On December 13, HC3 hosted an end-of-year discussion with prominent local health care leaders at the Illinois Medical District (IMD). The leaders shared their thoughts on some of the key trends and topics that arose in 2022, as well as some predictions and hopes for 2023.
Host's Remarks: Allysen Hansen, Executive Director, IMD (Illinois Medical District)
Moderator:
Meghan Phillipp, Executive Director, HC3
Panelists:
Veronica Clarke, CEO, TCA Health
Mary Kate Daly, Vice President, Patrick M. Magoon Institute for Healthy Communities, Ann and Robert H. Lurie Children’s Hospital of Chicago
Mark Ishaug, CEO, Thresholds
Cheryl Rucker-Whitaker, MD, Entrepreneur-In-Residence, Health 2047, Inc. & CEO, Complete Care Management Partners
David Smith, Co-Founder, HC3 & Founder and CEO, Third Horizon Strategies
Left to Right: Dr. Cheryl Rucker-Whitaker, David Smith, Veronica Clarke, Mary Kate Daly, Mark Ishaug, Meghan Phillipp
Watch the live event:
Event Recap
Event Host’s Remarks
Allyson Hansen, Executive Director, Illinois Medical District (IMD) Allyson welcomed guests to the IMD’s facilities and invited attendees to visit their website (https://medicaldistrict.org/) to learn more about their master plan, which outlines some of the strategic goals of the IMD over the next few years. Allyson has been with the IMD for a year; prior to this role, she shared that her professional background was in health care and private equity. She is honored to serve in this role leading the IMD and serving the needs of Chicago’s local community.
Moderator's Remarks and Introductions
Meghan Phillipp, Executive Director, HC3
Meghan thanked the IMD and HC3 guests for their continued support and engagement of HC3. Since its inception in 2016, the HC3 platform has continued to evolve but remains focused on its three pillars: addressing health and social drivers, economic development, and system transformation. She said that today more than ever before, these pillars are driving conversations and initiatives to address health equity in Chicago.
MP: Our focus areas as a platform are centered around our three pillars, and health equity continues to be at the center of our efforts. Could each of you share some examples of health equity in action this year from your organizations? These can include projects, strategies, or other vehicles you are pursuing to promote health equity.
Cheryl Rucker-Whitaker (CRW): Complete Care Management Partners (CMP) is focused on closing the care gap for people who are vulnerable upon discharge. We work with Managed Care Organizations (MCOs) to identify these members and engage quickly to provide support. There is a huge opportunity here to scale our efforts, and I am personally passionate about what we are doing. We are currently using the CMT (Care Management Tool) to train the team in conducting Medicaid Health Risk Assessments, in addition to notifying the MCOs when these assessments have been completed. Ensuring equity is a top priority for our organization, as well as balancing the experience following discharge from an acute care facility.
Veronica Clarke (VC): At TCA Healthcare, we are focused on “meeting people where they are.” We are all aware that equitable access to care has been an issue for a very long time. One of the many contributors is transportation. Our appointment data showed that patients were missing appointments frequently, so we developed initiatives that allow us to address this barrier. We partner with Kaizen Health to coordinate patients’ transportation to and from our facilities to make them more accessible and convenient for patients. Our main site is currently located in a transportation desert, meaning there are not a lot of public transportation options making it a critical need. Through our programs, we are able to pick up patients from their homes for their appointments. Transportation has been a top priority, but we are also exploring and implementing several other initiatives to address the social determinants of health (SDoH).
Mary Kate Daly (MKD): Lurie Children’s is exploring several programs to address health equity, including one centered around food insecurity. We are partnered with Top Box Foods to identify families experiencing food insecurity and coordinating grocery delivery once a week to their residences. At Lurie, our focus is on reducing the stressors that contribute to a possible worsening situation that can be brought about by having a sick child. We believe that if these stressors are minimized, overall outcomes can be improved. We recently began piloting this initiative and have already reached about 200 families. Another example within the hospital system to address equity in communities is around some of the partnerships we have with financial institutions to provide loans to community-based development organizations. For these economic initiatives, we are primarily focused on the west side of the city of Chicago. We have both short-term and long-term goals for those initiatives to drive impact.
Mark Ishaug (MI): Amid the COVID-19 pandemic, Thresholds developed a new strategic plan. Our board and leadership decided to center the plan on DEI (diversity, equity, and inclusion) and fighting structural racism to achieve health equity. All of the organization’s operations and activities are centered around our strategic plan’s strategy. Recently, we opened a brand-new health clinic in Chicago’s Austin neighborhood called Thresholds Health. Not only is the new site in a community where we can address critical needs and focus on our core work in behavioral health and social services, but this site will also provide primary care services for both current and new Threshold’s clients. This expansion is in line with our efforts to integrate behavioral health services. We also continue to explore programs and opportunities to address the housing barrier that may Thresholds clients face.
David Smith (DS): Health equity is a core tenant for Third Horizon Strategies (THS) and all that we do. Our team spends a tremendous amount of time focused on and promoting equity throughout our operations and our client portfolio. HC3 is a great example of some of the ways in which we promote health equity, from our pro-bono partnerships to linking well-endowed organizations with community based organizations to leverage resources. Another example of THS’ focus on equity in Chicago is the development of the south side health project which we have been working on for a few years. We are in the process of formally renaming this initiative Third Coast Care (TCC). TCC has three major design principles:
1. Community ownership – Initial investments will be diluted to the community (51 percent/49 percent breakdown) being able to transfer wealth to the local community.
2. Cultivate unique referral packages that leverage technology solutions to connect to communities' resources. Staffing will also be hyper local, leveraging Community Health Workers (CHW) from within the community.
3. Function on a capitated basis to ensure financial sustainability. We are currently working with nine business partners to get this off the ground and hope to operationalize this concept within the next 12 months.
MP: “Meeting people where they are” has also been a common theme for HC3 this year. We discussed home health innovations in May; addressing the youth’s behavioral health crisis and reaching children where they are in August; addressing the unmet needs of older adults in September; and the future of Medicaid access in October. Throughout this past year, we’ve heard various perspectives on reaching and addressing the various needs of different populations. What does the integration look like to meet the needs of your patients for those of you who are looking at direct service lines? And, for David and any others that also want to offer a broader perspective, what are the ways in which alternative payment models, value-based care, or a shift in technological innovations to support care delivery look like to help facilitate new ways of meeting the complex needs of patients?
MI: Threshold has about 106 behavioral health providers around the state. Hearing from other panelists this evening, there are many synergies between what we are all doing and how we are all accomplishing this work. From capitated payments to leveraging technologies to critical target populations. We should all continue to collaborate and see how we can reach an expanded scope of beneficiaries.
CRW: To build on Mark’s point, we also need to work together to identify how to distill all the data available into actionable items. There is a gap in the workforce, and opportunities exist to train and upskill people to utilize data effectively. I am always challenging people on my team to dig into the datasets and tease out the meaning to benefit our work. It is important that we begin to think of ways to upskill our workforce in these areas, so we have data analysts that can present data in a way that is easier to utilize.
VC: Interoperability is important for collaboration. TCA Health and a few other south-side providers use the Epic EMR (Electronic Medical Record) system, however many FQHCs (Federally Qualified Health Centers) do not. And, most major Chicago hospital systems also use Epic. Through the South Side Healthy Communities Organization, we are working on the development of a shared tool that will make it possible for all providers – FQHCs, hospitals, and the like – to be able to share information. It has become increasingly more imperative that FQHCs, especially, have a seat at the table when it comes to sharing patient and community information. The South Side Healthy Communities Organization is being funded through HFS’ Healthcare Transformation Collaboratives.
MKD: Lurie Children’s has a federal grant to develop an integrated care model for children. This grant has allowed us to test the viability of a clinically and socially integrated network of care across two zip codes in Chicago. This pilot project is based on the theory that if we can effectively integrate care, we will eventually have better outcomes. There are currently seven additional sites trying this across the country, and we meet to share our experiences across a range of issues.
MP: One of the key solutions or drivers that has come up a lot this year on HC3’s platform is that decisions get made to address an issue or operationalize a program because of the “data.” Without proof and without data, it is all just an assumption. But what are we doing when the data is being put directly in front of us, and there are not improvements being made? How are your organizations collecting, valuing, and operationalizing data-driven projects to drive better outcomes for patients or impact in communities?
CRW: Developing new workflows based on available data is a major opportunity because if we don’t shift what is being done to be responsive to data, nothing new happens.
DS: I agree with Cheryl, and the use of ADT (Admission Discharge Transfer) systems is the baseline of where we should be headed. If there was ever a time to figure out how to do this at scale in more complex ways, this is it. I anticipate that over the next five years or so, data will go from being a commercialized weapon that everyone tries to keep within their EMR (electronic medical records) systems to a democratized tool.
CRW: About a decade ago, we proposed a cloud-based mammography app where a woman could get a mammogram, pay a small subscription fee, and the information would go to the cloud. If the patient needed that information in the future, she wouldn’t have to wait and have it at her disposal. Unfortunately, we could not get a single hospital to participate in a project like this. This was a decade ago, so with everything changing, I would like to hear others' thoughts on how innovation may be more poised for change.
DS: The days when hospitals can refuse to participate in this sort of innovation, especially for patients who want it, are coming to an end. Under federal regulation, our industry is working on these issues and we will soon see more changes.
MI: We do not have the right data yet, nor are we collecting or measuring the right things to determine whether our services are resulting in better outcomes and cost savings. For example, I don’t have a way of showing the causal relationship between supportive housing and better outcomes for our IHPA (Illinois Health Practice Alliance) members or even our supported employment programs. We require different and additional measurements, and data from various silos need to be integrated.
MP: The impact of the COVID-19 pandemic has changed the way people live and work in ways that we could not have predicted. Earlier this month, HC3 launched our newest series – the Future of Work, to unpack the various challenges and opportunities we must tackle to address the workforce crisis. Our initial conversation shed light on just the monumental culture shift, reflecting on issues such as the great resignation, quiet quitting, and the like to discuss ways in which many of us are refocusing, and our priorities have shifted to address more holistic approaches to employee well-being and purpose-driven work. What are some of the barriers and challenges you all are seeing within the context of your organizations or those you serve in safeguarding a sustainable workforce?
MI: Through advocacy efforts with our partner organizations in the sector, we were able to bring 180 million Medicaid dollars to support the behavioral health care workforce. This was a game changer, as we were then able to raise some salaries by as much as 30 percent. We would have lost a huge portion of the workforce otherwise.
MKD: The workforce, particularly our nursing workforce, has been a major issue for Lurie recently because many people are retiring. In addition to some of the short-term solutions we are working on, we have intensified our approach to providing mentorship to interns that come to work with us, with the goal of hiring them once they are ready for full-time staff positions. There are a variety of long-term benefits to this approach to addressing the workforce crisis.
VC: Outside of better salaries, we do have initiatives aimed at exposing individuals early on in their education to careers in health care. Additionally, we are exploring avenues to upskill and train people to ease the burden on physicians, nurses, and so on. One of the most important things that we do at TCA Healthcare is bringing joy into the workplace. With so many people burned out, investing in our staff is very important. My goal is to have the happiest workforce, and we continuously work tirelessly to achieve that.
DS: It is important to compensate people fairly for the work that they do. However, people also want to make sure that they are doing meaningful and impactful work, so taking the time to cater to that is important. Also, creating an atmosphere where people enjoy working with one another is very important. The responsibility for creating this sort of environment is on the leadership of organizations, and we need to continue to prioritize this. At Third Horizon Strategies, everyone is encouraged to take off one day every quarter to focus on their mental health and well-being. Our staff knows that this is an important value within our organization because it is paid time off that we cover. In the almost five years of the company’s operations, we have not had one case of voluntary attrition.
CRW: Building a culture where people care for each other, even at work, is important. We have prioritized this and have put systems in place so that people can work but still have time to live the lives they want, spend time with family, and rest. We compensate people above the market average and offer competitive benefits. In over a year, we have not had any turnover and consistently get feedback on how much people love working with us.
Audience Q&A
Q: A lot of time, we see/experience friction within the workflows that we are implementing. It is one of the major issues faced by frontline workers. There is often more logistical work being done than caring for people. Can you talk more about how your organizations are easing the burden on that front?
VC: We remain flexible and encourage employee input. We have frequent employee input meetings where we discuss these issues and assess workflows to address what is working and what is not.
MI: One of the ways we are approaching this issue is by having an integrated strategy. While we are trying to do everything we can internally to ease this burden, we still struggle because almost all our funders have their own preferred reporting mechanism that involves different software or tools. As advocates for our work and workforce, we continue to push the public sector and MCOs who are funded by the public sector to get on similar platforms so that we can be more efficient.
CRW: There is an opportunity to unlock the power of Artificial Intelligence (AI) to address this issue. Healthcare is behind in unlocking the possibilities brought about by AI because most people don’t know where to start.
MP: Meghan closed out the event by thanking all of the panelists for the continued efforts to address health care needs in Chicago. She expressed gratitude to the event host, the IMD, and the continued partnership and support of the Third Horizon Strategies team.