On January 25, HC3, in collaboration with Nixon Peabody, hosted an in-person discussion focused on the future of health care in Illinois. During this session, influential leaders offered insights into the potential opportunities and existing challenges we face in developing a sustainable and equitable health care system in Illinois.
Keynote Speaker: Grace Hou, Deputy Governor for Health and Human Services, State of Illinois
Moderator: April Schweitzer, Partner, Nixon Peabody
Panelists:
Kristen Schultz, Chief Strategy and Operations Officer, Planned Parenthood of Illinois
Michael Ziri, Director of Policy, Equality Illinois, Director of Policy
Steph Willding, CEO, CommunityHealth
Watch the Live Event
Event Recap
Summary of Keynote Speaker Deputy Governor Grace Hou's Address
Deputy Governor Grace Hou reflected on her transformative journey from the Department of Human Services to her current role as Deputy Governor in October. Drawing from her extensive experience in the nonprofit sector, including key positions at the Chinese American Service League and the Woods Fund Chicago, she articulated how these roles have profoundly influenced her perspective on public service. Deputy Governor Hou expressed optimism regarding effective leadership in the public sector while candidly acknowledging both the challenges and rewards inherent in working at the forefront of government initiatives.
In her address, Deputy Governor Hou highlighted key leaders across various state agencies, underscoring their unwavering commitment to community engagement. Notable appointments in agencies such as the Department of Children and Family Services and the Department of Aging underscored the administration's dedication to fostering positive change. Deputy Governor Hou emphasized the diverse skill set and compassionate leadership of these appointees, illustrating a deliberate effort to bring together professionals from community-based organizations.
Deputy Governor Hou delved into significant accomplishments during her tenure, such as reducing Medicaid backlogs and streamlining the SNAP program. These achievements underscored a steadfast commitment to efficiency and responsiveness in government services, directly addressing critical needs for vulnerable populations.
Addressing the intricacies of her onboarding process in the Governor's office, Deputy Governor Hou stressed the importance of continuous learning and understanding the vast array of government functions. Her commitment to spending time in the field, shadowing caseworkers, and meeting with community providers underscored her dedication to grasping the nuances of public service at the ground level. She also shared insights into challenges faced by the state, including workforce shortages and the time-consuming process of modernizing infrastructure. However, she expressed determination to tackle historically impossible tasks, reflecting the administration's dedication to meaningful progress. Deputy Governor Hou highlighted the migrant crisis as a significant focus area, outlining collaborative efforts with the city of Chicago and emphasizing the humanitarian aspects of dealing with new arrivals.
Concluding her address, Deputy Governor Hou outlined upcoming opportunities, including the 1115 waiver, which aims to factor in social determinants of health for reimbursement. She commended Cook County's groundbreaking initiative to eliminate medical debt, wanting to replicate such successes.
Deputy Governor Grace Hou's comments vividly showcase her passion for public service, commitment to collaboration, and nuanced understanding of the challenges and opportunities in health and human services in Illinois. Her speech not only reflects her personal journey but also highlights the collective efforts of the administration to create positive and lasting change.
Q&A with Deputy Governor Hou
Q: What do you think about bringing in private agencies and other parts of the ecosystem to work with government agencies?
A: One of the main ways we have tried to do that is through task forces, commissions, and working groups where you bring public sector leaders and private sector leaders together to talk. This is an important part of the process, but it’s not enough. I welcome opportunities to think about how we can actually roll up our sleeves and do the work together. If you know of a commission or task force that you want to participate in, let us know. The commissions and task forces are only as good as the members of the task force are willing to make them.
Q: What is the governor and your agency going to do to be prepared for the ongoing continued assault on affordable health care and public health infrastructure?
A: I think that the Illinois government has worked through laws, resources, and additional capacity to protect reproductive rights in Illinois, so that is solid. I think that there are additional opportunities in terms of figuring out what value-based health care looks like here. What do Certified Community Behavioral Health Clinics (CCBHCs) look like in the future? Illinois has so many innovative, community-based leaders. That is the future of health care. I think we are looking really seriously at how we need to deal with homelessness and how to change the rates of black mortality rates. We have to do everything all at once, that's the hard part of government. I look for feedback from all of you on what else you think is there that we haven't tried to enact.
Panel Discussion (Responses edited for clarity and brevity)
Panelist Introductions
(Michael Ziri) MZ: I serve as the director of public policy at Equality Illinois, our state's LGBTQ+ civil rights organization. Recently, I celebrated my ninth year with the organization. As the policy director, my role involves frequent trips to Springfield to ensure our legislators uphold our pro-equality stance and keep Illinois progressing. This is crucial, especially in the face of a staggering increase in anti-LGBTQ+ bills being introduced across the country, with 340 already in just the first few weeks of January. Last year saw only about 90 bills introduced by this time. Unfortunately, some states, like Ohio, have successfully passed harmful legislation, such as bans on gender-affirming care for youth. Many neighboring states have also implemented similar bans. Illinois stands as a beacon of support for LGBTQ+ rights, attracting individuals seeking refuge from oppressive laws elsewhere. Our state's commitment to reproductive and gender-affirming health care has drawn numerous families seeking sanctuary. Recognizing the importance of equitable health care access, we've prioritized initiatives addressing this need, along with advocating for comprehensive sexual health education and the safety of sex workers. By continuing to work together, we can ensure Illinois remains a progressive and inclusive state for all.
Kristin Schultz (KS): I am the Chief Strategy and Operations Officer at Planned Parenthood of Illinois, and I've been part of the organization since January 2020, even starting while 30 weeks pregnant. Over the past four years, I've focused on overseeing operations across our 18 health centers statewide and managing our telehealth platforms. Additionally, I lead strategic planning efforts alongside senior leadership and our CEO.
Our work has evolved significantly, especially in anticipation of potential threats to abortion rights. We've invested in physical and digital infrastructure to expand access, despite setbacks like the COVID-19 pandemic and labor shortages. With the looming possibility of Roe v. Wade being overturned, we've intensified efforts to ensure abortion access through various strategies.
Now, as we navigate a post-Roe environment, our focus is on sustainable growth and resilience in the face of ongoing challenges. Illinois has become a destination for out-of-state abortion patients, reflecting our commitment to accessibility and quality care. Looking ahead, we prioritize equity, innovation, and self-sustainability to continue serving our patients, staff, and communities effectively. Collaboration with local partners and deepening our roots in the state are key components of our future plans.
Steph Willding (SW): I'm Steph Willding, the CEO of Community Health, the nation's largest volunteer-based free health center. While similar to federally qualified health centers in the care we provide, the key difference lies in how we fund our services—offering them completely free of charge, primarily to uninsured and underinsured patients. With over 30 years of experience, our recent focus has been on addressing the new arrivals crisis. Serving primarily immigrant communities, we've been actively providing health care on the front lines of this humanitarian crisis, both in police precincts and within our health centers.
From an advocacy standpoint, we've been urging elected officials to integrate health care into every phase of the new arrivals' experience, whether they find themselves in a police precinct, landing zone, shelter, or apartment. Our goal is to center their health and wellness at every step of their settlement process in our city.
While I speak passionately about immigrant health care and the challenges they face, it's important to acknowledge that I don't personally have the lived experience of being an immigrant. My perspective comes from my professional experience, extensive community listening, and a lot of humility.
April Schweitzer (AS): What strategies have changed at Planned Parenthood, given both funding and policy changes over the past few years?
KS: As I mentioned, our focus has been on expanding access, not only for abortion care but also for gender-affirming care and basic family planning needs. Equity has been at the core of our expansion efforts, ensuring we cater to local communities and out-of-state patients without overtaxing local resources. To achieve this, we've expanded our physical footprint strategically, opening health centers in key locations such as Waukegan and Carbondale, complemented by a robust telehealth presence.
Additionally, we've bolstered our support services, including behavioral health and patient navigation teams, recognizing that supporting abortion patients benefits all our patients. Despite regulatory challenges, particularly post-Roe v. Wade, we've seen a significant increase in abortion demand, with patients coming from 41 states to access our services. This has placed financial strain on our organization, with substantial costs associated with supporting out-of-state patients, including transportation and lost wages.
While we've been fortunate to receive private support, sustainability remains a concern as the demand continues to outstrip available funding. Moving forward, we must carefully consider how to address this ongoing challenge within our ecosystem.
AS: Could you talk briefly about how your actual services have changed and how that affects your staffing?
SW: Reflecting on the past few years, Community Health, like many health care providers, has been on the front lines of crisis, including the global pandemic. Within a year of its onset, we piloted an innovative health care model called a micro clinic. These are small health centers co-located within community-based organizations addressing social determinants of health. Recognizing that our patients were often traveling long distances for care, we wanted to bring health care closer to them. This initiative has been successful, allowing us to meet better the needs of our diverse patient population across Chicago.
In response to the migrant crisis, we've adapted our approach further, launching a street medicine program to provide care directly in precincts. This has helped overcome barriers like childcare, transportation, and safety concerns for immigrant communities. By challenging traditional notions of health care delivery, we've been able to place ourselves where our patients need us most.
Our workforce, which includes both employees and volunteers, has been crucial in this endeavor. With over a thousand volunteers, we have the flexibility to ramp up access quickly, tapping into their expertise and dedication during times of crisis. This unique structure enables us to adapt to community needs swiftly and effectively.
AS: Can you talk a little bit about the barriers that the LGBTQ community faces and the current strategies or priorities that you're working on right here?
MZ: I want to clarify that we're not a direct service provider; we focus on translating provider experiences into policy. I work closely with the policy and government affairs team at Planned Parenthood Illinois, as well as a network of LGBTQ+ community organizations across the state, like Carbondale Rainbow Cafe, Howard Brown Health, and Peoria Proud.
As part of our strategic planning process two years ago, we conducted a listening campaign to understand where the gaps in care still existed despite Illinois's progressive laws. One major area we identified was the lack of access to affirming and equitable health care. I vividly recall a story from Carbondale about a young trans person traveling five hours each way to access affirming care at Howard Brown.
We also heard stories of individuals facing discrimination and a lack of understanding from health care providers when seeking services like PrEP. These barriers are compounded by issues such as housing instability, economic inequality, and discrimination in various aspects of life, including the criminal justice system and schools.
Moreover, there's a lack of transparency among health care providers regarding which services are covered for non-medical reasons, leading to additional trauma for patients who are denied care at the last minute.
Efforts like legislation requiring health care providers to provide advance notice of procedures they do not offer for non-medical reasons, as seen in Colorado, are crucial steps toward addressing these barriers.
Overall, the multitude of challenges faced by LGBTQ+ individuals seeking health care underscores the urgent need for systemic change and greater transparency within the health care system.
AS: How are you making sure that patients can get transportation to care and follow-up care as well?
KS: Our navigation team's approach is deeply rooted in learning from organizations like the Chicago Abortion Fund, leveraging their expertise to expand our practical support program for patients seeking abortion care and gender-affirming services. We initially partnered with the Chicago Abortion Fund to bolster their capacity, recognizing the importance of relying on existing expertise within the ecosystem.
While our navigation team primarily supports patients seeking abortion care, we've also extended our practical support to those seeking gender-affirming care in Illinois. However, the needs of these two patient groups differ significantly. Patients seeking abortion care typically require support for a short period, including follow-up care, especially if returning to a restricted state. Balancing patient access and transparency while protecting their privacy in restrictive states is crucial.
Our practical support program encompasses various forms of assistance, from transportation to childcare, in collaboration with organizations like the Chicago Abortion Fund. Additionally, for gender-affirming care patients, ongoing support is essential, highlighting the importance of our expanding presence, such as in Carbondale.
Ensuring gender-neutral and compassionate care for transgender and non-binary individuals seeking abortion care is a priority for us. We've also invested in building a gender-affirming hormone therapy case management team despite not receiving additional reimbursement for this essential work.
Overall, our approach involves navigating complex barriers and collaborating closely with partners to provide comprehensive support to patients while also addressing systemic challenges within the health care system.
MZ: The policy implications of receiving care in Illinois but facing potential legal consequences upon returning to a state like Missouri, where abortion is criminalized, are significant. About a year ago, Planned Parenthood, Equality Illinois, ACLU, and other organizations collaborated on the Patient-Provider Protection Act to provide protections for both providers and patients seeking care in Illinois. These protections include safeguarding medical records from demands by home states for prosecution purposes.
However, challenges persist beyond clinic walls. For instance, if a state seeks to prosecute someone for receiving abortion or gender-affirming care in Illinois, they might demand license plate reader data from local law enforcement to prove the individual's presence at the clinic. Regulations were passed last year to address this, thanks to Secretary of State Giannoulias, governing how Illinois law enforcement shares such data with other states. These regulations aim to protect individuals seeking reproductive health care, gender-affirming care, or immigration assistance.
Given the unpredictability of other states' actions in criminalizing lawful health care, Illinois's laws must remain innovative and responsive. Governor Abbott, Governor DeSantis, Governor Parson, and others may seek to penalize individuals for accessing care in Illinois, underscoring the need for ongoing policy considerations to protect patients' rights and privacy.
AS: Could you talk a little bit about how you're thinking about balancing emergency situations or crisis services with patients you have been seeing long-term?
SW: As we anticipate the potential influx of individuals seeking care in Chicago, particularly during the upcoming events like the DNC, the challenge lies in preparing for the uncertainty of the situation. We're ramping up our efforts in volunteer recruitment, especially for Spanish-speaking interpreters and other essential roles, while also fast-tracking the start dates for new positions to ensure adequate staffing levels. However, despite our proactive measures, we're facing unprecedented demand, leading to the longest waitlists and wait times we've ever experienced. To address this, we're leaning into our strengths as a primary care provider for immigrant communities and expanding initiatives like mobile care and street medicine. Collaborating with other organizations and breaking down silos is crucial to meet the needs of those seeking care efficiently. By focusing on what we do best and fostering partnerships, we aim to navigate this challenging period while ensuring the delivery of quality health care to all who need it.
AS: As we're going into 2024 and election year, what are you thinking about funding?
MZ: In our strategic planning process, we identified a significant issue: LGBTQ+ organizations in Illinois are severely underfunded compared to non-LGBTQ+ organizations, both publicly and privately. Recognizing the critical services these organizations provide, such as housing and health care support, our CEO prioritized addressing this disparity. We recently welcomed a new director of leadership capacity building to focus on supporting LGBTQ+ partners in leadership development and expanding their access to funding. However, with a tighter state budget projected this year, the challenge of meeting the community's needs with limited resources looms large. We're exploring alternative solutions beyond funding, such as legislative advocacy, to address this pressing issue and ensure equitable support for LGBTQ+ organizations.
KS: When it comes to our financial sustainability, I see it from a few perspectives. Firstly, we're refining our revenue model to adapt to changing reimbursement structures and rising costs, focusing on efficiency and lower-cost care provision models, including value-based care. Secondly, in terms of funding access, while we have resources and expertise in securing institutional funding like Planned Parenthood, we recognize the need to support smaller LGBTQ+ organizations that may lack such resources. We aim to build ecosystem partnerships to enhance funding access for these organizations, ensuring a more equitable distribution of resources. Additionally, we're mindful of our reliance on private donations and the importance of using these funds strategically for capacity-building investments rather than just operational expenses. Overall, our approach to financial sustainability involves refining our revenue model, building ecosystem partnerships for funding access, and strategically utilizing private donations for organizational growth and development. Our financial outcomes are directly related to our explicit choices for equity, we provide an immense amount of subsidized or free care, and our choice to continue to do that has to remain in balance with our financial sustainability. We think about it as equity access and financial sustainability.
SW: In discussing our financial model, it's important to understand that as a free health center, our approach to funding differs from traditional health care providers. We operate on three main pillars: volunteerism, philanthropy, and partnerships. Volunteerism significantly reduces our personnel expenses, while philanthropy provides crucial financial support. Our partnerships with academic institutions, corporations, and pharmaceutical companies enable us to access donated goods and services, including lab services and medications, which are essential for our operations. Diversifying our revenue streams involves not only monetary contributions but also leveraging opportunities for donated resources. As part of the free and charitable clinic sector, we play a vital role in the health care ecosystem by providing exceptional care to uninsured individuals and alleviating strain on other health care entities. Our sector is advocating for recognition and support from state and city governments, as evidenced by recent grants from the Illinois Department of Public Health. Overall, our focus on financial sustainability involves maximizing the impact of our resources while advocating for our place at the table in health care policy discussions.
AS: What gets you up in the morning to do your job that you're excited about as we head into this year?
SW: I want to share a story that highlights the importance of health care justice. One day, while providing care in precincts, we only saw three patients, which might seem like a failure in traditional health care terms. However, one of those patients stood out to me. She had received a positive pregnancy test result, and it was evident that this news brought her distress, especially considering her circumstances of sleeping in a precinct. As she shared her story with our medical provider, she revealed that her pregnancy resulted from a traumatic experience of kidnapping and rape during her journey to the United States. She feared the repercussions if her husband were to find out. We swiftly guided her to our main location at Community Health and connected her with organizations like Planned Parenthood, providing her with a safe and private space to make decisions for her safety and well-being, as well as for her daughter's future. This experience reminds me that despite the challenges and moments of burnout, every individual we catch in our safety net represents a victory. It's moments like these that instill hope amidst dystopian times. Collaboration and collective efforts, exemplified by the many volunteers and supporters at the precinct that day, reaffirm our commitment to making a difference and building a better future for all.
KS: As we contemplate our partnerships with communities and our workforce, it's crucial to give a voice to those affected by our decisions. I can't help but notice the absence of people of color and immigrants on this panel, and it serves as a reminder of our duty to incorporate diverse perspectives into our leadership and organizational strategies. We have a unique opportunity to challenge the status quo and reimagine health care in a more inclusive, accessible, and compassionate way. This responsibility weighs heavily on me, and I'm committed to embracing it alongside you both.
MZ: What gives me hope amidst the challenges we face, including a surge in anti-LGBTQ legislation and a contentious political climate, is the resilience and strength of LGBTQ+ communities across Illinois. I vividly recall an encounter from my early days at Equality Illinois, where a legislator dismissed the relevance of LGBTQ issues in their district, claiming it was solely a Chicago concern. Today, such dismissals are rare because LGBTQ individuals and their allies have made their voices heard in every corner of our state. They are not waiting for change; they are actively shaping their communities and advocating for their rights. Despite political attacks and attempts to sow division, LGBTQ communities are fighting back with courage and determination. This spirit of resilience and activism is truly inspiring and reaffirms my belief in the power of people to create positive change.
Panel Discussion Q&A:
Q: For places like Community Health that have a large volunteer workforce or a large student resident workforce, what challenges have you faced in that space, and how have you addressed that?
SW: Regarding resident training programs and medical education, I'll set them aside for a moment and focus on our larger volunteer base. At Community Health, our approach to running clinics differs from traditional safety net health systems. While a family practice doctor in such settings might see 12 to 14 patients per clinic session, at Community Health, that number is more like 4 to 6, depending on the mix of new and follow-up appointments. Our volunteer providers appreciate this difference because it allows them to practice medicine in a more holistic manner, with access to over 20 specialty care services, behavioral health, dental care, pharmacy services, health education, and preventive care. When we ask these volunteers to pick up a clinic session, they often don't mind because the experience at Community Health aligns with their vision of practicing medicine. However, there's a concerning trend of resident burnout and fatigue, which has been brought to my attention recently. While our expectations at Community Health are lower than those in other settings, residents still feel overwhelmed. This is an issue I'm beginning to explore further, as it's become a recurring theme in recent discussions. Overall, our volunteer base is consistently amazed by the unique experience of working at Community Health, where the focus is on providing quality care rather than managing high patient volumes within tight timeframes.
Q: As we move towards this ideal model of community health worker certification and Medicaid reimbursement, how do we ensure that that doesn't become a fee-for-service-based model and shift back from value-based care to fee-for-service?
SW: I share your concerns about the risk of community health work being reduced to a mere checkbox on a list. Community health workers are deeply rooted in human-to-human connections, and their effectiveness lies in the personalized care and support they provide. Implementing reimbursement for community health workers must coincide with a shift towards value-based care, where the focus is on the quality and outcomes of care rather than the quantity of encounters. Separating these two aspects could lead to a mechanistic approach that undermines the essence of community health work.
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