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HMPRG's Testimony from Cook County Health and Hospitals System's Strategic Planning Town Hall Meeting (10/20)

Health & Medicine Policy Research Group (HMPRG)
October 21, 2009


Testimony before the Cook County Health and Hospitals Systems Board

October 2009

My name is Margie Schaps, I am the Executive Director of the Health and Medicine Policy Research Group, a policy and advocacy group that has worked to improve health systems and the health of the public in Chicago, Cook County and the State. We have worked on issues related to the County Health system for all of our 28 years, were instrumental in making the case for the new hospital and for the creation of the Independent Board of Directors.

Health and Medicine believes that the County Health system is so complex and large and that it should be, like nearly all other large public health systems in the country, governed by an independent board of directors.  The current board should be applauded for all that it has accomplished in its short tenure including hiring of a strong competent CEO, and for undertaking the difficult task of strategic planning.

That said, we have serious concerns about the recommendations that are being put forth in the preliminary strategic planning document and want to raise several issues that do not seem adequately addressed in the document:

• First and foremost the system is different from all other hospitals and health centers in our communities….your responsibility is to a population, those who need the public health system. Therefore you need to take a population based approach to all of your recommendations and evaluate each of them on how they will affect the health of the public.  The so called plan put forth is not a coherent plan based on the population needs of our County…rather it is a series of individual recommendations that do not come together around improving the health of the county’s residents.

• Recognizing that your mission is to serve all regardless of ability to pay, you are still in a position of needing to maximize revenue into the system. No other public health system in the country has been able to draw commercially insured patients into their system, and we should assume the same will be true here. Given that reality, the Systems board should proceed to work closely with Medicaid. There is no mention in the document of working with or planning with the state Medicaid program….they need to be viewed as a partner with the County health system, and this should be undertaken in a very aggressive manner

• As for specifics in your recommendations—first with regard to partnering with FQHC’s to provide primary care.  This certainly has some merit, but must be done with the greatest of caution…FQHC’s are very diligent about keeping the percentage of uninsured to a manageable amount for them to remain solvent…many FQHC’s in Chicago keep their percent uninsured at or below 10%, others are able to go as high as 40%.  In LA County, the health system got out of the primary care business by “partnering” with other health centers, and did not get any insured patients back into their system. We should enter into agreements with health centers only after making sure that the County Health system gets what it needs and deserves out of the relationship, ie. If patients need hospitalization will they guarantee they return to County, even, and especially if they are insured patients. Will County residents be able to train at these sites, and if not what will that mean to your training programs?

• Hubs of care: Again, there might be some merit to this notion, but it must be remembered that people want to get primary care close to where they live. Furthermore, there might be significant financial implications by taking certain services outside the hospital—Medicare and Medicaid rates for specific services pay much higher rates when the services are provided within the hospital than they do outside.

• All public systems face the problem of losing patients to other hospitals once they get insurance. The way to address this in part is to have comprehensive, population based programs to address serious health issues like cancer, stroke, diabetes and heart disease. If people are convinced their health issues are being addressed comprehensively they will be more likely to stay within the system even when they become insured

• Provident: The south side needs health care facilities. The University of Chicago is cutting back on the amount of free care and Medicaid they will provide. There may be an opportunity to collaborate with the Uof C and get support from them for serving low income people on the south side. The Systems board should appoint a task force to look closely at what opportunities there may be for Provident before making any final decisions on its fate. Furthermore, if the system decides to maintain emergency services at Provident, this can’t be done without having some level of inpatient services.

• Oak Forest: Again, I would reiterate that the greatest growing need in the County is on the south side and the southern suburbs. Before making significant changes to the Oak Forest facility we would recommend appointing a  task force to look at all options to serve the growing population in need in that area.

• One of the only things that all health reform proposals in Congress right now share is that everyone with an income below 133% of poverty will be covered by Medicaid.  This does mean that many of the people now served in the County system will have Medicaid…the challenge to the System is to create programs and services that will manage the health problems faced by this population and will make people want to use them.

• Finally, we urge the board and the system leadership to look for opportunities to collaborate or merge with other public systems, including the Chicago Department of Public Health and other public systems across Northern Illinois.