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Letter from the CEO of Cook County Health

Saturday, October 31, 2020
Special to suffredin.org

October 2020

Letter from the CEO

Dear Cook County Health Friends and Partners,

For the past 10 years, Cook County Health has been transforming the provision of health care by promoting community-based primary and preventive care, developing a robust, collaborative health insurance plan, and greatly enhancing the patient experience.

Using the net proceeds from our health plan, we have worked with our community partners to invest, develop and provide critically needed programs and services in mental health, opioid addiction and recovery, housing and food insecurity for the residents of Cook County.

What would happen if all of these services were taken away?

What would happened to the 370,000+ members enrolled in our Medicaid managed care health plan and the estimated 94,000 individuals who are eligible for coverage under the Affordable Care Act (ACA)?What would happen to our health system and our 186-year-old mission as one of the largest public health systems and safety net for healthcare for Chicago and Suburban Cook County?

The investments in services and programs, individuals in need of a managed care plan, and providing care to all regardless of their ability to pay are all possible because of the ACA, also known as Obamacare.

Now, there is a threat to overturn the entire ACA. The potential for a repeal of the ACA will be devastating to the patients we care for and will put the fundamental mission of this organization in jeopardy.Our community healthcare partners will also be impacted.

The ACA has been integral in our transformation. It allowed us to build CountyCare, our own Medicaid managed care health plan that has grown to be the largest in Cook County. CountyCare has provided coverage and reimbursements for care to previously uninsured individuals. We believe our CountyCare Health Plan that is made possible by the ACA has also provided stability to other safety net hospitals in Cook County.

In fact, Cook County Health has been able to withstand a 75% decrease in local tax support to fund its operations since 2009 – from $481 million to $83 million this year – in large part due to new revenues available as a result of the implementation of the ACA.

Earlier this month, Cook County Board President Toni Preckwinkle, together with five members of Illinois’ federal congressional delegation, joined Cook County Health leadership to discuss the impact a potential ACA repeal would have on our health system.

Of the 370,000+ members enrolled in our Medicaid managed care health plan, some 94,000 are individuals who became eligible for coverage under the ACA. All 94,000 in our health plan and an additional 214,000 individuals in other Medicaid health plans risk losing their coverage. That’s 308,000 individuals in Illinois alone who are likely to lose their coverage and become uninsured if the ACA is repealed.

Those who lose their coverage may have no other options for alternative insurance coverage. They may be forced to discontinue medications for chronic diseases, such as diabetes and heart disease. Many will go back to relying on local emergency departments for basic health needs or waiting until they are acutely ill to seek care – a much more costly way to receive care. And they will not be insured as we continue to respond to the COVID-19 pandemic. This is yet another hit on minority communities who disproportionately comprise the Medicaid population in Cook County and who have experienced the most negative outcomes from COVID-19.

The financial impact of a repeal is equally staggering.

Should the ACA be repealed, the projected impact to Cook County Health is $1.4B as the result of lost reimbursement and a projected increase in charity care.

This $1.4B number does not include any projections around the cost of care for the number of individuals currently enrolled in a marketplace plan who could lose their coverage or those under the age of 26 who will be thrown off their parent’s coverage. It also doesn’t include those with preexisting conditions who may not be able to obtain coverage. Many of these individuals are likely to turn to us for care as well.

This is a real threat to our organization: losing the progress we have made as an organization and a society under the Affordable Care Act.

Should the ACA be repealed, it is our patients who will be impacted the most. Their ability to access preventive care, mental health and substance abuse treatment and medications will be stripped from them. They will go back to the days of having to choose between food for their families or medications needed to stabilize their health.

These are not choices that any human being should have to make, much less someone living in the richest nation in the world, particularly in the middle of a global pandemic which has illuminated the racial and health inequities in this country once again.

Repealing the ACA can’t be seen as a political victory or loss. It must be seen through the eyes of individuals who do not know the security of having health insurance, the ability to go to a doctor for the common cold or the pharmacy for their insulin or through the eyes of the individual who once rationed their heart pills to pay their rent.

These next few months will be critical in our fight to protect our patients and our health system. I hope you will join us in this fight.

Sincerely,

Debra D. Carey

Interim CEO

COVID-19 Updates from Cook County Health

Cook County Health Leads AstraZeneca Phase III COVID-19 Vaccine Trial

Cook County Health is participating in a Phase III, randomized, double-blinded, placebo-controlled trial for a COVID-19 vaccine known as AZD1222. Cook County Health is one of three centers in the Chicago area participating in the study.

Oxford University’s Jenner Institute and Oxford Vaccine Group developed AZD1222. The candidate vaccine was licensed to AstraZeneca for further development. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, and the Biomedical Advanced Research and Development Authority (BARDA), part of the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response, are providing funding support for the trial.

Unlike the Phase I and II trials that primarily looked at the safety data of the vaccine and documented the antibody response on test subjects, the Phase III trial will evaluate if the vaccine will actually prevent symptomatic COVID-19.

“The effects of COVID-19 have been devastating and have had a significant impact on our way of life. It is critical to identify new strategies to combat this pandemic,” said Dr. Temitope Oyedele, an infectious disease expert at Cook County Health and principal site investigator of the vaccine trial. “This trial is an important step in determining whether an effective vaccine can be developed to halt the COVID-19 pandemic.”

Study participants for the clinical trial must be 18 years or older and be willing and able to provide written, informed consent prior to the start of study procedures. Study investigators are looking for candidates who are considered at an increased risk of contracting COVID-19 and have never tested positive for the virus.

Illinois Department of Public Health, Cook County Department of Public Health Announce New Mitigation Guidelines

On October 26, Cook County Board President Toni Preckwinkle and the Cook County Department of Public Health (CCDPH) confirmed new mitigation measures issued by the Illinois Department of Public Health (IDPH) for public areas in suburban Cook County, including restaurants, retail establishments and other settings. The measures went into effect on Wednesday, October 28, at 12:01 a.m.

Increasing positivity rates and hospitalizations triggered IDPH to move Region 10 from a blue designation to an orange one, indicating there are warning signs of increased COVID-19 risk, per the Restore Illinois Resurgence Mitigations Plan, which uses a standardized approach to monitor the state as a whole, while also monitoring regional trends.

“We have seen eight days of increases in test positivity and seven days of increased hospital admissions,” Dr. Rachel Rubin, CCDPH Co-Lead and Senior Medical Officer, said on October 26. “The positivity rate is now 7.7%, up from 7.2% last week. Metrics like these prompted the state to mandate Tier 1 Resurgence Mitigations, similar to other counties with increased transmission.”

“The numbers are very concerning and a wake-up call as we head into colder weather, flu season and the holidays,” President Preckwinkle said. “We are all experiencing COVID fatigue, but we must remain vigilant and continue practicing the commonsense strategies that have been proven to slow the spread of COVID-19 and save lives.”

Recent studies have shown when people gather indoors to drink and eat at parties, bars or restaurants they are more likely to become lax in following physical distancing and masking guidelines.

“And taking the party home isn’t necessarily safer,” said Dr. Kiran Joshi, Cook County Department of Public Health Co-Lead and Senior Medical Officer. “People are exposed to the virus and are bringing it home to their families and friends. As tempting as it may be to celebrate Halloween with friends, even small gatherings pose significant risk – especially for loved ones who may be more vulnerable to serious illness.”

Suburban Cook County Mitigations

The following mitigations have been issued by IDPH and will be enforceable by CCDPH and law enforcement:

Bars and restaurants

·All bars and restaurants close at 11 p.m. and may reopen no earlier than 6 a.m. the following day

·No indoor service

·All bar and restaurant patrons should be seated at tables outside

·No ordering, seating, or congregating at bar (bar stools should be removed)

·Tables should be 6 feet apart

·No standing or congregating indoors or outdoors while waiting for a table or exiting

·No dancing or standing indoors

·Reservations required for each party

·No seating of multiple parties at one table

Meetings, social events and gatherings:

·Limit to lesser of 25 guests or 25% of overall room capacity both indoors and outdoors

·No party buses

·Gaming and casinos must close at 11 p.m., are limited to 25% capacity and, if applicable, must follow the mitigations for bars and restaurants

Offices

·Continued emphasis on telework for as many workers as possible

Organized group recreational activities & gyms (fitness centers, sports, etc.)

·All sports guidance effective Aug 15, 2020 remains in effect

·Outdoor activities (not included in the above exposure settings) continue per state guidance

In addition to the required mitigations above, CCDPH reminds residents of the Continued Mitigation Strategies that were recommended by the department on August 3:

·Restaurant and bar maximum party size of 6 people per table outdoors

·Indoor fitness class maximum class size of 10

·No personal services that require removal of face coverings (e.g. facials and shaves)

·Residential property managers are asked to limit guest entry to 6 people per unit

·Continue to recommend self-quarantine based on travel guidance to states with high rates of community transmission

Illinois Department of Public Health Releases Halloween Guidelines

As COVID-19 continues to spread, the Illinois Department of Public Health has released guidelines for a safe and healthy Halloween. The list of all the guidelines can be found here. Among the highlights:

·Trick-or-treating needs to incorporate social distancing, masking and proper handwashing, as well as aherance to event size limitations.

·Refer to your local village/city for guidance or policies specific to your location.

·If you think you could have COVID-19 or may have been exposed to someone with COVID-19, you should not participate in in-person Halloween festivities and should not give out candy to trick-or-treaters.

·Anyone who would like to distribute treats should leave individually wrapped candy or treats on a table, on their front walkways, sidewalks or any other outdoor space that allows for at least six feet of social distance from the door.

·Individually wrapped candy should be spread out so each piece is not touching another.

·Anyone distributing candy or treats should wash their hands properly for at least 20 seconds before placing the candy on the table and when replenishing.

·A costume mask is not a substitute for a face covering. If face coverings are worn under costume masks, please ensure this does not create breathing problems, and if so, discard the costume mask.

Cook County Health Expresses Gratitude for Donations

Cook County Health would like to thank everyone who has supported the health system throughout the pandemic. Our staff has been overwhelmed by donations from organizations and individuals who wanted to lift up health care workers, particularly in the early weeks of the pandemic.

Please watch our thank you video here.

Cook County Board President Toni Preckwinkle, Elected Officials and Cook County Health Leadership Discuss the Potential Repeal of the Affordable Care Act

Toni Preckwinkle, President, Cook County Board of Commissioners, Jan Schakowsky, Congresswoman (IL-9), Robin Kelly, Congresswoman (IL-2), Sean Casten, Congressman (IL-6), Danny Davis, Congressman (IL-7), Raja Krishnamoorthi, Congressman (IL-8), Cook County Health patients and staff spoke out in support of the ACA.

Left: Sheila Roberson, a CountyCare member and Cook County Health patient, spoke about what a repeal of the ACA would have on her continuity of care.

Right: Cook County Board President Preckwinkle; Sheila Roberson, a CountyCare member and Cook County Health patient; Debra Carey, interim CEO; and Dr. Whitney Lyn, family medicine physician.

Cook County Board President Toni Preckwinkle, together with Cook County Health interim CEO Debra Carey, joined federal elected officials on October 7 to discuss the impact of a potential repeal of the Affordable Care Act (ACA) on the busiest and largest public health system in the Midwest.

Along with Toni Preckwinkle, president, Cook County Board of Commissioners, and Debra Carey, interim CEO, Jan Schakowsky, Congresswoman (IL-9), Robin Kelly, Congresswoman (IL-2), Sean Casten, Congressman (IL-6), Danny Davis, Congressman (IL-7) and Raja Krishnamoorthi, Congressman (IL-8) spoke about what a repeal of the ACA would do both locally and nationally.

On November 10, oral arguments are scheduled to begin in the Supreme Court to determine the fate of the ACA. A repeal of the law will result in a loss of coverage through Medicaid or the marketplace for millions of Americans. Additionally, a repeal will impact key provisions of the law, including coverage for pre-existing conditions, access to preventive services like cancer and chronic disease screenings, and immunizations.

At least 300,000 individuals in Cook County who gained Medicaid coverage under the ACA are expected to lose their coverage if the ACA is repealed. The loss of coverage will result in an exponential growth in charity care for CCH and other providers. Click here to learn more.

Sleeve Up: Time to Get the Flu Shot

The impact of COVID-19 on our operations has been great and now we face the possibility of a “twindemic,” with COVID-19 and the flu season happening simultaneously.

Getting a flu vaccine this fall can reduce your risk of getting flu and help save medical resources needed to care for people with COVID-19. It’s important for everyone to do their part to stay healthy this flu season. Prevent the spread of flu and other respiratory illnesses, such as COVID-19, and remember to:

·Mask Up: Cover your nose and mouth with a mask when out in public.

·Lather Up: Wash your hands frequently with soap and water.

·Sleeve Up: Roll up your sleeve to get a flu shot.

The more people vaccinated against flu, the more people protected from flu and the more resources available to care for individuals with COVID-19.

Learn more: https://www.cdc.gov/flu/season/protect-your-health.html

Cook County Health Emergency Physicians Helping Patients Register to Vote with the VotER Program

?Staff from the Cook County Health emergency department showcase the lanyards that assist patients in registering to vote.

Emergency medicine physicians and staff at Cook County Health are helping patients register to vote while they wait to been seen in the emergency room.

Ahead of the November election, CCH is among the more than 60 institutions across the U.S. participating in VotER, a national nonpartisan voter registration drive.

“It is estimated more than 50 million eligible people in the United States are not registered to vote,” said Dr. Ameera Haamid, emergency medicine physician. “Our VotER program is designed to encourage our patient population and remind them voting is a civic duty that is deeply connected to their health.”

CCH emergency medicine physicians are wearing lanyards with a QR Code attached to their identification badges. Patients can scan the QR code with their smartphone and are taken to TurboVote, an online voter registration tool.

The process takes less than two minutes. People who complete the registration can receive optional text reminders about the address of their polling place and the time the polls are open.

CCH’s emergency departments care for more than 120,000 patients each year.

“Many of our patients come from communities that are underserved or affected by health disparities that cause them to use emergency departments at higher rates because of a lack of access to traditional forms of health care,” said Dr. Haamid. “These populations are directly impacted by policies that address areas such as behavioral and mental health, insurance coverage, reproductive health rights, and addiction and access to healthy foods, which are often topics of discussion during elections.”

Cook County Health to Distribute 2,000 Wellness Kits to Patients Impacted by COVID-19

Cook County Health received a grant from the NFL Foundation and the Players Coalition through the Cook County Health Foundation to assemble wellness kits for patients most at risk for COVID-19, including those living in congregate settings such as homeless shelters.

Through the grant, Cook County Health assembled more than 2,000 backpacks that are full of supplies to help keep people healthy during the pandemic. These supplies include face masks, hand sanitizers, socks and gloves, soaps and more.

We are grateful to the NFL Foundation, the Players Coalition and the Cook County Health Foundation for their support of our historic mission of caring for the underserved.

Re-imagining HIV Testing and PrEP Services During COVID-19

Cook County HIV Integrated Programs (CCHIP) which consists of CCH sites: Austin CBC, SSHARC (Blue Island, Robbins, Cottage Grove) Provident, and the Ruth M. Rothstein CORE Center, is proud of our work as the Midwest’s leader in HIV/AIDS care. COVID-19 has required us to re-think how to effectively and safely administer HIV testing and PrEP [SC1] (Pre-Exposure Prophylaxis) services and provide HIV/AIDS education for those who need it.

While COVID-19 has grabbed much of the public’s attention, the need for HIV testing and PrEP services remains great and is especially urgent right now. Routine HIV testing is recommended as part of routine health care and taking PrEP is recommended for those who want added protection against HIV. PrEP is a pill taken once daily to prevent HIV and is another form of HIV prevention that is part of CCHIP’s community HIV testing initiative.

We are reimagining our efforts to best deliver the needed care but will continue to target the south and west sides of the city, which have the greatest need.

As part of our efforts:

·We have joined with the Cook County Health/Cook County Department of Public Health mobile COVID-19 testing units to provide HIV testing and PrEP services.

·We are partnering with other organizations that are administering COVID testing and providing HIV testing and PrEP services as well.

·We will be piloting self-administered HIV testing later this fall, thanks in part to a donation from OraSure Technologies.

Cook County Health Receives Grant to Increase Breast Cancer Services

During Breast Cancer Awareness Month, Cook County Health announced it has received a $100,000 grant for the “Breast Cancer Risk Identification, Screening, and Prevention (bCRISP)” initiative to increase access to evidence-based breast cancer risk management and genetic counseling/testing services for traditionally underserved patient populations throughout Cook County.

Through genetic testing and other risk factor assessments, this program focuses on identifying women who are at increased risk for breast cancer in order to provide individualized risk management strategies, including chemoprevention (treatment that slows or prevents the development of cancer), risk-reducing surgeries and alternate screening strategies that can reduce breast cancer mortality through prevention and/or early detection.

According to the American Cancer Society, 1 in 8 women is at risk for developing breast cancer, but women with the BRCA1 or BRCA2 mutation can have up to a 72 percent risk. Identifying these patients early can have an exponential impact on both survival and quality of life of the patient as well as at-risk family members who can also be identified.

Due to socioeconomic and racial disparities, along with other co-morbidities, Cook County Health’s patient population experiences higher mortality rates after a diagnosis of breast cancer compared with women from other racial and socioeconomic classes. This contributes to the marked racial disparities in breast cancer outcomes in the metropolitan Chicago area.

This project is part of the Breast Cancer Screening, Prevention and Treatment Program, directed by Dr. Pamela Ganschow. In collaboration with our community partners, Equal Hope and the Illinois Society of Genetic Professionals, we will expand access to cancer genetic services beyond our health system.

Cook County Health Awards and Recognitions

John H. Stroger, Jr., Hospital Named Top Teaching Hospital

Cook County Health’s John H. Stroger, Jr. Hospital was ranked among the 50 best major teaching hospitals in the country by the Washington Monthly. Hospitals were ranked based on their performance in: patient outcomes, civic leadership and value of care.

The Washington Monthly is a bimonthly nonprofit magazine that focuses on U.S. politics and government. The rankings were compiled in partnership with the Lown Institute, a non-partisan health care think tank.

Dr. Michele Kanter Honored by American Board of Applied Toxicology

Dr. Michele Kanter was the recipient of the American Board of Applied Toxicology’s (ABAT) Exceptional Service Award.

ABAT members are recognized as clinical toxicologists demonstrating exceptional knowledge, experience and competence. Since 2014, Dr. Kanter has served as moderator of the organization’s twice yearly toxicology journal club webinars. As part of her role, she chooses the journal articles to be discussed, picks and mentors the speakers and moderates the live webinars.

Dr. Keiki Hinami Recognized for Research Work on Housing

The Health & Medicine Policy Research Group recognized Dr. Keiki Hinami with the Dr. Steve Whitman Research Award at their annual gala, which was held virtually this year.

A general internist at Cook County Health and a researcher within CCH’s Collaborative Research Unit, Dr. Hinami has done extensive research work on housing and the connection to overall health.

Dr. Mathew Fakhoury Receives Resident Clinical Innovation Award from LUGPA

Large Urology Group Practice Association (LUGPA), a non-profit, trade association that represents independent urology group practices in the U.S., announced the selection of Dr. Mathew Fakhoury as winner of the LUGPA 2020 Resident Clinical Innovation Award. The award acknowledges the value of clinical innovation to harness new technologies, access big data, and develop systems of care to prevent, diagnose or treat urological disease and promote urological health.

Dr. Fakhoury’s winning project, “A Multi-Institutional Quality Assurance Patient Safety Project Across Urban Chicago; Changing County’s/Christ’s Catheter Culture,” implemented a difficult Foley catheter algorithm aimed at non-urologists in order to reduce Foley catheter associated trauma and catheter associated urinary tract infections (CAUTIs). Educational sessions were also developed for and provided to high-volume, non-urologist utilizers of Foley catheters.

Dr. Steven Aks Named to Illinois Governor’s Advisory Committee on Marijuana

Illinois Governor J.B. Pritzker announced appointments to the Illinois Adult Use Cannabis Health Advisory Committee, including Cook County Health’s Dr. Steven Aks.

Dr. Aks is currently the Director of the Toxikon Consortium and Director of the Division of Toxicology at Cook County Health’s Department of Emergency Medicine. He has received multiple honors, awards and distinctions for his work and is considered one of the nation’s preeminent experts on opioid use disorders.

Physician Profile:

?Dr. Julie Wecsler, Breast Cancer Surgeon

Dr. Julie Wecsler has been a breast cancer surgeon at Cook County Health since 2017. She has special training in oncoplastic surgery, which involves combining oncologic surgical principles with plastic surgical principles in order to focus on a better cosmetic outcome while effectively treating cancer.

Dr. Wecsler attended University of Southern California’s (USC) Keck School of Medicine and completed her residency and fellowship at USC as well.

At Cook County Health, Dr. Wecsler works with a multidisciplinary breast cancer team that ensures all patients have access to timely and high-quality care. She is focused on helping patients after their initial diagnosis find the treatment that best fits them.

“Great advances have been made in breast cancer treatment,” Dr. Wecsler said. “While a breast cancer diagnosis can be scary for patients, we have a wonderful team that is dedicated to our patients to make sure they have access to treatments that can give them the best outcome.”

Resources for Food Insecurity

The pandemic has heightened food insecurity in Cook County. Please share the following resources with those in need.

Chicago Public Schools Meal Info

Chicago Public Schools is hosting more than 450 meal sites for the 2020–21 school year. Students, parents or guardians may pick up free meals at the nearest school Monday through Friday, 8 a.m. to 1 p.m. You can find the nearest meal distribution site using this map. If families are unable to visit a meal site in-person, the district will continue to provide free delivery for those who need additional support.

Greater Chicago Food Depository Resources

To find food near you, visit the Greater Chicago Food Depository’s food locator: https://www.chicagosfoodbank.org/find-food/

Need help applying for food benefits? Contact the Greater Chicago Food Depository by calling 773-843-5416 or visit their website at https://www.chicagosfoodbank.org/benefits-outreach/

Cook County Health in the News

Chicago Tribune: Going to a Chicago ER? Now you can register to vote while you’re there.

ABC 7: Breast Cancer Awareness Month brings renewed push for screenings

NBC 5:Increase in Stress-Related Illnesses Attributed to COVID-19

Illinois Health Officials Issue Guidance on Halloween During the Coronavirus Pandemic

President Trump’s COVID-19 Diagnosis Highlights Push for Contact Tracing

WGN: What is Regeneron’s antibody cocktail? Here’s what we know about Trump’s treatment

Chicago Sun-Times: 300,000 patients could lose insurance if Obamacare repealed, analysis warns

WBBM: The viral antibody cocktail Trump took is being studied in Chicago

WBEZ: Health Officials Say Repealing Obamacare Would Be ‘Catastrophic’ For Cook County

Crain’s Chicago Business:Progressive policy is good for public health

Visit our website at cookcountyhealth.org

?If you would like to invite a representative from CCH to attend a community event, please send an email to events@cookcountyhhs.org.

To provide feedback on CCH Community News, update your contact information, or unsubscribe, please email Marcelino Garcia, Director of Community Affairs, at mgarcia6@cookcountyhhs.org.

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