Rate
Hold Time
Average Speed to Answer
5.2) Claims/Encounters Acceptance Rate
5.3) Claims Payment Turnaround Time (days)
Oct'15
Nov'15
1.09%
0:00:43
0:00:11
FY'15 Q1
Dec'15
1.16%
0:00:43
0:00:14
FY'15 Q2
32
Jan'16
1.85%
0:00:59
0:00:18
24%
FY'15 Q3
36
31
3.95%
0:01:08
0:00:31
Feb'16
% Change From
Prior Month
Trend
113.5%
0:00:09
0:00:13



Change from
Prior Q
-13.9%

FYTD'16
Budget or
Goal
% to
Budget/
Goal
Goal
Goal Met
Y
N
Y
30.0%
< 5%
< :01:00
< :00:45
80%
# Days
< 35
Goal Met
Y
Comments:
• Significant deterioration in member and provider call center performance
• Inquiry to TPA about performance pending
CCHHS BOD | Feb 26, 2016
8