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Study Warns of Looming Crisis in Cook County Health System

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August 15, 2006

CHICAGO --- The Cook County health care system is facing a crisis that will require a comprehensive effort to solve critical problems in financial stability, personnel practices, inter-institutional relations, meeting growing demand throughout the county, and governance.

Those are the findings of a comprehensive study conducted by the Northwestern University Feinberg School of Medicine Institute for Healthcare Studies.

The study, commissioned by the Chicago-based Otho S. A. Sprague Memorial Institute and released today (Aug. 7), analyzed assets and challenges faced by the Cook County Bureau of Health Services, one of the largest and most comprehensive public health and hospital systems in the country.

It urges creation of a civic “Blue Ribbon Commission,” preferably in collaboration with the Cook County Board President’s Office and Board of Commissioners and co-chaired by a key civic and/or business leader and a Cook County Commissioner.

Kevin Weiss, M.D., director of the Northwestern institute, said, “The commission would address the problems created by increasing and changing demands on the services of the Cook County Bureau of Health Services.” They include:

• Decreases in revenue from the State Medicaid program, the system’s primary source of patient revenue

• Growing demand for health services from an increasing number of uninsured and under-insured people

• Escalating health care costs that approach double digits annually

• New regulatory requirements for quality of care and patient safety that will necessitate significant changes in how care is given and documented

• Changing demographics of populations and communities that depend on services

• The increasing inability of not-for-profit hospitals and clinics in Cook County to meet growing demand

• The lack of a comprehensive solution from Washington and emerging national policies that may further strain public health systems

• The State of Illinois’ move to changing its model for delivering care toward disease management, requiring innovation for the system to respond effectively

The report provides a 10-point “action agenda” for improving quality, access and efficiency of the services being offered by the bureau. The agenda includes actions for the civic community, the County Board and the Bureau itself.

Key among these is the need for change at the highest level of governance of the board including:

• Create transparency by establishing performance measures in quality, access and efficiency that would serve as the basis for an annual public report for the county’s health care system and benchmark for system’s improvements

• Use national best practices to restructure governance of the bureau, with the specific addition of high-level expertise in management of large healthcare systems

• Initiate a comprehensive assessment of current taxing level to determine if it is adequate to support the system’s needs

• Develop and implement a comprehensive financial strategy for the bureau

• Redesign the county human resources system to reflect an accountable process that is consistent with other human resource systems in the health care industry, specifically freeing it from its historic bureaucratic constraints and political influence

• Further nurture historic connections to other health care providers (including hospitals and clinics) to assure that the wider health care “safety net” is functioning efficiently and resources are not duplicated

• Undertake a comprehensive assessment of the facility and workforce needs of the system and assure that the appropriate complement of services are in place to meet changing demographic needs

• Initiate and coordinate an ongoing community forum to assess how Cook County government handles health care safety net issues

THE STUDY

The six-month, three-phase project was directed by Dr. Weiss in collaboration with investigators from Health Management Associates (HMA). The HMA investigators have had past experience in senior leadership, both within the Cook County health care system and the Illinois Department of Healthcare and Family Services. HMA is nationally known for its work with public health and hospital systems throughout the country, consulting directly for local governments to assess their systems and to develop and implement strategies that more effectively and efficiently assure care to the most vulnerable residents.

The first phase of the study was based on the lessons learned in other similar communities; public information on the county’s financial and non-financial performance; information on federal and state support of the county’s health facilities; interviews with Cook County Commissioners and Chicago-area civic, business, advocacy and health care leaders; and two focus groups with Cook County Bureau physicians.

The second phase included peer-review by national experts that included expertise from safety net providers from other communities, as well as scholars in the field of health care provision for the uninsured and “blinded” peer review from Chicago-area community leaders with experience in health care delivery for safety net populations.

The last phase was review of a final draft report with a complete set of recommendations, conducted in focus groups with Chicago-area leadership in health care for Cook County’s uninsured and one-on-one reviews with selected civic, business and health care leaders.