On January 26, 2022 the Health Care Council of Chicago (HC3) hosted the 2022 State of Chicago Healthcare Forum. The forum, sponsored by the Illinois Health and Hospital Association (IHA), featured a robust discussion with health care thought leaders about trends and their expectations across the industry in 2022. David Smith, founder and CEO of Third Horizon Strategies and co-founder of HC3, kicked off the event by providing an executive overview of HC3’s recently-released issue brief on the rapid development and rollout of the COVID-19 vaccines.
Moderator: David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3
Featured Panelists: Senate Majority Leader Mattie Hunter, Illinois State Senate, 3rd District (D) David Munar, President and CEO, Howard Brown Health Jordan Powell, Senior Vice President, Health Policy and Finance, Illinois Health and Hospital Association (IHA)
Watch the Recap | Link to YouTube
Jordan Powell: 2021 was another challenging year for the health care industry, but there were some positive outcomes. There has been a lot more focus on health equity and addressing health care disparities. The Illinois Health and Hospital Association (IHA) is working with partners to create racial equity in their health care progress report which serves as a document to track long-term change. The state of Illinois passed several comprehensive health equity reform laws, including instituting requirements for providers to take implicit bias training and reimbursement from Medicaid for community health workers. Telehealth reimbursement and parity with in-person services for state-regulated and individual insurance policies were also ratified.
The pandemic has continued to place a lot of pressures on hospitals. The nursing staff shortage represents one of the most urgent challenges that Illinois hospitals are facing to date. According to recent federal developments, actions around potentially investigating these staffing agencies will be necessary according to recent federal actions, and it will continue to be a priority for IHA and others to find a solution.
Leader Hunter: The COVID-19 pandemic revealed the flaws that our system has and exacerbated racial disparities that already existed between race and class. I sponsored a loan to support legislation to rectify some of these existing inequities. Most recently, we have been focused on the health care and human services pillar of the legislative Black caucus. We are addressing access to health care, hospital closures, MCO reform, maternal and infant mortality, and more. CHW certification to put them back out on the streets and identify needs.
David Munar: The challenges of 2021 caused significant change in the ambulatory care system and honestly destabilized the sector. We didn’t think things could get worse than 2020, but 2021 was really stressful. In the early part of 2021 it was about rationing vaccines to the groups as we rolled it out, and a strong focus on testing, and then by spring we thought it was ‘over.’ August – October, Howard Brown saw a significant uptick in patients returning for in-patient care, and amid the demand for more in-person services than there were capacity challenges. This all happened at a time when there was a lot of changes in the labor market (the great resignation), with people reevaluating their careers, moving away from Chicago and so on. At the end of 2021, 10 percent of Howard Brown’s workforce had documented Omicron. A lot of the workforce had the same needs as patients, as they were also scrambling for testing, recuperating from COVID, and so on. The challenges they faced at the end of 2021 showcased how vulnerable we still are, and David hopes there’s more preparedness in the future.
David Munar: We are focused on supporting the workforce, but there are still limitations and opportunities for us to wrap our heads around this better. It would be good if there were government programs to help train medical staff who are not licensed on even the basics (e.g., infectious disease, medical protocols). Howard Brown does have infectious disease physicians who they rely on to present on the ever-changing landscape, data, and variants arise, but is still challenging to support staff in what they need to know to do their work well.
Workforce development and funding to support emergency preparedness would be a big benefit. We have been on a hamster wheel trying to meet the next challenges, and ultimately employee health has been another area of great need because of the constant demand. At the end of the year, one in three patients were testing positive for COVID-19. So, the workforce was competing against the community for testing resources. I had hundreds of staff who needed testing and even 3rd party organizations were slammed and limited in their ability to help. Howard Brown’s walk-in sexual health clinic has ballooned into an emergent care model.
People are coming in with complex health needs, and meeting that demand has been very difficult. However, we are glad they are not going to the emergency room, because they are very congested. These people coming in, are folks that have historically avoided the system, but now they are asking for help. We want to do the best we can, but it has been a difficult lift.
Jordan Powell: I can’t emphasize enough the workforce shortages we are seeing. It is also not new; this has been something health care leaders have been signaling for a long time. Prior to the Omicron surge, many organizations reported to IHA that they lost 15 percent of their nursing staff.
The shortage has created an immediate financial crisis where travel nursing agencies are now charging four times their normal rates. Because of this, traveling nurses don’t have to travel now – they are hired at hospitals nearby and just getting paid higher rates. Hospitals have reported that 30 percent of their nursing staffs are from agencies – so this is all having a significant impact. We are pushing for passage of a nurse licensure compact to provide temporary licensure for out of state staff in the short term. In the longer term, we need to continue to address nursing shortage through a homegrown pipeline. We are also hearing that there are plenty of nursing students/candidates, but not enough faculty, so we need invest there as well. Pre-authorizations for hospital assessment programs will be critical funding.
Leader Hunter: There has been a shortage of nurses for a very long-time and we’ve been putting a band-aid on that issue without really addressing it. I am working on a bill to create a health care workforce repayment plan and scholarship program to encourage providers to relocate to areas of great need (Senate Bill 3734). I am also trying to change the rate of safety net hospitals. Last year Senate Bill 2294 was passed to overhaul Medicaid, and we’ll get some more relief once the health and human services pillar is implemented. We are still trying to figure out how to spend all our federal ARPA dollars and where the greatest needs are, as we want to put the greatest resources where the greatest needs are.
Leader Hunter: Behavioral health is another area of the system experiencing workforce shortages, so we are trying to encourage more people to get into the field. Over the years, we have defunded mental health services, and now it’s exploded with the pandemic and there is a huge increase in mental health needs accompanied by a shortage of access. We need to do better at working with universities to provide trainings, so that folks in real need can relieve the pressure in the field.
COVID-19 continues in 2022
Jordan Powell: We are all on this hamster wheel together. All the stakeholders are at the table and there is better coordination now, than there has been in the past to do this together. We need to continue to focus on these partnerships and breaking down the silos though in order to get past this.
Pending system collapse
David Munar: The backbone of ambulatory health services are the lay staff workers, and unfortunately for the supportive workforce (e.g., medical assistants, front desk etc.), the market rates are very low and have been hit by inflation. Furthermore, there is a lot of turnover in this area that is concerning because these folks are scared of these hard jobs without the pay-offs. But there are opportunities, and we need to consider better ways for this to be attractive to someone with an associate’s degree and looking to get started in the health care field. We need to prepare for the next variant and doing emergency preparedness at the regional or municipal level.
Jordan Powell: I have been impresses with our hospitals’ ability to become innovative and that’s encouraging. A lot of the concerning issues are things we have been worried about for decades. I don’t think we are near immediate collapse, but we need immediate and long-term assistance from government to prevent it.
How do we feel about what’s to come?
Leader Hunter: Optimistic. Our system is being challenged, but we are working hard on things, and we have strong community providers and systems of care in Illinois. We have the right systems and collaborations lined up, we just need to sit down and figure this out.
Special thanks to our generous event sponsor, the Illinois Health and Hospital Association for supporting this program.