Cook County Health and Hospitals System’s budget for 2015 calls for opening a call center, hiring hundreds of nurses and investing in everything from wheelchairs to exam tables to bolster the patient experience.

The initiatives, part of the system’s proposed budget for the fiscal year beginning Dec. 1, are designed to keep patients from seeking care elsewhere. The biggest chunk of the estimated $1.4 billion in total revenue comes from CountyCare, an innovative Medicaid program that launched as a pilot in 2012 and in July became a full-fledged managed care program that made the health system an insurer.

Cook County Health also plans to reduce its subsidy from county taxpayers to $164 million, from $175 million budgeted for the end of the current fiscal year. Those savings are due to being more financially efficient and having more of its patients insured through the Affordable Care Act.

“We hope that our budget is putting our money where our mouth is” as the competition for patients becomes even more fierce, Cook County CEO Dr. John Jay Shannon told the finance committee of the independent hospital board on Aug. 15.

Cook County Health is one of the largest public health systems in the nation. The system, which historically has treated a predominantly poor and uninsured population, includes John H. Stroger Jr. Hospital on the Near West Side, Provident Hospital on the South Side and several clinics. For the last six months, the majority of patients treated were insured, Dr. Shannon told the committee.

In 2015, the preliminary budget calls for $1.4 billion in revenue, 11 percent more than the health system estimates it will end the current fiscal year with, at $1.2 billion. Expenses are expected to climb 9 percent, to $1.5 billion in 2015, from $1.4 billion at the end of 2014.

Much of the expansion in the proposed budget is due to the growth of CountyCare, which has about 100,000 members and is expected to swell to at least 150,000 people in 2015. The program, which started only with newly-insured adults, now is taking on a broader population of patients, including families, seniors and people with disabilities. CountyCare is expected to generate $915 million in revenue, 67 percent of the system’s total revenue.

Managing the surge in patients is key, said Laurence Msall, president of the Civic Federation, a Chicago-based fiscal watchdog group.
“That’s an enormous growth of the CountyCare program, and it’s going to require some sustained effort not just on drawing in new members, but how you’re going to manage the costs,” Mr. Msall said.

He added that he’d like to see a multi-year forecast and a plan for where resources are going to be allocated.

Among the efforts to improve patients’ experience, Cook County Health plans to open a call center where patients can book a doctor’s appointment or talk to a clinician about symptoms that might trigger a visit to the ER. Now, there’s no standard process, with some patients paging their physicians when they need care or others re-visiting clinics they’re familiar with, Dr. Shannon said in an interview.

The health system also plans to spend about $10 million on capital investments, including such things as blood pressure cuffs, wheelchairs and patient beds.

To help trim expenses, Cook County Health is focusing on pharmaceutical costs, with a particular focus on pricey drugs. For example, the health system could save about $5 million a year by having CountyCare patients who take expensive HIV drugs order a 90-day supply rather than a 30-day supply, said Steven Glass, who oversees managed care for Cook County Health.

Many of the new initiatives depend on hiring more staff. The health system has about 5,600 employees and plans to spend about $22 million filling about 500 vacancies in 2015, particularly nurses. It will still have about 600 vacancies.

“We’ve put most of our energy in the past year on the hiring end,” Dr. Shannon said. “I think we’re going to have to put an increased focus on retention. … Most organizations recognize it’s hard to get satisfied patients if you have unhappy staff.”

Filling 500 vacancies is an ambitious target, Dr. Shannon said, especially since Cook County is still trying to reform its cash-strapped pension plan and the uncertainty has triggered retirements and resignations.

The proposed budget is scheduled to go before the 11-member hospital board on Aug. 29 and will be introduced to the Cook County Board in September.

Read the article at Crain’s Chicago Business.