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1 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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Presentation on theme: "1 Cook County Health & Hospitals System: Strategic Planning Stakeholders Forum November 14, 2008 UIC Student Center West 828 South Wolcott, 3:00 p.m."— Presentation transcript:

1 1 Cook County Health & Hospitals System: Strategic Planning Stakeholders Forum November 14, 2008 UIC Student Center West 828 South Wolcott, 3:00 p.m.

2 22 Cook County Health & Hospitals System 2008 Cook County Health & Hospitals System

3 33 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. 2008 Cook County Health & Hospitals System

4 44 Todays Goals An overview of the strategic planning process and objectives. An overview of our preliminary findings on the current environment. 2008 Cook County Health & Hospitals System

5 55 Strategic Goals Securing the operational stability of the CCHHS. Developing more specific long term goals (in spite of immediate challenges). Planning Process 2008 Cook County Health & Hospitals System

6 66 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 2008 Cook County Health & Hospitals System

7 77 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 2008 Cook County Health & Hospitals System

8 88 Changes in Population Total county population declining, but growth in Suburban Cook County partially offsetting decline in Chicago population. Hispanic and non-white population growingSuburban Hispanic population grew 34%, more than 100,000 individuals. Demographic Characteristics and Patterns of Change in Suburban Cook County and Chicago Population Suburban Cook CountyCity of Chicago 20002006 2006 from 2000 20002006 2006 from 2000 Total Population 2,480,7252,539,3722.4%2,896,0162,749,283-5.1% Nonwhite Population 670,280856,04927.7%1,680,7011,744,5233.8% Hispanic or Latino 318,096426,91534.2%753,644774,0422.7% Source: Census Bureau for County and City; Suburban Cook estimated; Note that Nonwhite includes more than one race and two or more races categories; 2008 Cook County Health & Hospitals System

9 99 Growth in Poverty Demographic Characteristics and Patterns of Change in Cook County and Chicago Economics Cook CountyCity of Chicago 20002006% Change20002006 % Change 2006 from 2000 Median Household Income $45,922$50,69110.4%$38,625$43,22311.9% % 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. 2008 Cook County Health & Hospitals System

10 10 The Uninsured Selected Statistics for Numbers and Rates of Uninsurance YearCategory Suburban Cook County City of Chicago Metro Area (8 counties) Illinois 2000 Number of Uninsured < 65 162,932690,0001,260,0001,623,382 2005 Number of Uninsured < 65 233,367536,2241,197,3741,710,451 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 2005but preliminary data suggests increases since 2005. Metro and Chicago decline in uninsured. All decline in Chicagonumber of uninsured in Suburban Cook County increased by 43% (although still smaller than in Chicago). 2008 Cook County Health & Hospitals System 233,3 67

11 11 Births Declining – Faster in Chicago Number of Live Births by Place and Township Place of Residence YEAR 20022005 % Change 2002- 2005 Cook County81,56777,891-4.51% Chicago47,95845,218-5.71% Suburban Cook33,60932,673-2.78% Source: Cook County Department of Public Health Births are declining everywhere in the County More slowly in Suburban Cook County 2008 Cook County Health & Hospitals System

12 12 Note: There are 43 zip codes in Strogers Primary Service Area (PSA) that account for 18,902 or 80% of the hospitals 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 2008 Cook County Health & Hospitals System *Total discharges exclude normal newborns

13 13 Note: There are 44 zip codes in Oak Forests PSA that account for 2,258 or 80% of the hospitals 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 2008 Cook County Health & Hospitals System *Total discharges exclude normal newborns

14 14 Note: There are 10 zip codes in Providents PSA that account for 4,802 or 80% of the hospitals 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 2008 Cook County Health & Hospitals System *Total discharges exclude normal newborns

15 15 System Hospitals: Average Daily Census by Hospital, 2004 thru 2007 Source: IDPH Data, 2004-2007 2008 Cook County Health & Hospitals System

16 16 System Hospitals: Admission Trends, 2004-2007 Source: IDPH Data, 2004-2007 2008 Cook County Health & Hospitals System

17 17 ACHN Clinic Locations 2008 Cook County Health & Hospitals System

18 18 Visits: Ambulatory Community Health Network Clinic Visits by Location FY2005 - 2008 Source: ACHN Manual Counts 2008 Cook County Health & Hospitals System

19 19 CCHHS Financing: Summary 1.66 Bill2.02 Bill1.88 Bill1.74 Bill1.79 Bill1.71 Bill Source: Audited Financial Statements, FY 04-08; Management estimate for FY 08-FY 09 CCHHS Sources of Support FY04 - FY09 ($M) 2008 Cook County Health & Hospitals System Source: Audited statements and internal documents ;

20 20 Source and Notes: Countys 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); IGT/BIPA Funds Declining Over Time 2008 Cook County Health & Hospitals System

21 21 BIPA Funding Shared with State 2008 Cook County Health & Hospitals System

22 22 Cook County Health & Hospitals System FY 2008-FY2009 Budget Comparison CategoryFY2008FY2009Difference Operating $822M $867M +$45M Capital $31M $63M +$32M Total $853M $930M +$77M Source: Audited Financial Statements, FY 2008-2009 2008 Cook County Health & Hospitals System

23 23 Adopted Appropriations: Health Fund 2008 Cook County Health & Hospitals System 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;

24 24 Adopted Appropriations: Capital 2008 Cook County Health & Hospitals System 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;

25 25 CCHHS Patient Payor Mix Cook County Health and Hospital Systems: Patient Mix Payor YearEstimatedProjected FY 2006FY 2007FY 2008FY 2009 Self-Pay52%57%56% Medicaid31%28% Medicare11% Other6%4%5% Source: Audited Financial Statements, FY 06-07; Management estimate for FY08 and FY09; 2008 Cook County Health & Hospitals System

26 26 Public Hospital Subsidy Subsidy per Capita for a Sampling of Public Hospitals and Systems HospitalCounty 2006 Population 2006 State/Local Subsidies Per Capita Subsidy Subsidy as %of Net Patient Care Revenues ParklandDallas 2,345,815$345,139,836$14742% Grady Fulton & DeKalb 1,683,611n/a Jackson Memorial Miami 2,402,208$353,775,130$14728% Cook County Cook 5,288,655$244,727,114$4649% WishardMarion 865,504$83,505,375$9623% Harris CountyHarris 3,886,207$393,831,000$10148% Los Angeles County Los Angeles 9,948,081$834,937,007$8439% Denver HealthDenver 566,974$27,720,000$497% Maricopa 3,768,123$0 0% Hennepin County Hennepin 1,122,093$20,333,603$184% 2008 Cook County Health & Hospitals System

27 27 P olicy 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. 2008 Cook County Health & Hospitals System

28 28 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. 2008 Cook County Health & Hospitals System

29 29 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. 2008 Cook County Health & Hospitals System

30 30 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. 2008 Cook County Health & Hospitals System

31 31 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? 2008 Cook County Health & Hospitals System

32 32 2008 Cook County Health & Hospitals System Questions?


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