The COVID-19 pandemic put a spotlight on the disparities in healthcare delivery and outcomes for traditionally underserved and vulnerable communities. But those of us who have dedicated our careers to equity in medicine did not need a generational public health crisis to know that the current healthcare ecosystems are broken—at the national and local levels, and especially for community-based providers.
While it’s easy to say the healthcare system isn’t working, particularly in places like Chicago’s South Side, it’s more difficult to confront the systemic challenges that traditionally and continually create barriers to care for patients. But it can be done.
Questions like, “What does a well-functioning healthcare system look like?” and, “Are the gaps in healthcare only in traditionally underserved communities?” are critical to consider. Yet more important than who asks these questions is who is empowered to answer them. We’ve learned the best way to understand problems in healthcare delivery—and to work toward solving them—is to ask community members.
We hear from residents on the city’s South Side that they don’t want to leave their own communities for services. They don’t want to wait six months for a doctor’s appointment and find themselves in the emergency department for acute care during that wait. They want direct access to specialty care in locations that are convenient for them.
Everyone, regardless of ability to pay, deserves these fundamental services and functions from healthcare providers. But what can healthcare leaders do to make this a reality?
The answer is for larger, well-resourced hospitals and health systems to partner with community hospitals and federally qualified health centers within the same ecosystem, as well as for health-focused community leaders and community-based organizations to build coalitions that can create the future of medicine for patients and providers.
UChicago Medicine is one of 13 members of the South Side Health Transformation Project, which in 2021 launched the South Side Healthy Community Organization model, leading to the establishment of a 501(c)(3) organization. Through collaborative partnerships and with funding from the state of Illinois, the SSHCO is leveraging its collective strength, in the community and in medicine, to transform healthcare throughout Chicago’s South Side.
SSCHO developed a care delivery model that creates better access to care for patients, prevents and treats chronic diseases at scale within communities disproportionately affected by them, and connects people to resources addressing social determinants of health. The organization is navigating the traditional hurdles of mismatched electronic health records and other technology gaps to build a health system that allows every clinic, health center, community hospital and large academic hospital within our coalition to truly talk to each other.
Already, we’re relying on the strength of coalition members in training community health workers and taking into account the feedback we received at multiple town halls run by community representatives.
The initiative’s goal is to increase access to care in places left behind by our imbalanced health system, to prevent more community hospitals from shuttering, and to preserve and expand service lines in critical areas, including obstetrics and gynecology, that have in recent years fallen away and worsened health outcomes in our communities.
We want every patient, regardless of ZIP code, to get access to the care they want and need, in their community and at their convenience. Doing this will not only improve health outcomes, but will improve attitudes around and confidence in healthcare within underserved communities, which could lead to significant improvements in the city’s overall public health.
While these changes are right for patients, they’re also right for hospitals and health systems. Rightsizing the healthcare ecosystem in the community creates an economic balance that works for every institution serving it, including more affluent hospitals and less-resourced safety-net hospitals.
Our coalition didn’t happen without challenges for the leaders of each institution involved. What would be the cost to each of us? Could 13 different organizations work together and agree upon a care model design? Would we cooperate with each other? Would the community participate in a system that linked care across our respective institutions?
For leaders who want to consider a similar approach, it’s important to look at where the participating organizations align. For our coalition, what we all have in common is a unified goal to reduce health inequities and chronic disease disparities. By putting this “true north” in perspective, we have ventured forward together to fundamentally transform health in our communities.
We agreed that if well-resourced health systems do not invest in community health, patients will get sicker and more skeptical. And an imbalanced healthcare system will become unsustainable. We have a moral and fiscal obligation to rightsize the system and serve every patient where they are.