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COOK COUNTY HEALTH & HOSPITALS SYSTEM
CCHHS Board of DirectorsQuality Dashboard Overview
26 February 2016Krishna Das, MD, Chief Quality Officer
CCHHS Board QPS Committee1
COOK COUNTY HEALTH & HOSPITALS SYSTEM
CCHHS Board of DirectorsStroger Hospital Quality Plan Summary
26 February 2016Krishna 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 organizationQuality Plan 2016 Overview4
Regulatory Standards: CMSConditions 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
Quality Plan 2016 Overview5
Regulatory Standards: CMSConditions 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
Quality Plan 2016 Overview6
Regulatory Standards: CMSConditions 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
Quality Plan 2016 Overview7
Joint Commission StandardsLeadership
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
Quality Plan 2016 Overview8
Joint Commission StandardsPerformance 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
Quality Plan 2016 Overview9
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
Quality Plan 2016 Overview10
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 authority-
enhance 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.
Quality Plan 2016 Overview11
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
Quality Plan 2016 Overview12
Quality Committee
Quality Plan 2016 Overview13
Hospital Quality Improvement and
Patient Safety Committee ‘HQuIPS’
General Med-Surg
ED Services
Critical Care &
Emergency Response
Behavioral Health
Nursing Care
PeriopServices
Med Mgmt
Environ of Care
Medical Education
Maternal Child
Patient Experience of Care
Diagnostic Testing
Record of Care
Diagnostic Imaging
Infection Control
Overview of Reporting GroupsReporting Group Departments or
DivisionsCommittees 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/ Emergency Response
Critical Care (various),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 Overview14
Overview of Reporting GroupsReporting Group Departments or
DivisionsCommittees 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 Safety
Radiology Radiation Safety
Nursing Services Nursing Nursing Quality Nursing, Provision of Care
Hospital InformationManagement
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 GMECQuality Plan 2016 Overview15
HQuIPS Reporting, cont’d.
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 Overview16
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
Quality Plan 2016 Overview17
Key Performance Indicators
Quality Plan 2016 Overview18
Hospital Indicator1 Baseline Q3 2015 Target 50th %ile2 90th %ile Reporting
Interval 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 25% reduction
- - Quarterly
Hospital Acquired Pressure Ulcers
0.6 25% reduction
- - Quarterly
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
Quality Plan 2016 Overview19
*Related to Joint Commission Safety Goals
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
Quality Plan 2016 Overview20
COOK COUNTY HEALTH & HOSPITALS SYSTEM
Human Resources Metrics forCCHHS Board Of Directors
February 26, 2016
Gladys Lopez, Chief of Human Resources
CCHHS Human Resource Committee I 02/19/161
2 CCHHS Board of Directors I 02/26/16
CCHHS Employment Plan (Plan) is an employment policy governing hiring andother employment actions which is required by a 2007 Court Order as one of theconditions to achieving substantial compliance with the Shakman ConsentDecrees. Its key objectives are: transparency, consistency and equal opportunity.
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
External Oversight: Court Compliance Administrator (CA)& Inspector General (IG)
Internal Oversight & Implementation: Employment Plan Officer (EPO)& Human Resources (HR)
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 Employment Plan: Overview
CCHHS Human Resource Committee I 02/19/16
CCHHS Human Resource Committee I 02/19/16
CCHHS Employment Plan: Training Update
3
Employment Plan requires that all New Hires attend Employment Plan Training within 90 days of their start date.
CCHHS Human Resource Committee I 02/19/165
CCHHS Employment Plan Office: 2015 Incident Report Update
Sustained vs. Not Sustained Findings
(7 Reports Issued)
Issue Breakdown
GeneralHiring
Actively Recruited
Direct Appointment
Advanced ClinicalPosition
6 CCHHS Board of Directors I 02/26/16
Employment Plan: Hiring Process – Advanced Clinical Position (ACP)
Solicit Recommendations
Direct Contact
Departmental Tours
Candidate Interaction
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
An ACP is a clinical position requiring licensure that qualifies an Employee to make independent decisions concerning diagnosis and/or treatment of patients.
Job Classifications that Qualify as ACP• Advanced Practice Nurse• Physician Assistant• Medical Doctors• Doctor of Dentistry
An ACP pilot program was implemented at Cermak Health Services on November 19, 2015
ACP Comparison• Job Submittals: 63 within 1 year 36 within 3 months
(applicants)
• Fill Time: 302 days 174 days
FY15 FY16
Exceptions to the General Hiring Process
CCHHS Human Resource Committee I 02/19/16
Comparison of Hiring Processes
DescriptionGeneral Hiring
Actively Recruited
Advanced ClinicalPosition
The candidate must meet the minimum qualifications listed in the job description and posting √ √ √
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, Candidateselection meetings, Application Review meetings, etc. √ √
All candidate contact is monitored √ √
Hiring Manager is able to see all candidates who applied √ √
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 02/19/167
8 1 Data thru 1/31/16 CCHHS Board of Directors I 02/26/16
DATA THROUGH:
Gladys Lopez, Chief of Human Resources
FY15 TOTAL Quarter 11 Quarter 2 Quarter 3 Quarter 4 FY16 TOTALCCHHS External 114 34 34CCHHS Internal 56 7 7Total CCHHS: 170 41 41
Nursing External 37 3 3Nursing Internal 17 1 1Total Nursing: 54 4 4
CCHHS Separations 176 103 103 -73 -41%Total Net New CCHHS: -62 -69 -69 -7 11%
Nursing Separations 58 27 27 -31 -53%Total Net New Nursing: -21 -24 -24 -3 14%
CCHHS FTEs 6,017 6,316 6,316 299 5%Total CCHHS Turnover: 2.9% 1.6% 1.6% -1.3% -44%
CCHHS New Hire FTEs 114 34 34 -80 -70%CCHHS New Hire Separations 2 2 2 0 = 0%Total FY15 New Hire Turnover: 2% 6% 6% 4% 235%
Target
Total CCHHS Vacant Positions: 750 767 823 823 56 7%11 0
Total RTHs in HR (In Process): 744 463 463 -281 -38%
Target
Average Days to Hire (Month): 110 203 117 117 -86 -42%AVERAGE TIME TO HIRE
VACANCIES FILLED
SEPARATIONS VARIANCE
TURNOVER
OPEN VACANCIES
Less Deleted Positions / PIDs
Human Resources Metrics Summary 01/31/16
Goal: Continue to maintain open
vacancies at 750 or ≤Fiscal Year 2016December 1, 2015 - November 30, 2016
CCHHS Human Resource Committee I 02/19/16
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)
Finance Committee Meeting: February 2016 2
Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14Operating Revenue 63,843 78,595 72,198 52,582 - - (13,628) (18,268) 122,413 112,909
Operating Expenses
Salaries & Benefits 48,006 44,271 167 276 4,950 4,274 738 939 53,861 49,760 Supplies 9,864 13,935 6,293 734 77 11 29 (668) 10,609 19,666 Purchased Services, Rental / Other 7,731 13,828 78,186 47,992 586 105 46 63 (13,628) (17,599) 72,921 44,388 Insurance Expense 1,771 1,456 368 185 140 32 35 1,988 1,998 Depreciation 2,223 2,777 - - 16 20 1 2 2,240 2,799 Utilities 129 - - - 129 - Total Operating Expenses 69,725 76,267 78,353 54,929 6,471 4,616 828 1,068 (13,628) (18,268) 141,749 118,611
Operating Margin (5,882) 2,328 (6,155) (2,347) (6,471) (4,616) (828) (1,068) - (0) (19,336) (5,702) Operating Margin % -9% 3% -9% -4% 0% 0% 0% 0% -16% -5%
Non Operating 5,911 12,109 23 4,399 5,894 151 377 - 10,461 18,403
Net Income/(Loss) 29 14,437 (6,155) (2,324) (2,072) 1,278 (677) (691) - (0) (8,875) 12,701
Acute Care CountyCare Cermak Public Health Eliminations Total
Finance Committee Meeting: February 2016 3
Balance Sheet Summary (in thousands)Category Dec-15 Total cash & cash equivalent 358,521 Total property taxes rec 165,511 Total receivables 132,120 Inventories 5,206TOTAL CURRENT ASSETS 661,358
Depreciable assets - net 386,937
TOTAL ASSETS 1,048,295
Finance Committee Meeting: February 2016 4
Balance Sheet Summary (in thousands)Category Dec-15
Accounts payable 154,741 Third-party settlements 112,000 Claims Payable 92,714Other Liabilities 126,354 TOTAL CURRENT LIABILITIES 485,809LONG-TERM LIABILITIES: 47,030
TOTAL LIABILITIES 532,839
TOTAL NET POSITION 515,455
TOTAL LIAB & NET POSITION 1,048,295
Metrics Summary: Membership• (--) 164,221 members; -0.1% from month prior, 8.0% below
budget
– 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
10
Population MembershipChange 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%
Finance Cte | Feb 19, 2016
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 $25.8 million
• PMPM payments current for ACA only– No FHP or ICP payments since October’15
• CY’16 rates setting meeting 2/19
Finance Cte | Feb 19, 2016
11
CountyCare MetricsPrepared for: CCHHS Board of Directors
Doug Elwell, Deputy CEO, Strategy & FinanceFebruary 26, 2016
CCHHS BOD | Feb 26, 2016
BOD Managed Care MetricsData as of 2/2/2016
2
Key Measures Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal1) QUALITY
1.1) Ambulatory Access - ACA & FHP AdultsCountyCare Overall 68.7% 68.7% 68.7% 0.0% --CCHHS 66.3% 66.3% 66.3% 0.0% --MHN ACO 71.0% 70.9% 70.7% -0.3% --ACCESS 67.7% 67.7% 67.6% -0.1% --All Other 68.8% 68.8% 69.3% 0.7% --
2) RISK MANAGEMENT2.1) Completed HRS/HRA (all populations, cum)
Overall 52.0% 56.4% 8.5% 100% 52.0%MHN ACO 73.2% 75.8% 3.6% 100% 73.2%La Rabida Care Coordination (CSNs only) 64.2%All Other 31.9% 37.8% 18.5% 100% 31.9%
3) UTILIZATION3.1) ER Utilization/1,000
ACA 944 939 965 2.8% 1,017 92.3%FHP 743 747 848 13.5% ICP 1,315 1,322 1391 5.2%
3.3) Value of CCHHS "Paid" Claims (FYTD) 250,376,821$ $15,414,501 $25,511,681 60.4%4) MEMBERSHIP
4.1) Monthly Membership 167,148 165,949 164,365 164,221 -0.1% -- 178,457 92.1%ACA 75,882 72,479 73,270 73,152 -0.2% -- 85,000 86.2%FHP 88,657 89,926 87,559 87,192 -0.4% -- 90,506 96.7%SPD 3,417 3,544 3,536 3,877 9.6% 2,951 119.8%Home/Community Waiver (incl DD) 596 581 617 655 6.2% LTC 212 222 229 251 9.6%
4.2) FYTD Member Months 1,846,036 165,949 330,314 494,535 356,914 92.5%ACA 978,347 72,479 145,749 403,466 170,000 85.7%FHP 836,463 89,926 177,485 264,677 181,012 98.1%SPD 32,034 3,544 7,080 10,957 5,902 120.0%
5) OPERATIONS
FY'15 Q2 FY'15 Q3Change from
Prior Q # Days Goal Met5.3) Claims Payment Turnaround Time (days) 36 31 -13.9% < 35 Y
TBD
Quality MetricsProvided for Discussion Purposes Only
4
CCHHS BOD | Feb 26, 2016
Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal1) QUALITY
1.1) Ambulatory Access - ACA & FHP AdultsCountyCare Overall 66.7% 68.7% 68.7% 68.7% 0.0% --CCHHS 64.6% 66.3% 66.3% 66.3% 0.0% --MHN ACO 68.8% 71.0% 70.9% 70.7% -0.3% --ACCESS 65.8% 67.7% 67.7% 67.6% -0.1% --All Other 66.6% 68.8% 68.8% 69.3% 0.7% --
1.2) Ambulatory Access - ICP AdultsCountyCare Overall 72.0% 73.3% 73.8% 74.3% 0.7% --CCHHS 72.3% 74.1% 76.3% 75.6% -0.9% --MHN ACO NA NA NA NA NAACCESS 66.8% 67.6% 69.5% 69.1% -0.6% --All Other 74.3% 75.6% 75.0% 76.1% 1.5%
1.3) CY'15 State P4P Measures (FHP & ACA)Inpatient Follow-Up 46.9% 46.0% 46.0% 45.9% -0.2% --Well Child 15 Months - 6 Visits 7.1% 6.7% 6.7% 6.7% 0.0% --Well Child Visits, 3-6 years 58.8% 63.6% 63.6% 63.5% -0.2% --Immunization Status - Combo 3 0.0% 0.0% 0.0% 0.0% 0.0% --Developmental Screenings 37.4% 37.9% 37.9% 37.9% 0.0% --Post Partum Care 40.1% 42.6% 42.6% 42.5% -0.2% --Prenatal Care 78.7% 78.2% 78.2% 78.1% -0.1% --
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
Risk Management MetricsProvided for Discussion Purposes Only
5
CCHHS BOD | Feb 26, 2016
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.
Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal2) RISK MANAGEMENT
2.1) Completed HRS/HRA (all populations, cum)Overall 51.7% 52.0% 56.4% 8.5% 100% 56.4%MHN ACO 72.1% 73.2% 75.8% 3.6% 100% 75.8%La Rabida Care Coordination (CSNs only) 64.2%All Other 32.1% 31.9% 37.8% 18.5% 100% 37.8%
2.2) High-Risk Stratification (all populations, cum)Overall 3.2% 3.0% 2.9% -3.3% 3.0% 96.7%MHN ACO 5.0% 4.8% 4.6% -4.2% 3.0% 153.3%La Rabida Care Coordination (CSNs only) 7.3%All Other 1.4% 1.2% 1.2% 0.0% -- 3.0% 40.0%
Utilization MetricsProvided for Discussion Purposes Only
6
CCHHS BOD | Feb 26, 2016
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 $28 million
Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal3) UTILIZATION
3.1) ER Utilization/1,000ACA 957 944 939 965 2.8% 1,017 94.9%FHP 744 743 747 848 13.5% ICP 1,288 1,315 1,322 1391 5.2%
3.2) Inpatient Utilization/1,000ACA 170 151 158 169 7.0% 168 100.6%FHP 111 91 93 98 5.4% ICP 361 348 367 375 2.2%
3.3) Value of CCHHS "Paid" Claims (FYTD) 167,298,969$ 250,376,821$ $15,414,501 $25,511,681 60.4%
Membership MetricsProvided for Discussion Purposes Only
7
CCHHS BOD | Feb 26, 2016
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
Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal4) MEMBERSHIP
4.1) Monthly Membership 168,749 167,148 165,949 164,365 164,221 -0.1% -- 178,457 92.0%ACA 76,910 75,882 72,479 73,270 73,152 -0.2% -- 85,000 86.1%FHP 88,538 88,657 89,926 87,559 87,192 -0.4% -- 90,506 96.3%SPD 3,301 3,417 3,544 3,536 3,877 9.6% 2,951 131.4%Home/Community Waiver (incl DD) 593 596 581 617 655 6.2% LTC 201 212 222 229 251 9.6%
4.2) FYTD Member Months 1,678,888 1,846,036 165,949 330,314 494,535 535,371 92.4%ACA 902,465 978,347 72,479 145,749 218,901 255,000 85.8%FHP 747,806 836,463 89,926 177,485 264,677 271,518 97.5%SPD 28,617 32,034 3,544 7,080 10,957 8,853 123.8%
4.3) Mbrs by Delegated Care Management GroupCCHHS (ACHN, LTSS, non-MHN ACO) 85,335 84,539 84,609 84,378 85,976 1.9% MHN ACO 83,414 82,609 81,340 79,987 78,245 -2.2% La Rabida Care Coordination (CSNs only) 2,561 2,563 2,564
4.4) Members Lost to Medicaid Cancellation# Mbrs Due for Redetermination 5,208 5,493 5,470 3,775 7,362 95.0% # Rede Cancellations 3,580 2,368 2,800 4,161 48.6% # Coverage Restored 879 1,285 1,379 772 -44.0% % Cancelled Due to Lack of Rede 51.9% 19.7% 26.0% 89.8% 245.6% < 22%
4.5) Cook County Enrollment by Health Plan (rank order) RankAetna Better Health Inc. 72,893 94,684 73,523 96,824 0.9% -- 6thBlue Cross Blue Shield 122,123 130,494 154,507 196,826 26.5% 1stCountyCare 163,375 165,518 160,415 162,435 -1.8% 2ndFamily Health Network 150,885 151,137 151,001 150,893 0.1% -- 3rdHarmony Health Plan 107,853 106,683 105,418 104,628 -2.3% 5thIlliniCare Health Plan 89,805 108,446 87,366 106,503 -2.7% 4thMeridian Health Plan 73,784 77,376 71,913 76,076 -2.5% 8thMolina Health Care 77,862 7thNext Level Health 19,460 9th
Operations MetricsProvided for Discussion Purposes Only
8
CCHHS BOD | Feb 26, 2016
Comments:• Significant deterioration in member and provider call center performance
• Inquiry to TPA about performance pending
Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16% Change From
Prior Month Trend
FYTD'16 Budget or
Goal
% to Budget/
Goal5) OPERATIONS
5.1) Member & Provider Services Call Center Goal Goal MetAbandonment Rate 1.09% 1.16% 1.85% 3.95% 113.5% < 5% YHold Time 0:00:43 0:00:43 0:00:59 0:01:08 0:00:09 < :01:00 NAverage Speed to Answer 0:00:11 0:00:14 0:00:18 0:00:31 0:00:13 < :00:45 Y
5.2) Claims/Encounters Acceptance Rate 24% 80% 30.0%
FY'15 Q1 FY'15 Q2 FY'15 Q3Change from
Prior Q # Days Goal Met5.3) Claims Payment Turnaround Time (days) 32 36 31 -13.9% < 35 Y