History, Accomplishments, and Legacy - Health & Medicine Policy Research Group

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History, Accomplishments, and Legacy

For more information about this program please contact:

Wesley Epplin
Policy Director wepplin@hmprg.org

Alizandra Medina
Health and Aging Organizer amedina@hmprg.org

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History, Accomplishments, and Legacy

  • Overview


In 2001, Health & Medicine created the Center for Long-Term Care Reform — now called the Aging Equity Center — to work on policy to promote the rebalancing of Illinois’ long-term care system for older persons in favor of home and community-based care.  

Through this Center, Health & Medicine has been centrally involved in Illinois’ long-term care reform process, working closely with legislators, state agency leadership, advocates, and providers in support of a long-term care system for older adults that is affordable, accessible, high-quality, adequate to meet needs, and predominantly home and community-based.  

In 2001, the Center convened bipartisan study groups to inform and educate a broad base of Illinois legislators about the need and potential for long-term care reform. In response to legislators’ insistence that their constituents were not concerned about long-term care, the Center conducted community forums around the state with older adults and their family members. The final report, “Illinois Residents Speak Out on Long-Term Care” (May 2004), demonstrated unequivocally that long-term care is a significant concern and priority issue for Illinois’ older adults and their caregivers.  

Development of the Older Adults Services Act: The Center’s work helped set the foundation for the 2004 development and passage of SB 2880, the Older Adult Services Act, which began an unprecedented process of systems change in Illinois, intended to “promote a transformation of Illinois’ comprehensive system of older adult services from funding a primarily facility-based service delivery system to primarily a home-based and community-based system.” The legislation also created the Older Adults Services Advisory Committee (OASAC), which paved the way for a $63 million increase in state spending to support older persons wishing to remain in their communities. 

The Bridge Model: Transitions in care after hospitalization are often complex, stressful, and difficult for patients and their caregivers to navigate. The consequences of poor transitions are serious and costly: high re-hospitalization/readmission rates, unnecessary nursing home admissions, and deteriorating health – as well as increased burden and costs on individuals, insurers, public funding sources, and safety-net healthcare providers. Further complicating this problem, national research shows that readmissions affect minorities at disproportionately high rates and are often caused by lack of or inadequate care coordination across medical and social services following hospitalization. 

To address these issues, Health & Medicine joined with other partners in 2008 to collectively develop and disseminate the Bridge Model of transitional care, an interdisciplinary and social work-led intervention that helps individuals safely transition from the hospital to their homes and communities. The Bridge Model improves transitions of care by utilizing master’s-prepared social workers in a case management role, who conduct comprehensive biopsychosocial assessments, help coordinate medical and social services after discharge, and utilize psychotherapeutic techniques to target patient engagement. Bridge programs emphasize care continuity across settings, interdisciplinary teamwork, and the importance of caregiver support. Bridge helps reduce hospital readmission rates, decrease patient/caregiver burden and stress, and improve physician follow-up. Earlier on, Health & Medicine managed the Bridge Model in collaboration with Rush University Hospital. The program is now at the Center for Health and Social Care Innovation at Rush University Hospital. 

Behavioral Health and Primary Care Integration: Recovery from mental illness is a life-long process, and therefore requires long-term services and supports. However, programs and providers that serve people with mental illness are too often siloed and marginalized within the overall health and social services system, resulting in fragmented services, exceptional challenges to information sharing and care coordination, and chronic underfunding of programs. 

Recognizing budgets and regulations of programs that serve people with mental illness often reflect stigma, the Aging Equity Center started the Behavioral Health-Primary Care Integration Learning Collaborative in 2015 to guide local advocacy and facilitate practice-level change to improve the lives of people with mental illness and substance use disorder. Health & Medicine launched a multi-phase project to help primary care and behavioral health providers develop strategies to better implement evidence-based models for the integration of behavioral and physical care to facilitate more effective utilization of available resources and expand the capacity of behavioral health and primary care providers to provide high quality, person-centered care to more people in need. 

In the fall of 2015, Health & Medicine initiated a Behavioral and Primary Care Integration Learning Collaborative — a team-based approach to improving processes, practices, and systems by sharing experiences, resources, and challenges — to identify and adopt best practices for behavioral health-primary care integration in Illinois. The collaborative brought together community behavioral health agencies, primary care providers, facility-based behavioral health providers, and people in recovery to share their experiences, participate in trainings, and prepare to pilot evidence-based models that can be tested and continuously improved by systematically tracking processes and outcomes. 

Illinois’s State Plan on Aging: In 2020, Health & Medicine worked with the Illinois Department on Aging to research, develop, solicit public comment, and respond to public comments of the State Plan on Aging, which is the Administration on Community Living requires for state agencies that administer Older Americans Act dollars. Health & Medicine was contracted to support the advancement of a stronger health equity and aging equity focus in the 2021-2023 plan. You can view the plan here. 

The Center has remained centrally involved and has served on all OASAC committees; worked closely with providers, advocates, policymakers, and legislators; and provided the analysis, information, and perspective needed to advance an informed, person-centered, and equity-focused reform agenda that prioritizes home and community-based care for all older persons in our state. In that capacity, we have served as an advisor to the Illinois Department on Aging and other state leaders on aging issues across several administrations.