What is Cook County Health’s interim CEO thinking?

Dr. Shannon Checks in with Crain’s Chicago Business

As a college junior, John Jay Shannon got a taste of his future life as a physician. He biked from his apartment to a small hospital in Mobile, Ala., where he worked for about a year, performing tasks on nights and weekends that, he recalls, nobody else wanted to do.

Among the duties: shaving patients the night before their surgeries. The practice no longer is typically done since it increases the likelihood of getting an infection at the surgical site, he said.

“Almost everything that I did then has been shown to be either a bad practice, or it’s something we don’t do anymore,” said Dr. Shannon, 54. “It’s very interesting to see how medicine changes over time.”

Dr. Shannon, who spent 15 years in the Cook County Health & Hospitals System between various stints, was second-in-command behind Dr. Ramanathan Raju until about two weeks ago, when the chief executive departed for a new gig in New York after leading Cook County Health for about two-and-a-half years. Dr. Shannon, a champion of helping improve the health of asthmatic patients, took over as interim CEO.

The Cook County system, one of the largest public health systems in the country, treats a disproportionately large portion of poor and uninsured patients. The two-hospital network includes John H. Stroger Jr. Hospital on the Near West Side, Provident Hospital on the South Side and a network of clinics.

In a recent interview with Crain’s, Dr. Shannon highlighted his immediate goals: keeping the momentum going for two landmark initiatives Dr. Raju spearheaded — launching and expanding an innovative Medicaid program called CountyCare, and selling an HMO product on the Illinois Health Insurance Marketplace this fall.

His other goal is more personal: to make his temporary position permanent.

The son of a nurse and a plastic film salesman, Dr. Shannon is the eighth of 12 children. “I come from a really big family,” Dr. Shannon said. “We talk a lot. We laugh a lot. You have to kind of get a word in edgewise.”

Here, in this edited transcript, he gets his say:

Crain’s: You’ve only been in your interim role for a short time, but how has your life changed?

Dr. Shannon: I think for me the part that has changed is certainly having a better understanding of all the things that Dr. Raju was doing that I was not doing.That’s a pretty big book of business. Dr. Raju left the organization in far better shape than he found it two years earlier. And so I’m lucky to be leading the organization at a time when I think we’ve got an established vision. I think we’re in far better financial shape than we were in 2011. We’re still filling out a few pieces of that, but we’ve got a good leadership team in place.

The other thing that Dr. Raju was able to do that I hope I’ll be able to maintain is to kind of establish credibility as an important part of the health care delivery system for the region and a place that plays an important role, that isn’t an afterthought to the academic health centers and to the big private non-for-profits.

You mentioned Dr. Raju’s big book of business. Can you provide an example of initiatives he was doing that you weren’t?

Dr. Shannon: The integration and continued evolution of the managed care program that is CountyCare.

How are things going with CountyCare and creating a product to sell on the exchange?

Dr. Shannon: It’s really fun to look back on the past year. I joined the organization in the last week of February of 2013, and we were literally setting up shop. I remember, you know, celebrating because we had 100 members. We are now over 90,000 card-carrying members, which is just an unbelievable accomplishment.

We are continuing to pursue an HMO license. A very substantial proportion of people who are in Medicaid will earn enough money to fall out of eligibility for Medicaid, and similarly people who are working at the lower end of the economic spectrum may lose work and fall into Medicaid eligibility. As those transitions are happening, we don’t want people to be falling in and out of care.

At what stage are you with getting the license from the state?

Dr. Shannon: Actually that’s a separate piece. We first have to get a resolution passed by the General Assembly that allows us as a county to get and hold an HMO license. That’s kind of working its way through our policy and our legislative point people. And in the meantime, if we needed to we could lease a license.

When do you think the General Assembly will sign off on a bill to license the county?

Dr. Shannon: That’s one of those things that’s always in flux. It’s a busy year. It’s an election year.

A permanent CEO could be named within a few months. It’s not a lot of time to be interim, so how do you envision your role?

Dr. Shannon: As interim my most important role is to keep the organization moving, keep it moving on the strategies that we’ve got laid out for this year.The fact that the CEO leaves, it doesn’t mean that we go into a state of suspended animation.

Do you have any changes in mind that you would like to make?

Dr. Shannon: It’s not a stabilizing behavior to come in and say, ‘OK, now that guy’s gone. Here’s what I’m going to do.’ As I mentioned a little bit ago, I think Dr. Raju set out a very audacious, but a very doable plan. And so I am trying to keep the focus of the organization on the execution of that plan. We will not be incorporating any significant deviations from that plan.

If the Cook County hospital board asked you to be the permanent CEO, would you take the job?

Dr. Shannon: If they asked me to be the chief executive officer, I would.

What do see as some of the challenges on your plate?

Dr. Shannon: 2013 was the can-we-enroll-them in CountyCare year. In 2014 a big focus is on how are we delivering care, and are we delivering on the promise of a managed care plan. That is, are we delivering high-quality care in a coordinated way? It’s actually improving the health of these individuals who were previously uninsured. That’s a big deal and it’s a significant challenge.

You’re also still chief of clinical integration, overseeing patient care and quality. How are you juggling both of these large roles?

Dr. Shannon: We’ve brought on very competent leadership over operations of ambulatory, over operations of hospital-based services. We have a dynamic and I think very effective nursing executive who’s helping to coordinate functions there. And other members of the team are being brought on so that different from when I joined a year ago, we have both a broader and a stronger supporting cast that’s helping.

In a recent interview on WTTW’s “Chicago Tonight,” you mentioned lessons you learned as chief medical officer of Parkland Health & Hospital System, a Dallas system that the federal Centers for Medicare & Medicaid Services deemed ‘an immediate and serious threat to patient health and safety.’ Can you shed some light on those lessons and how you’re applying them here?

Dr. Shannon: When you’re working in an urban safety-net environment, you don’t have the ability to turn on or turn off the demand spigot, which other organizations do. So that when problems come up, you have to fix them at the same time that you’re responding to the care needs and demands of the community that you serve. That’s a real challenge for people who work in public health because the demand always outstrips your ability to meet it.

And so I try to look at the things that we’re trying to do both within our health system and within the context of CountyCare and say, ‘How do assure that the care that we give is going to be reliable, that it’s going to be safe?’ Patients have got to have an experience that’s so good that not only will they say no when they are buffeted by requests to jump to another system of care, but in fact that they become our proselytizers.

Read the full article at Crain’s Chicago Business.