COOK COUNTY HEALTH & HOSPITALS SYSTEM Commission Standards. ... – Emergency department wait times and throughput ... COOK COUNTY HEALTH & HOSPITALS SYSTEM.

COOK COUNTY HEALTH & HOSPITALS SYSTEM

CCHHS Board of DirectorsQuality Dashboard Overview

26 February 2016Krishna Das, MD, Chief Quality Officer

CCHHS Board QPS Committee1

2 CCHHS Board QPS Committee

Board Quality Dashboard


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


(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



(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


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


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


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


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.


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 Committee


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


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


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


Key Performance Indicators


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


Prevention:Influenza Vaccination


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


*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



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 Employment Plan: Training Update

3

Employment Plan requires that all New Hires attend Employment Plan Training within 90 days of their start date.


CCHHS Employment Plan Office: Investigation Update

4


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


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


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)


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


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


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

Data ChartsProvided For Discussion Purposes Only

3

Quality MetricsProvided for Discussion Purposes Only

4


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


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.


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


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


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


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


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


Comments:• Significant deterioration in member and provider call center performance

• Inquiry to TPA about performance pending


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

COOK COUNTY HEALTH & HOSPITALS SYSTEM Commission Standards. ... – Emergency department wait times and throughput ... COOK COUNTY HEALTH & HOSPITALS SYSTEM.

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