Research: Strengthening the Safety Net in Illinois After Health Reform - Health & Medicine Policy Research Group

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Research: Strengthening the Safety Net in Illinois After Health Reform

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Research: Strengthening the Safety Net in Illinois After Health Reform

  • Overview


Creating Healthy Communities: Helping the Safety Net Navigate the Challenges and Opportunity of Health Reform In 2017 Health & Medicine conducted a research project examining how the ACA and state level health reforms can support the move toward health equity and stronger communities in the Chicago area with a specific focus on the Western Suburbs. This research led to two paper:
Beyond the Clinic: A National Health Equity Review Implications for our local safety net (March 2018) This policy and practice review of national work examines how the safety net can use this time of health reform opportunity to shift toward addressing social determinants of health, structural determinants of health inequities, and ultimately health equity. There are ample studies and papers detailing clinical care interventions and programs to provide more services to meet unaddressed needs. However these studies rarely focus on the need for large safety net institutions to utilize their individual and collective political power to change the structural inequities that drive the inequitable distribution of social determinants of health. To make a valuable and new contribution to the trajectory of healthcare’s interest in advancing health equity, this paper does not focus on social determinants of health. Rather, it gives examples of this work to orient readers to research and national efforts. The paper also addresses how the power of the health sector—which represents roughly 18% of the U.S. economy—could be better used to influence structural drivers of inequities. A Qualitative Review of Chicago’s West Suburban Safety Net: Consequences, Adaptation, and Recommendations for Future Reform (March 2018) This study extends previous research examining the impact of the Affordable Care Act and state Medicaid expansion on the safety net. The paper analyzes how the current political context is impacting the safety net sector while also examining overall adaptations to health reform, understanding its consequences, and identifying safety net stakeholders’ policy and philanthropy recommendations for future reform. This research focused specifically on the safety net in western Cook County and eastern DuPage County, Illinois (the western suburbs of Chicago). Researchers conducted key informant interviews with executive leadership and focus groups with staff from thirteen area federally qualified health centers (FQHCs), hospitals, free and charitable clinics, insurers, and community-based organizations, using semi-structured focus group and interview guides. In addition to qualitative analysis, our report offers policy and practice recommendations to help address the challenges of reform at the institutional, state, and federal level.
Strengthening the Safety Net After Health Reform: An Examination of the Cook County Safety Net (June 2016) Click here to download a PDF of Strengthening the Safety Net in Illinois After Health Reform. In late 2016, Health & Medicine completed new research on the Cook County Safety Net in partnership with Loyola and others to capture how state an federal health reform efforts have impacted Federally Qualified Health Centers (FQHCs), free and charitable clinics (FCCs), and hospitals in Cook County. This study was unique from others that examine the safety net in that it intentionally asked participants to discuss both the anticipated effects and the unintended consequences of health reform implementation. Key themes include:
  • The challenge of navigating the changing insurance and provider landscape
  • Continued barriers to access as services remained unaffordable even with reform
  • The need for greater support for quality improvement activities as well as enhanced capacity to respond to the demand for patient-centered care that addresses social determinants of health
These anticipated and unintended consequences have required FCCs, FQHCs, and hospitals to constantly adapt to the reformed environment and have revealed the depth of each of the systems’ organizational capacity and assets. Our report is designed to deepen understanding of a sampling of the safety net in Cook County while providing recommendations for policymakers and philanthropy, as well as identifying areas for further research to guide health reform and policy.