All In Chicago: Improving the Health of a Community Cannot Be Accomplished By a Single Institution

Edited by, Meghan Phillipp and Laura Starr

It is estimated that under the current Affordable Care Act legislation, there will still be more than 500,000 Cook County residents without health insurance next year – and, if the ACA is repealed, that number will only increase.

CommunityHealth is the largest free health clinic in the nation, currently working as a convener of health care providers, insurers, and other key business and civic leaders to make Chicago the first major metropolitan city to have a fully functioning system in place ensuring that every resident has access to the right care, at the right time, in the right place.

The flagship event of the All In™ campaign is a breakfast summit held each November. For the last two years, we brought together leadership from across sectors to engage in a conversation about the importance of data and social determinants of health to provide access to health care for all Chicago residents – but we only had the time to answer a fraction of the important questions posed by our guests at this event. So we reached out to our 2016 keynote speaker Mark Humowiecki*, from the Camden Coalition of Healthcare Providers, to address just a few of the unanswered questions we had about Camden’s successful model for addressing the needs of the underserved in their community.

If you missed the event, you can view Mark’s enlightening presentation here.

CommunityHealth: What does being "All In" mean to you?

Mark Humowiecki: “All in” is about building deep coalitions to work on complex issues. The work of improving the health of a community cannot be accomplished by a single institution - whether a hospital, a clinic, or a public health agency. It requires collaboration from many different individuals and organizations to develop a shared set of goals and strategies. “All in” is about building a table large enough for everyone to sit and a structure that taps the energy, excitement, resources, intelligence, and skills of each partner to fulfill this common purpose. 

All In Chicago, November 17, 2016 - Tiia Norsym Photography

CH: Has the Camden Coalition found overall costs of care going down? (Taking into account social service costs like housing)

MH: We are in the middle of a Randomized Control Trial with researchers from MIT to study the impact of our care coordination intervention, but we do not yet have results ready for publication. Calculating overall costs for a community is extremely challenging. In the evaluation of our first community-wide ACO contract, we saw total costs go down slightly. However, there were some areas of cost that changed for reasons unrelated to our work - for example, pharmaceutical spending rose dramatically because of an increase in people accessing an expensive, but life-saving Hepatitis C treatment. We have seen some dramatic cost reductions with patients for whom we are providing care management, particularly those who are in our housing first program, but these lack the methodological rigor to say definitively that we are saving money.

CH: How do you integrate social risk factors with cost and utilization data to identify individuals for interventions?

MH: The screening process for our care management intervention begins with utilization. It uses the hospitals’ admission, discharge and transfer (ADT) data and electronic medical records (EMR) to identify individuals who have been hospitalized at least twice within six months. It then applies a series of inclusion and exclusion criteria that include medical, psychological, and social risk factors. The program is designed for individuals with the most complex psycho-social risk factors such as homelessness, addiction, mental illness, social isolation, poverty and food insecurity. 

All In Chicago, November 17, 2016 - Tiia Norsym Photography

CH: What role does health education play in your model? Does your organization use community health workers to do health ed?

MH: Health education is an important component of our work. Our care philosophy seeks to empower individuals to manage their own care and better navigate the healthcare system. Our teams consist of nurses, social workers, and community health workers. Community health workers play an instrumental role in teaching and coaching patients how to manage their chronic disease. In addition, we operate a community health program called Faith In Prevention, which works with churches, mosques, and other faith based organizations to provide education on healthy eating and lifestyle. Our community health workers train lay leaders within the faith based organizations to provide education to their community members through a formal six week program. This program is in its third year and has been enormously successful in integrating values and tools for healthy living within the community.

Mark Humowiecki is General Counsel and Senior Director of National Initiatives at the Camden Coalition of Healthcare Providers. The Camden Coalition is a nationally recognized community based organization working to improve the quality, coordination, and efficiency of the local health care system, particularly for the City’s most vulnerable residents. Mark leads the Coalition’s new National Center for Complex Health and Social Needs, which is leading a national effort to coalesce a new field of healthcare and a national movement to improve care to those with the most complex health and social needs. Mark is a graduate of Yale College and Yale Law School, and is a native of Oak Park, Illinois.

How can the Camden Coalition’s successes and learnings be applied to Chicago or other communities? We want you to be part of our continuing conversation.  To learn more about our All In™ campaign, please visit www.allin-chicago.org.

Together, we can build a healthier Chicago. #AllInChicago