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Cook County Health Debuts An Ambitious Roadmap

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A billboard advertises CountyCare, the Cook County health system's Medicaid business.

A billboard advertises CountyCare, the Cook County health system’s Medicaid business.

Shannon Heffernan/WBEZ

Cook County Health, the county-run healthcare system, wants to become a go-to medical provider for the county’s roughly 22,000 government workers, as well as for other employers. It also wants to court more patients who have insurance, and beef up services at its Provident Hospital on the South Side.

Another part of the plan: woo more expectant moms. After all, they and their growing families could become lifelong patients.

These ideas are part of the health system’s ambitious proposed strategic plan for 2020-22. The goal is to generate more money and boost access to medical care. As the medical anchor in Cook County, the health system’s patients are largely low-income and people of color. Cook County Health needs to attract more insured patients to cover the hundreds of millions of dollars the system writes off each year for other patients who are either uninsured or can’t afford to pay their medical bills.

Cook County Health could become even more of a destination for the poor, as other hospitals that serve this population shrink their services or close.

“The challenge that’s going to be facing us is the safety net … is going to fray further in the county during this strategic plan,” said Dr. Jay Shannon, who has led Cook County Health since 2014.

He presented a draft of the three-year roadmap to the health system’s board today.

The bold vision comes as the health system has had to defend its reputation after a critical report last month from Cook County Inspector General Patrick Blanchard. He raised serious questions about the finances of the health system and its CountyCare Medicaid business. Blanchard’s findings included a roughly $700 million backlog of bills CountyCare owed medical providers and others in 2018. Shannon has disputed that finding.

Blanchard’s report caused a swift backlash from angry Cook County commissioners who demanded answers. Health system leaders plan to provide them during a county board meeting next week, and they’re considering whether to have a third-party review Blanchard’s findings.

The health system’s strategic plan is packed with aspirations. It’s not clear how much some ideas would cost, or how much money others would generate.

Among the goals:

*A key focus is growth. This involves adding more neighborhood clinics that are convenient and cheaper for patients compared to pricey hospital emergency department visits, beefing up specialty care -- think Centers of Excellence for women’s health -- and modernizing technology so doctors who don’t work for the health system can more easily refer them there.

The idea is not only to increase access to medical care, but to better compete for patients against rival doctors and hospitals. The health system’s CountyCare Medicaid business is a money-maker. That’s important to the county’s overall budget, too. But CountyCare is paid based on enrollment. So attracting more members is key. CountyCare has about 317,000 enrollees.

*More than 14,000 county health system patients or CountyCare members each year age into Medicare. That’s the federal health insurance program for seniors 65 and older. Many of these patients typically leave the health system when they start Medicare insurance. Cook County Health is considering different types of programs to help prevent these patients from leaving.

*There are plans to build a new modern facility on Provident’s South Side campus. This would consolidate inpatient and outpatient services to attract new patients, and prevent people from having to travel to the health system’s other hospital, John H. Stroger Jr. on the Near West Side, for common tests. The health system also aims to reopen Provident’s emergency room to ambulances to generate more revenue. That effort stopped in 2011.

*Cook County workers have insurance through dominant Blue Cross and Blue Shield of Illinois, and Cook County Health is part of the network. Leaders want to encourage county workers to use the health system more.

Laurence Msall, president of the Chicago-based Civic Federation, which analyzes government finances, said he finds this idea intriguing.

“The county should be the low-cost provider of health care services to its own employees,” Msall said.

It’s also a way to expand the demographics of the people who access care within the health system, and strengthen the county’s bottom line, Msall said. That’s because Cook County Health would get reimbursed by Blue Cross, which typically pays more than government insurers like Medicaid. That insurer covers people who are low income or disabled..

The health system would not provide more details on proposals in the strategic plan. A spokeswoman said it would be “premature” because the plan is a draft.

Many of the goals are lofty and likely expensive. The strategic plan acknowledges that the health system must keep its finances in check to pay for robust proposals.

“... Without the financial resources to invest in infrastructure, technology and employees, CCH will be at a competitive disadvantage, making it even more critical for CCH to collect every dollar possible to protect the mission of the organization,” the plan said.

Blanchard, the county inspector general, has criticized the health system for not collecting all the money it’s owed by insurers and patients. Health system leaders have said they’ve been forced to change rapidly, while other hospitals have been billing multiple insurers for years.

While leaving money on the table, Cook County Health at the same time provides more free medical care by far than any other hospital in the county. There are about 70 hospitals. The county health system has two of them.

Health system board members today mulled whether to set a goal for the types of patients doctors there treat. More insured patients versus fewer, for example.

“I just don’t know how we can survive if we don’t contemplate that,” board member Mary Richardson-Lowry. “We cannot just be only charity.”

Another board member, David Ernesto Munar, suggested using the CountyCare insurance business as a way to market the health system as more than just a provider of medical care.

Cook County Health plans to submit its strategic plan to the full Cook County Board this fall.

Kristen Schorsch covers Cook County politics for WBEZ. Follow her on Twitter @kschorsch.

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