On March 18, HC3 hosted a virtual event host examining findings from its “The Challenging Future of the Chicago Safety Net” white paper. With support from Medical Home Network and Sinai Chicago, HC3 conducted a regional examination of revenue and cost trends compounded that create unfunded liabilities threatening further restrictions to the capacity of, and access to, the city’s safety net hospital system.
David Smith, founder and CEO of Third Horizon Strategies and co-founder of HC3, opened the event by providing an executive summary of the collective findings. Then, a panel of health care thought leaders discussed the economic, political, and structural barriers to a sustainable system and ways policymakers and providers can embrace a transformative approach to Chicago’s indispensable safety net.
David Smith, Founder & CEO, Third Horizon Strategies and Co-Founder, HC3
Brenda Battle, Senior Vice President and Chief Diversity, Equity, and Inclusion Officer, Community Health Transformation
Cheryl Lulias, CEO, Medical Home Network
George Miller, President and CEO, Loretto Hospital
Karen Teitelbaum, CEO, Sinai Chicago
PANELISTS DISCUSS PATH FORWARD FOR SAFETY-NET HOSPITALS | Health News Illinois, March 22, 2021 | Link to Article
Press Release | HC3 releases “The Challenging Future of the Chicago Safety Net" White Paper, Februray 26, 2021 | Link to Press Release
Watch the Recap | Link to YouTube
Read the white paper
David: Why does the issue of inequity and the safety net matter?
Karen: At Sinai we serve communities of color and some of Chicago’s most vulnerable populations. Those we serve experience three times the diabetes rate and seven times the unemployment rate compared to the rest of the city. The mortality rate in Chicago is up to 18 percent – 13.5 percent higher than the rest of the state – because of the comorbidities. So, why does this matter? What does this mean? Well, the difference in lifespan is truly telling. Having easy access to quality health care is critical and we are working together to reduce those barriers. We will need the safety nets to be stable institutions in order to prevent early deaths for our vulnerable populations.
David: They say the pandemic has shed a light on all the underserved, vulnerable – but it’s always been like that. Where are we getting it right in terms of collaboration, and where are we getting it wrong?
Brenda: We cannot expect one institution, the government, or the state to fix everything. No one entity can solve these issues born in our community alone. It requires collaboration and multiple stakeholders necessary. When I came here nine years ago, the different organizations on the south and west sides of Chicago were all siloed, doing their own work with no collaboration or coordination. The COVID-19 pandemic has created more unnatural or unique collaborations and it brought the south and west sides together to figure out how to bring testing and resources to the communities that needed it the most. Hospitals and community-based organizations have all worked together during this critical time. I think this created a realization that these collaborations were necessary in order to achieve our collective goals. And this transformational work is breaking down preexisting barriers and boundaries.
David: George, you have been here less than others on the panel, what is your current view of the Chicago health care landscape?
George: I came from Austin, Texas where the government would not expand Medicaid. The citizens of Travis county taxed themselves to provide services to those in need and worked with the community organizations to create a strategic infrastructure to provide access to health care. A 75,000 sq ft clinic in Texas for collaborative care did everything “from the womb to the tomb, from birth to the hearse.” Collaboratively working to end disparities in health care is a wonderful model.
Chicago is different, but there is an opportunity going forward to utilize some of the solutions mentioned in the paper in order to get everyone together with really being a catalyst for change. Can we reimagine how we do health care? Can we include transportation, food, housing, and more? We also need to make sure everyone has high speed internet to improve broadband access. The state Medicaid program, while it has merits, the budget has not been raised since 2011. Part of our problem could be the way we current fund the program, because it doesn’t allow for creativity and innovation.
David: What can we do now that we couldn’t 5 or 10 years ago?
Karen: I agree that we are at an inflection point to move from a health care system to integrated system of care that is mission driven. We have an opportunity to focus on the continuity of the care journey by using traditional methods, but with new modalities. We have advanced technologies now that allow us to connect and collaborate in ways that we could not before (e.g., data liquidity, real time records) which impacts how we coordinate care. Interoperability will have to translate into our ability to communicate and break down silos. Partnerships are necessary because the problems are too complex to solve alone. Virtual and digital advancements throughout the pandemic basically flipped a switch overnight and showed us what was possible with virtual care models.
What is the role of the state or the city, and what is the role of the community? And do we get that moving?
George: We need high powered individuals to convene groups committed to solving these complex issues – which now center around the survival of safety net. While the city and state should not drive those collaborations, they do need to be at the table to support them. In Chicago, the community is engaged and knows what their health and wellness needs are. Therefore, it is critical to engage community perspective. As decisions are being made on how to transform communities, the right people/stakeholders/leaders need to be there to listen to the voices of these communities.
Brenda: Some of the funding opportunities should be set aside to address specific issues. The city and state are just as siloed as our institutions on the ground and they that need to come together.
“Collaborating with the community hasn’t been done with a collective approach from city, state, and health care stakeholders.”
Karen: I am encouraged by more recent collaborations that are unique and far-reaching. For example: 1) The Corporate Coalition, an important civic organization that cares about Chicago which is aimed at encouraging deeper investment into workforce and other economic drivers that don’t involve just writing a check, 2) The Ogden Commons is being developed and Wintrust is opening a branch there, and 3) Invest Southwest has also put their money where their mouth is by choosing projects that will enhance these communities.
What do hospitals have to do to change and how hard is that?
George: It requires collaboration and willingness to work with your partners. Loretto is collaborating with other organizations to try to improve health for our most vulnerable individuals and trying to address health inequities in the community, especially with cancer and breast cancer. “You lose 20 years of life in a 20-minute drive.” Loretto cannot take care of this issue alone; we must get help from other organizations to address the bigger systemic problems (e.g., housing, transportation, food, drug stores per capita). Having the right interoperability is really important. Hospitals keep duplicating the same services because they cannot get access to records from another hospital.
Karen: The payment system is critical to how quickly and effectively hospitals are able to change care. We are not incentivized to keep people well. We need to invest more in the right things and then hospitals would be able to be weaned off the economic engine (admission, surgical services, etc.)
What do payers need to do to drive change?
Cheryl: The pandemic showed us that fee-for-service is risky and it does not reward outcomes, so we need an alternative payment model (APM). The different sources of funding are one of the things that we need to focus on, but an APM is necessary to focus driving the changes that we want. Payers need to do more value-based contracts and reward whole-person care.
George: “We have an illness model of health care in America, we don’t have a wellness model.” Stopping elective care at the beginning of the pandemic took out 40 percent of our revenue, which proved that fee-for-service does not work. Hospitals need to be incentivized to keep patients healthy. Many patients in the Loretto ER need primary care, not emergency care. Sometimes it may not be drugs or therapy that will address their issues, sometimes it’s something else.
Brenda: Payment reform is necessary. The cost for services provided by safety net hospitals has increased, but their reimbursement has not. We cannot get away from the reality that adjustment to the current Medicaid system needs to be made.
There are so many stakeholders that are interested in the same issue, whether it is from a health care, economic, or even a human goodness perspective. These stakeholders need to collaborate and drive necessary changes within their own sectors to improve the system as a whole. What would you do for an extra 20 years of life? We should apply the same vigor at extending that opportunity to all people living in our communities.