COOK COUNTY HEALTH & HOSPITALS SYSTEM

COOK COUNTY HEALTH & HOSPITALS SYSTEM CCHHS Board of Directors Quality Dashboard Overview 26 February 2016 Krishna Das, MD, Chief Quality Officer 1 CCHHS Board QPS Committee

Board Quality Dashboard 2 CCHHS Board QPS Committee

COOK COUNTY HEALTH & HOSPITALS SYSTEM CCHHS Board of Directors Stroger Hospital Quality Plan Summary 26 February 2016 Krishna Das, MD, Chief Quality Officer

Goals of a Quality Program To comply with law and regulations which govern quality management in the healthcare setting To continually improve quality processes and outcomes To improve patient safety and to comply with laws regarding safety event evaluation and reporting To assure successful accreditation and certification To create value for the organization 4 Quality Plan 2016 Overview

Regulatory Standards: CMS Conditions of Participation: 42 CFR 482.21 The hospital must develop, implement, and maintain an effective ongoing, hospital-wide, data-driven quality assessment and performance improvement program (a) Program scope: To show measurable improvement in indicators with evidence that it will improve health outcomes and identify and reduce medical errors Track indicators including adverse patient events to assess care, hospital service and operations 5 Quality Plan 2016 Overview

Regulatory Standards: CMS Conditions of Participation: 42 CFR 482.21 (b) Program data Incorporate quality data Use the data to monitor the effectiveness and safety of services and identify opportunities for improvement The frequency and detail of data collection must be specified by the hospitals governing body (c) Program activities Set priorities for performance improvement Track medical errors Implement performance improvement activities, measure success and track improvement 6 Quality Plan 2016 Overview

Regulatory Standards: CMS Conditions of Participation: 42 CFR 482.21 (d) Performance improvement projects Hospital conducts performance improvement projects Projects must be proportional to the scope and complexity of the hospital s services and operations (e) Executive responsibilities Leaders governing body, hospital administration and medical staff, ensure that a Quality Assessment and Performance Improvement plan is created and reviewed annually Assures resources for assessing and improving performance 7 Quality Plan 2016 Overview

Joint Commission Standards Leadership LEADERSHIP Quality and Safety Quality, safety and performance improvement planning is hospital wide. Work processes are designed to focus individuals on quality and safety issues Leaders set priorities for performance improvement activities and patient health outcomes Leaders give priority to high-volume, high-risk or problem prone processes Leaders implement a hospital wide safety program An individual or a multidisciplinary group manages the safety program The scope of the safety programs ranges from potential or no harm errors (near misses or close calls) to hazardous conditions and sentinel events 8 Quality Plan 2016 Overview

Joint Commission Standards Performance Improvement PERFORMANCE IMPROVEMENT The hospital collects data to monitor its performance Leaders set priorities for data collection Hospital compiles and analyzes the data Presents data in usable forms; tracks and trends Benchmarks data to external sources Uses data to identify improvement opportunities Hospital improves performance on an ongoing basis Prioritizes improvement opportunities Takes action on improvement priorities Evaluates actions to confirm that they resulted in improvements 9 Quality Plan 2016 Overview

Current Challenges Quality projects often performed in silos Quality management efforts are not widely disseminated Front line staff are not engaged in quality/pi Event reporting is good but PI efforts/ feedback loops must be completed Regulatory compliance manager education and accountability 10 Quality Plan 2016 Overview

Accountability for Quality Management and Reporting Existing departmental and committee structures are used for reporting data and provide governance Use concept of reporting groups to align reporting efforts and support robust discussion Regulatory readiness efforts are aligned with existing structure Incorporate readiness challenges into reporting group dashboards Local leaders report on local performance and lead improvement efforts Support leaders with quality data specific to their areas of authorityenhance reports Support leaders with guidance on performance improvement methods Continue to develop patient safety initiatives for areas which are high risk, high volume or problem prone. 11 Quality Plan 2016 Overview

Hospital Quality Innovations Nursing Quality and Safety Committee and Nursing Quality Council planned Align nursing indicators with National Database for Nursing Quality Indicators (NDNQI) Nursing oversight reconfigured Environment of care committee reporting redesign Combine life safety, clinical engineering, EOC, emergency management 12 Quality Plan 2016 Overview

Quality Committee ED Services General Med-Surg Infection Control Critical Care & Emergency Response Diagnostic Imaging Behaviora l Health Record of Care Nursing Care Hospital Quality Improvement and Patient Safety Committee HQuIPS Diagnostic Testing Periop Services Patient Experienc e of Care Med Mgmt Maternal Child Environ of Care Medical Education 13 Quality Plan 2016 Overview

Overview of Reporting Groups 14 Reporting Group Departments or Divisions Committees or Workgroups Perioperative Surgery, Anesthesia OR, PI team Medication Management Environment of Care Infection Control Critical Care/ Emergency Response General Med-Surg Emergency Services Pharmacy Environmental, Police, B&G, CE Infection Control, OR/SPD, Nursing Critical Care (various), Palliative Care Family Medicine, Medicine, Surgery, Case Management EM, Trauma/Burn, Nursing Drug & Formulary, Med safety, DUE Environment of Care Infection Control Critical Care, Resuscitation, Bioethics Stroke, Diabetes, Immunization, UM/CM, NSQIP Capacity Management Joint Commission Chapter Medication Management EOC, Life Safety, Emergency Management Infection Control Provision of Care Provision of Care Provision of Care Quality Plan 2016 Overview

Overview of Reporting Groups Reporting Group Departments or Divisions Committees or Workgroups Joint Commission Chapter Maternal Child Pediatrics, Ob-Gyne Perinatal Network Provision of Care Behavioral Health Psychiatry, Nursing Bioethics Provision of Care, Patient Rights Diagnostic Testing Pathology SFRC, IT Committees Radiology/ Radiation Safety Radiology Radiation Safety Nursing Services Nursing Nursing Quality Nursing, Provision of Care Hospital Information Management HIM HIM, IT Committees Record of Care and Information Management 15 Patient Experience of Care Patient Experience, Patient Relations Medical Education GME GMEC Patient Experience Council Patient Rights Quality Plan 2016 Overview

HQuIPS Reporting, cont d. Reporting Group All Reporting Groups listed Cancer Committee Contract Compliance Correctional Health Food/Nutrition Human Resources Oral Health Patient Safety Council and Oversight Functions Transfusion Committee Frequency Quarterly Annual Annual Annual Quarterly Monthly, then Quarterly Semi-annual Monthly Annually 16 Quality Plan 2016 Overview

Reporting Group Dashboards Core measures referable to a reporting group Departmental indicators: Process measures (eg VTE prophylaxis) Preventive measure (eg immunization) Patient safety measure (time outs, HAI) Documentation measures (H&P or Op notes) Efficiency measures (clinic follow up or readmissions) Patient safety events hospital acquired events, sentinel events, medication safety events, procedural complications PI activity related to patient safety events PI activity related to ongoing regulatory readiness Patient experience data and patient complaints Dashboards are updated at least monthly 17 Quality Plan 2016 Overview

Key Performance Indicators Hospital Indicator 1 Operating Room: OR on-time starts (%) Operating Room: OR room turnaround time (minutes) Core Measure: VTE Prophylaxis General Care Prevention: Influenza Vaccination Patient Satisfaction: Recommend the Hospital Patient Satisfaction: Communication with Nurses is good Fall rate/ falls with injury Hospital Acquired Pressure Ulcers Baseline Q3 2015 Target 50 th %ile 2 90 th %ile Reporting Interval 47 80 64 88 Quarterly 47 min 35 min 29 23 Quarterly 89 99 88 99 Quarterly 75 90 93 100 Quarterly 69 84.7 72.4 84.7 Quarterly 69 85.7 79.5 85.7 Quarterly 0.6 25% reduction 0.6 25% reduction - - Quarterly - - Quarterly 18 Quality Plan 2016 Overview

Focus Areas- High Risk, High Volume, Problem Prone High Risk Emergency department wait times and throughput Operating room start times and throughput High Volume VTE (venous thromboembolism) prevention Vaccinations Problem Prone* Procedural safety (time outs) Medication safety Alarm management Cognitive or psychiatric impairments in patients *Related to Joint Commission Safety Goals 19 Quality Plan 2016 Overview

Next Steps Approve plan Build out detailed dashboards in conjunction with reporting groups Work closely with BI team to automate and distribute dashboard data Work closely with Nursing quality to develop unit based performance improvement Train and deploy quality staff to coach performance improvement efforts in all departments Develop safety priorities and safety plan 20 Quality Plan 2016 Overview

COOK COUNTY HEALTH & HOSPITALS SYSTEM Human Resources Metrics for CCHHS Board Of Directors February 26, 2016 Gladys Lopez, Chief of Human Resources 1 CCHHS Human Resource Committee I 02/19/16

CCHHS Employment Plan: Overview CCHHS Employment Plan (Plan) is an employment policy governing hiring and other employment actions which is required by a 2007 Court Order as one of the conditions to achieving substantial compliance with the Shakman Consent Decrees. Its key objectives are: transparency, consistency and equal opportunity. External Oversight: Court Compliance Administrator (CA) & Inspector General (IG) EMPLOYMENT PLAN Approved by the Court on 10/23/2014 Roadmap for hiring Requires the creation of a Policy Manual to set out procedures for other employment actions Requires annual training on the Plan provisions Requires decision makers to sign an NPCC (No Political Consideration Certificate) Allows for real time monitoring of processes Requires that Employees report violations of the Plan to the EPO; report Political Discrimination/Contacts to the IG Internal Oversight & Implementation: Employment Plan Officer (EPO) & Human Resources (HR) SUBSTANTIAL COMPLIANCE o Create Employment Plan (Y) o Hire EPO (Y) o Train all staff on Plan (Y) o Create Policy Manual (N) o Train supervisors/managers on Manual (N) o Complete Implementation of Plan provisions (3/4) o Monitoring by CA after implementation of Plan & Policies (1/2) o Demonstrate ability to implement Plan & Manual consistently o CA recommendation to Court 2 CCHHS Human CCHHS Resource Board Committee of Directors I 02/19/16 I 02/26/16

CCHHS Employment Plan: Training Update 3 Employment Plan requires that all New Hires attend Employment Plan Training within 90 days of their start date. CCHHS Human Resource Committee I 02/19/16

CCHHS Employment Plan Office: Investigation Update 4 CCHHS Human Resource Committee I 02/19/16

CCHHS Employment Plan Office: 2015 Incident Report Update Issue Breakdown Sustained vs. Not Sustained Findings (7 Reports Issued) 5 CCHHS Human Resource Committee I 02/19/16

Employment Plan: Hiring Process Advanced Clinical Position (ACP) Exceptions to the General Hiring Process Solicit Recommendations General Hiring Actively Recruited Direct Appointment Advanced Clinical Position Direct Contact Departmental Tours Candidate Interaction An ACP is a clinical position requiring licensure that qualifies an Employee to make independent decisions concerning diagnosis and/or treatment of patients. An ACP pilot program was implemented at Cermak Health Services on November 19, 2015 Job Classifications that Qualify as ACP Advanced Practice Nurse Physician Assistant Medical Doctors Doctor of Dentistry Advance Clinical Process Benefits Decrease time from Request to Hire packet in HR to Decision to Hire/Selection in HR. Increase job submittals The ease for Applicants to submit their resume via e-mail More competitive with competitors Applicant engagement ACP Comparison Job Submittals: 63 within 1 year 36 within 3 months (applicants) Fill Time: 302 days 174 days 6 CCHHS Human CCHHS Resource Board Committee of Directors I 02/19/16 I 02/26/16 FY15 FY16

Comparison of Hiring Processes Description The candidate must meet the minimum qualifications listed in the job description and posting General Hiring Actively Recruited Advanced Clinical Position Training is required before a Hiring Manager can proceed Candidates and management must execute a No Political Consideration Certification (NPCC) The entire process is monitored in Taleo The position is subject to randomization The number of candidates is limited per PID 48 Hour Advance Notice is Required Prior to Interviews, Tours, Candidate selection meetings, Application Review meetings, etc. All candidate contact is monitored Hiring Manager is able to see all candidates who applied Candidates may submit their CV / Resume to an identified CCHHS email address The Hiring Manager is able to interview candidates during the posting period The Hiring Manager is able to interview one on one 7 The Hiring Manager must complete and maintain a Candidate Contact Log CCHHS Human Resource Committee I 02/19/16

Human Resources Metrics Summary DATA THROUGH: 01/31/16 Gladys Lopez, Chief of Human Resources VACANCIES FILLED FY15 TOTAL Quarter 1 1 Quarter 2 Quarter 3 Quarter 4 FY16 TOTAL CCHHS External 114 34 34 CCHHS Internal 56 7 7 Total CCHHS: 170 41 41 Nursing External 37 3 3 Nursing Internal 17 1 1 Total Nursing: 54 4 4 SEPARATIONS CCHHS Separations 176 103 103-73 -41% Total Net New CCHHS: -62-69 -69-7 11% Nursing Separations 58 27 27-31 -53% Total Net New Nursing: -21-24 -24-3 14% TURNOVER Fiscal Year 2016 December 1, 2015 - November 30, 2016 Goal: Continue to maintain open vacancies at 750 or VARIANCE CCHHS FTEs 6,017 6,316 6,316 299 5% Total CCHHS Turnover: 2.9% 1.6% 1.6% -1.3% -44% CCHHS New Hire FTEs 114 34 34-80 -70% CCHHS New Hire Separations 2 2 2 0 = 0% Total FY15 New Hire Turnover: 2% 6% 6% 4% 235% OPEN VACANCIES Target Total CCHHS Vacant Positions: 750 767 823 823 56 7% Less Deleted Positions / PIDs 11 0 Total RTHs in HR (In Process): 744 463 463-281 -38% AVERAGE TIME TO HIRE Target Average Days to Hire (Month): 110 203 117 117-86 -42% 8 1 Data thru 1/31/16 CCHHS Human CCHHS Resource Board Committee of Directors I 02/19/16 I 02/26/16

Cook County Health & Hospitals System Finance Committee : December 2015 Financials Finance Committee Meeting: February 2016 1

Income Statement : Dec-15 vs. Dec-14 (in thousands) Acute Care CountyCare Cermak Public Health Eliminations Total Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Dec-15 Dec-14 Operating Revenue 63,843 78,595 72,198 52,582 - - (13,628) (18,268) 122,413 112,909 Operating Expenses Salaries & Benefits 48,006 44,271 167 276 4,950 4,274 738 939 53,861 49,760 Supplies 9,864 13,935 6,293 734 77 11 29 (668) 10,609 19,666 Purchased Services, Rental / Other 7,731 13,828 78,186 47,992 586 105 46 63 (13,628) (17,599) 72,921 44,388 Insurance Expense 1,771 1,456 368 185 140 32 35 1,988 1,998 Depreciation 2,223 2,777 - - 16 20 1 2 2,240 2,799 Utilities 129 - - - 129 - Total Operating Expenses 69,725 76,267 78,353 54,929 6,471 4,616 828 1,068 (13,628) (18,268) 141,749 118,611 Operating Margin (5,882) 2,328 (6,155) (2,347) (6,471) (4,616) (828) (1,068) - (0) (19,336) (5,702) Operating Margin % -9% 3% -9% -4% 0% 0% 0% 0% -16% -5% Non Operating 5,911 12,109 23 4,399 5,894 151 377-10,461 18,403 Net Income/(Loss) 29 14,437 (6,155) (2,324) (2,072) 1,278 (677) (691) - (0) (8,875) 12,701 Finance Committee Meeting: February 2016 2

Balance Sheet Summary (in thousands) Category Dec-15 Total cash & cash equivalent 358,521 Total property taxes rec 165,511 Total receivables 132,120 Inventories 5,206 TOTAL CURRENT ASSETS 661,358 Depreciable assets - net 386,937 TOTAL ASSETS 1,048,295 Finance Committee Meeting: February 2016 3

Category Balance Sheet Summary (in thousands) Dec-15 Accounts payable 154,741 Third-party settlements 112,000 Claims Payable 92,714 Other Liabilities 126,354 TOTAL CURRENT LIABILITIES 485,809 LONG-TERM LIABILITIES: 47,030 TOTAL LIABILITIES 532,839 TOTAL NET POSITION 515,455 TOTAL LIAB & NET POSITION 1,048,295 Finance Committee Meeting: February 2016 4

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Metrics Summary: Membership (--) 164,221 members; -0.1% from month prior, 8.0% below budget Population Membership FYTD total membership below budget in similar proportions to monthly ( ) 89.8% of Medicaid cancellations at DHS Hoyne St. Office due to lack of timely redetermination Up from 26.0% last month Change from Month Prior Comp to Budget ACA 73,152 (--) 0.1% ( ) -13.9% FHP 87,192 (--) -0.2% ( ) -3.7% ICP 3,877 ( ) 9.6% ( ) 31.4% CountyCare is 2nd largest health plan serving Cook County beneficiaries; BCBS took 1st post-ace acquisitions Finance Cte Feb 19, 2016 10

Financial Highlights ( ) Dec 15 Financials Net Income = $1.4 million; ($3.6 million) after IGT for FHP & ICP PMPM CCHHS-generated revenue = $15.4 million 40% under budget of $25.8 million PMPM payments current for ACA only No FHP or ICP payments since October 15 CY 16 rates setting meeting 2/19 11 Finance Cte Feb 19, 2016

CountyCare Metrics Prepared for: CCHHS Board of Directors Doug Elwell, Deputy CEO, Strategy & Finance February 26, 2016

BOD Managed Care Metrics Data as of 2/2/2016 % Change From Key Measures Nov'15 Dec'15 Jan'16 Feb'16 Prior Month Trend 1) QUALITY 1.1) Ambulatory Access - ACA & FHP Adults CountyCare Overall 68.7% 68.7% 68.7% 0.0% -- CCHHS 66.3% 66.3% 66.3% 0.0% -- MHN ACO 71.0% 70.9% 70.7% -0.3% -- TBD ACCESS 67.7% 67.7% 67.6% -0.1% -- All Other 68.8% 68.8% 69.3% 0.7% -- 2) RISK MANAGEMENT 2.1) Completed HRS/HRA (all populations, cum) Overall 52.0% 56.4% 8.5% 100% 52.0% MHN ACO 73.2% 75.8% 3.6% 100% 73.2% La Rabida Care Coordination (CSNs only) 64.2% All Other 31.9% 37.8% 18.5% 100% 31.9% 3) UTILIZATION 3.1) ER Utilization/1,000 ACA 944 939 965 2.8% 1,017 92.3% FHP 743 747 848 13.5% ICP 1,315 1,322 1391 5.2% 3.3) Value of CCHHS "Paid" Claims (FYTD) $ 250,376,821 $15,414,501 $25,511,681 60.4% 4) MEMBERSHIP 4.1) Monthly Membership 167,148 165,949 164,365 164,221-0.1% -- 178,457 92.1% ACA 75,882 72,479 73,270 73,152-0.2% -- 85,000 86.2% FHP 88,657 89,926 87,559 87,192-0.4% -- 90,506 96.7% SPD 3,417 3,544 3,536 3,877 9.6% 2,951 119.8% Home/Community Waiver (incl DD) 596 581 617 655 6.2% LTC 212 222 229 251 9.6% 4.2) FYTD Member Months 1,846,036 165,949 330,314 494,535 356,914 92.5% ACA 978,347 72,479 145,749 403,466 170,000 85.7% FHP 836,463 89,926 177,485 264,677 181,012 98.1% SPD 32,034 3,544 7,080 10,957 5,902 120.0% 5) OPERATIONS Change from FY'15 Q2 FY'15 Q3 Prior Q # Days Goal Met 5.3) Claims Payment Turnaround Time (days) 36 31-13.9% CCHHS < 35 BOD Y Feb 26, 2016 2 FYTD'16 Budget or Goal % to Budget/ Goal

Data Charts Provided For Discussion Purposes Only 3

Quality Metrics Provided for Discussion Purposes Only Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 % Change From Prior Month 1) QUALITY 1.1) Ambulatory Access - ACA & FHP Adults CountyCare Overall 66.7% 68.7% 68.7% 68.7% 0.0% -- CCHHS 64.6% 66.3% 66.3% 66.3% 0.0% -- MHN ACO 68.8% 71.0% 70.9% 70.7% -0.3% -- ACCESS 65.8% 67.7% 67.7% 67.6% -0.1% -- All Other 66.6% 68.8% 68.8% 69.3% 0.7% -- 1.2) Ambulatory Access - ICP Adults CountyCare Overall 72.0% 73.3% 73.8% 74.3% 0.7% -- CCHHS 72.3% 74.1% 76.3% 75.6% -0.9% -- MHN ACO NA NA NA NA NA ACCESS 66.8% 67.6% 69.5% 69.1% -0.6% -- All Other 74.3% 75.6% 75.0% 76.1% 1.5% 1.3) CY'15 State P4P Measures (FHP & ACA) Inpatient Follow-Up 46.9% 46.0% 46.0% 45.9% -0.2% -- Well Child 15 Months - 6 Visits 7.1% 6.7% 6.7% 6.7% 0.0% -- Well Child Visits, 3-6 years 58.8% 63.6% 63.6% 63.5% -0.2% -- Immunization Status - Combo 3 0.0% 0.0% 0.0% 0.0% 0.0% -- Developmental Screenings 37.4% 37.9% 37.9% 37.9% 0.0% -- Post Partum Care 40.1% 42.6% 42.6% 42.5% -0.2% -- Prenatal Care 78.7% 78.2% 78.2% 78.1% -0.1% -- Trend FYTD'16 Budget or Goal TBD TBD TBD % to Budget/ Goal Comments: Chart chasing to begin March 16 Goals as set by HFS provided as percentiles, working to get actual scores Continued discussion with HFS on goal 4 CCHHS BOD Feb 26, 2016

Risk Management Metrics Provided for Discussion Purposes Only % Change From Prior Month FYTD'16 Budget or Goal Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 Trend 2) RISK MANAGEMENT 2.1) Completed HRS/HRA (all populations, cum) Overall 51.7% 52.0% 56.4% 8.5% 100% 56.4% MHN ACO 72.1% 73.2% 75.8% 3.6% 100% 75.8% La Rabida Care Coordination (CSNs only) 64.2% All Other 32.1% 31.9% 37.8% 18.5% 100% 37.8% 2.2) High-Risk Stratification (all populations, cum) Overall 3.2% 3.0% 2.9% -3.3% 3.0% 96.7% MHN ACO 5.0% 4.8% 4.6% -4.2% 3.0% 153.3% La Rabida Care Coordination (CSNs only) 7.3% All Other 1.4% 1.2% 1.2% 0.0% -- 3.0% 40.0% % to Budget/ Goal Comments: Completion of risk screens (HRS) and risk assessments (HRA) up overall Change in delegation from TPA to CCHHS Centralized Care Coordination Unit on-schedule for April 1 start. 5 CCHHS BOD Feb 26, 2016

Utilization Metrics Provided for Discussion Purposes Only % Change From Prior Month FYTD'16 Budget or Goal Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 Trend 3) UTILIZATION 3.1) ER Utilization/1,000 ACA 957 944 939 965 2.8% 1,017 94.9% FHP 744 743 747 848 13.5% ICP 1,288 1,315 1,322 1391 5.2% 3.2) Inpatient Utilization/1,000 ACA 170 151 158 169 7.0% 168 100.6% FHP 111 91 93 98 5.4% ICP 361 348 367 375 2.2% 3.3) Value of CCHHS "Paid" Claims (FYTD) $ 167,298,969 $ 250,376,821 $15,414,501 $25,511,681 60.4% % to Budget/ Goal Comments: ED and Inpatient utilization increased in all populations from prior month; Now two-month trend of increases Most likely seasonal in nature Will continue to monitor for other trends Paid claims to CCHHS $10 million below budget Overall contribution to CCHHS bottom line under budget by $28 million 6 CCHHS BOD Feb 26, 2016

7 Membership Metrics Provided for Discussion Purposes Only % Change From Prior Month Comments: Membership down slightly from prior month (0.1%); With ICP membership continuing to grow. Members assigned to CCHHS Care Management up Medicaid cancellations due to redetermination up, while restorations of coverage are down CountyCare is 2 nd largest plan serving Cook County beneficiaries; BCBS has taken top position FYTD'16 Budget or Goal Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 Trend 4) MEMBERSHIP 4.1) Monthly Membership 168,749 167,148 165,949 164,365 164,221-0.1% -- 178,457 92.0% ACA 76,910 75,882 72,479 73,270 73,152-0.2% -- 85,000 86.1% FHP 88,538 88,657 89,926 87,559 87,192-0.4% -- 90,506 96.3% SPD 3,301 3,417 3,544 3,536 3,877 9.6% 2,951 131.4% Home/Community Waiver (incl DD) 593 596 581 617 655 6.2% LTC 201 212 222 229 251 9.6% 4.2) FYTD Member Months 1,678,888 1,846,036 165,949 330,314 494,535 535,371 92.4% ACA 902,465 978,347 72,479 145,749 218,901 255,000 85.8% FHP 747,806 836,463 89,926 177,485 264,677 271,518 97.5% SPD 28,617 32,034 3,544 7,080 10,957 8,853 123.8% 4.3) Mbrs by Delegated Care Management Group CCHHS (ACHN, LTSS, non-mhn ACO) 85,335 84,539 84,609 84,378 85,976 1.9% MHN ACO 83,414 82,609 81,340 79,987 78,245-2.2% La Rabida Care Coordination (CSNs only) 2,561 2,563 2,564 4.4) Members Lost to Medicaid Cancellation # Mbrs Due for Redetermination 5,208 5,493 5,470 3,775 7,362 95.0% # Rede Cancellations 3,580 2,368 2,800 4,161 48.6% # Coverage Restored 879 1,285 1,379 772-44.0% % Cancelled Due to Lack of Rede 51.9% 19.7% 26.0% 89.8% 245.6% < 22% 4.5) Cook County Enrollment by Health Plan (rank order) Rank Aetna Better Health Inc. 72,893 94,684 73,523 96,824 0.9% -- 6th Blue Cross Blue Shield 122,123 130,494 154,507 196,826 26.5% 1st CountyCare 163,375 165,518 160,415 162,435-1.8% 2nd Family Health Network 150,885 151,137 151,001 150,893 0.1% -- 3rd Harmony Health Plan 107,853 106,683 105,418 104,628-2.3% 5th IlliniCare Health Plan 89,805 108,446 87,366 106,503-2.7% 4th Meridian Health Plan 73,784 77,376 71,913 76,076-2.5% 8th Molina Health Care 77,862 7th Next Level Health 19,460 9th % to Budget/ Goal CCHHS BOD Feb 26, 2016

Operations Metrics Provided for Discussion Purposes Only Key Measures Oct'15 Nov'15 Dec'15 Jan'16 Feb'16 % Change From Prior Month Trend FYTD'16 Budget or Goal 5) OPERATIONS 5.1) Member & Provider Services Call Center Goal Goal Met Abandonment Rate 1.09% 1.16% 1.85% 3.95% 113.5% < 5% Y Hold Time 0:00:43 0:00:43 0:00:59 0:01:08 0:00:09 < :01:00 N Average Speed to Answer 0:00:11 0:00:14 0:00:18 0:00:31 0:00:13 < :00:45 Y 5.2) Claims/Encounters Acceptance Rate 24% 80% 30.0% FY'15 Q1 FY'15 Q2 FY'15 Q3 Change from Prior Q # Days Goal Met 5.3) Claims Payment Turnaround Time (days) 32 36 31-13.9% < 35 Y % to Budget/ Goal Comments: Significant deterioration in member and provider call center performance Inquiry to TPA about performance pending 8 CCHHS BOD Feb 26, 2016