Cook County Health and Hospital System

Public health systems are vital assets to any community and it plays a vital role in a larger healthcare delivery system and the overall health of the communities that they help to serve. A vertically integrated health care system specifically seeks to provide a community with its health care needs all in one spot (Carlin, C. S., Dowd, B., & Feldman, R. 2015). Patients can obtain all of their care in a single location and health system thereby decreasing hassle for patients and maintaining the patient population within the healthcare organization.

They maintain a positive and mutually beneficial relationship for both patients and the healthcare networks.

With a motto to “care for the most vulnerable” Cook County Health and Hospital System (CCHHS) has been an exceptional example in delivering the above said since 1935. CCHHS has always been committed to working with its patients and their population to develop strategies and partnerships to have a real impact and negate health discrepancies. CCHHS has always been observant of the inventory of services it can deliver at an exceptional level and balance them out with the needs of the patients and their neighborhoods.

It has always stayed on top of emerging health trends and challenges such as Hepatitis C, Zika Virus, gun violence, the opioid crisis, or any other uprising epidemic (Cook County Health and Hospitals System. 2018).

There are many positive and negative aspects to vertically integrated health care such as an established system like CCHHS. Many improvements can be made to the system such as providing more support to the community, increasing training and technologies to the facilities, allocating resources properly, and seeking out the next era of technology and health care (Conway PH, Clancy C 2009).

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Background

Serving all without regard offorforoffer for their ability has been always been a priority and a historic mission of the CCHHS. The Cook County Health & Hospitals System (CCHHS) is one of the largest public health care systems in the United States. It offers a range of health care services regardless of a patient’s ability to pay. Thereby servicing patients in the community for free funded by taxpayers. There are not many hospitals in the country that offer such services at no cost to the patients. CCHHS serves approximately 300,000 unique patients annually through more than 1 million outpatient visits and more than 20,000 inpatient hospital admissions. CCHHS holds a network of 15 community health centers, 4 Outpatient Centers, a state and nationally certified public health department serving suburban Cook County, offers health care services to 50,000+ detainees at the Cook County Jail and residents of the Juvenile Temporary Detention Center every year, implements CountyCare, one of the largest Medicaid managed care plans in Cook County, and the System’s hospitals and ambulatory network are Joint Commission accredited (Cook County Health and Hospitals System. 2018).

Other facilities include

• Ruth M. Rothstein CORE Center (HIV/AIDS)
• Providence Hospital
• Oak Forest Hospital
• Population

Services rendered at CCHHS include

• Inpatient
• Outpatient
• Cancer-care
• Hospice
• Laboratory
• Pathology and Same-Day Surgery

Problem Statement

These 5 challenges listed below are required by CCHHS to leave its traditional methodologies and rework them into a contemporary, integrated health system, as well as help in managing all of its parts to guide towards supplying top-quality health care and the elimination of health discrepancies throughout Cook County.

• The community has been suffering from a lag to attain proper high health potential; no individual should be hindered from reaching their full potential due to being disadvantaged from financial potential or other socially affected circumstances (Marmot M, Bell R. 2012).
• Quality healthcare to an individual patient health care can be ensured by the proper quality of infrastructure, training, and competence of personnel through the efficiency of operational systems. The fundamental requirement is the adoption of a system that is ‘patient-centered’ and the implementation of highly dependable processes (Ballard DJ, Spreadbury B, Hopkins 2004).
• Focus on financial management and make current resources available to be spent with an optimal focus to meet the community’s needs, and strategic priorities and also ensure to avail industry-standard of services in a very cutthroat competitive environment (Brezis M, Wiist W. 2011).
• Building employees’ skills through education and development opportunities focused on improving efficiency and quality of care, as well as staff and patient satisfaction will serve as the basis for all of its work (Levinson et al., 2010).
• Top-notch clinical research, particularly for vulnerable populations. It is an important component to maintain the System’s workforce pipeline and develop effective innovations in care.

Analysis of the Problem

With changing trends a public health system needs to strengthen its delivery of outpatient services – primary care, specialty care, diagnostics, therapeutic, dental, behavioral health, and pharmacy thereby preventing unnecessary hospitalizations and reserving inpatient services when only medically indicated. A care management model needs to be employed with a focus to improve patient outcomes, engaging physicians and medical home teams, and improving patient satisfaction (Ignatavicius et.al 2016). Health systems need to be committed to employing additional efforts to improve the patient experience, rallying their workforce around a patient-centered approach that raises the bar on quality and customer service will require significant investment and effort across the organization. Ensuring that the System is continuing to meet national Culturally and Linguistically Appropriate Service (CLAS) standards. Health systems need to invest more in reputation, building, and branding around service lines. Ranging from staff expertise and centers of excellence or it might be through patient support centers to enhancements in its-patient parking all can help a health system better its overall look and reputation.

Competition has increased due to newly insured patients and capturing a larger share of the Medicaid plan is vital regardless of the plan in which a patient is enrolled. Leveraging the Affordable Care Act, contracts with MCOs, continued efforts to improve clinical documentation, billing, and increased marketing efforts will yield additional revenues. Initiatives related to staffing, supply chain management, information technology, and, marketing (Bakken S. 2001). Participation in national benchmarking databases will allow CCHHS to hone in on opportunities, both short and long-term that can have the greatest impact on lowering operating expenses, while new nurse staffing software will result in clinically appropriate staffing models that assure safe care and are responsive to fluctuations in census and severity of illness.

Professional development and training are critical imperatives in a modern health system. Health systems need, to be committed to the creation of a comprehensive professional development strategy that touches all employees and includes continuing education opportunities, assisting, encouraging, the and incentivizing employees to earn advanced degrees and, helping all employees better understand the impact of the external market (Hauer et. al, 2008). Leadership needs to host a monthly labor-management labor-management meeting that brings together system and union leadership to discuss common issues and to develop common solutions.

Research is critical for attracting residents and physicians into the clinical investigation community (American College of Physicians, 2007)., and training should be availed at all levels with an explicit goal to truly impact health imbalances, by exposing trainees and all employees, for that matter, to health discrepancies early in their careers, creating a lifelong passion for mission-based work. Training and research, business intelligence, the ce, and public health are enormous positive additives to the system, but greater integration could yield remarkable results in developing new care approaches to address health discrepancies and social factors of health.

Recommendations/Solutions

CCHHS being an exceptional example to public health system has a greater potential to improvise to make high outputs and become a provider of choice. By employing the following recommendations they can increase their overall throughout:

• Standardize clinical operations, practices, and, procedures across the System to improve quality, reliability, and efficiency.
• Improve the availability of and access to health care, especially preventive care, for Cook County residents.
• Ensure there is a continuum of services. To meet evolving needs of a patient and t ensure continuity of care and meet patient needs at all stages of their life.
• Develop systems that meet or exceed expectations and enhance the patient experience.
• Integrate services with correctional health, both by focusing on early interventions to prevent arrests and reduce the jail population and by ensuring the continuation of care when individuals are released from correctional or detention facilities and reside in Cook County (Strugar-Fritsch, 2013).
• Grow primary care base.
• Retain and grow CountyCare membership through marketing, acquisition and, State policy changes on redetermination and jail detainee coverage (Strugar-Fritsch, 2013).
• Identify existing centers of excellence and invest in the development of additional centers based on community needs expertise needsexpertiseneeds expertise, sysem expertise,e, and available resources.
• Maximize reimbursements from Managed Care Organizations (MCOs) and private insurance and compete on value, grow membership, and, influence MCO strategy (Garrett et al., 2003).
• Demonstrate fiscal responsibility with limited resources by controlling costs and maximizing efficiency.
• Improve provider documentation to support coding and billing to reflect the level of service offered and the complexity of illness of the patients.
• Deploy efforts to increase patient safety, documentation, system, and, communication to limit financial exposure to litigation claims, and minimize information and data security risks.
• Ensure patients and members receive the right care, at the right time in the right place
• Partner with labor to provide a health care experience that is convenient to patients.
• Recruit, hire and,, retain the best employees, who are committed to the CCHHS mission
• Enhance medical education by further development of safety culture and reporting.
• Promote interdisciplinary engagement to address complex medical conditions.
• Exploit relevant sources for monitoring quality, cost, utilization, and, patient outcomes.
• Utilize data and experience to address health imbalances to conceptualize and plan robust interventions to improve population health (Sterman, 2006).
• Invest in continuous learning and development, including training around domain-specific approach  best  practices
• Demonstrate value of undergraduate and graduate medical education and academic affiliations to the organization by analysis of costs, returns, pipeline to the workforce,  and facilitation of CCHHS mission.
• Ensure continued access to care for uninsured patients.
• Partner with other organizations to address population health care needs outside of the health care system, including those related to social factors of health.
• Advocate for National Health Service Corps (NHSC) Loan Repayment Program eligibility to be expanded.
• Advocate for influenza vaccine requirement for all health care workers in Illinois.
• Advocate for developments in identifying and addressing blood lead levels in children in suburban Cook County.

Implementation Plan:

• Leverage the Quality Council to implement standard measures. Integrate continuous process improvement in care delivery (e.g. Six Sigma methodology) (DelliFrane et al., 2010) and maintain improvements. Develop a system-wide professional practice model for the delivery of high-quality, safe, patient-centered, evidence-based nursing care.
• Make investments in outpatient facilities, leveraging data on population health and changes in the local health care environment impacting the availability of primary care or specialty service. Implement operational developments to improve access: expand evening and weekend hours at health centers and specialty care sites, adopt open access appointment model, timely follow up follow-up appointments from the Emergency Department (ED), and optimize times, locat, ions, and spectrum of specialty services available at CCHHS health centers.
• Develop cultural competency in the workforce. (Balcazar, Rosenthal, Rush, Matos & Hernandez, 2011) Explore options in acquiring additional members through changes in the marketplace. Work with local, state, and, federal stakeholders to streamline the care transition process for justice-involved populations to prevent gaps in care. Advocate for state policy changes that result in a simpler redetermination process.
• Continue outreach to MCOs to increase the number of contracts. Develop an approachanapproachlabor plansplan to review contracts to determine cost/benefit. Continue to review and improve operations and processes to maximize reimbursement from MCOs. Conduct utilization management, claims payment, and reporting to support MCOs contracts. Improve billing by the reconciliation of clinical registrations and billing system output (Garrett et al, 2003)
• Advocate for an adequate level of Medicaid spending in state appropriations. Work with external partners, including other large urban public health systems, on shared policy priorities and targeted advocacy efforts. Explore Disproportionate Share (DSH), and supplemental payment programs designed to assist providers treating specific populations. Advocate for policies to provide Medicaid reimbursement for detainees while in County jails.
• Foster patient safety program. Supply and offer education regarding risk reduction including documentation and communication. Mitigate claims expenses through employee training. Identify information technology risks and develop a hiringmanagementhiring many labor-management laborplans mitigation plans. Give tools for providers to collaborate with Health Information Management to achieve chart completion and coding queries to support timely billing. Execute marketing and branding strategy. Develop marketing tactics for specific service lines.
• Conduct an Employee Engagement Survey. Promote employee feedback email address. Perform annual performance evaluations. Strengthen management and leadership training. Streamline hiring the mastering process. Implement aligned approaches regarding Graduate Medical Education to attract and retain superior clinical faculty.
• Enhance collaboration with labor inmatewithinmate with-management with management to further employee engagement. Pursue academic partnership with one college of nursing to foster and grow nursing research. Invest dollars in capital equipment greater than annual depreciation. Conduct an assessment of each clinical training program to determine value such as cost/benefit, strategy, ic alignment, and workforce pipeline. Conduct parallel l assessments to determine the appropriate support structure for each program.
• Develop an uninsured plan to increase access to health care, avoid preventable acute care needs and improve outcomes. Collaborate with local government and local stakeholders to offer greater access to health care services at CCHHS for the uninsured.
• Assess contribution of Race, Ethnicity, and Language (REAL) factors to adverse events and develop mitigation strategies. Assess the contribution of discrepancies to health outcomes and adverse events. Determine if a patient’s cultural or racial factors contribute to adverse outcomes and evaluate the causes of these outcomes (Balcazar, et al, 2011).
• Partner with large urban public health systems to advocate for policy changes to the inmatethe exclusion. Support legislation to grant relief from liability to providers who administer opioid relief drugs.

Conclusion with Future Recommendations

CCHHS is progressive and ahead of its time can to being a vertically integrated health care system. Patients are able cantocan to meet all of their healthcare needs in one spot. Though CCHHS has been established in 1834, the organization can still put more effort into providing better care for its growing patients. CCHHS needs to continue its focus on the below major key points to growingInputting more and more in the competitive and versatile healthcare environment.

• Increased access to behavioral health care, including expansions of psychiatric and substance abuse services
• Continued focus on justice-involved populations
• Partnerships with community-based health and social service organizations.
• Bilingual/culturally competent staffing.
• Caring for the Inputtinguninsured population.
• Improving the patient experience.
• Maintaining the System’s mission to care.
• Increasing preventive health programs and home health services.
• Collaborating with elected officials to address community needs and structural imbalances through policy.

In putting efforts to advance CCHHS into the new era in healthcare, it can become not only a better vertically integrated healthcare system, but it can be a healthcare system that patients will strive to be a part of because of the care and overall advancements.