Background
For decades, the 900,000 residents of the South Side of Chicago have experienced health disparities ranging from materially higher disease incidence and comorbidities to significantly lower life expectancy. These health disparities reflect a history of racial inequities and underinvestment – both of which have contributed to a fragmented healthcare delivery landscape with limited resources. Today, over 50% of all South Side residents leave the South Side to receive their care. In an unprecedented initiative to address these challenges, which are only growing more acute, the care providers of Chicago’s South Side have formed a comprehensive coalition of FQHCs, safety net hospitals and health systems – driven by community input and dedicated to fundamentally advancing health care access and better health outcomes for Chicago’s South Side residents.
The coalition – comprised of Advocate Trinity Hospital, Beloved Community Family Wellness Center, Chicago Family Health Center, Christian Community Health Center, Friend Health, Jackson Park Hospital, Near North Health, The New Roseland Community Hospital, Saint Bernard Hospital, Sinai Chicago – Holy Cross Hospital, South Shore Hospital, TCA Health, and University of Chicago Medicine – plans to establish a new, 501(c)(3) not for profit organization – the SSHCO as the vehicle by which it will facilitate – in partnership with the community – health care transformation on Chicago’s South Side.
The SSHCO will do so by implementing a comprehensive Healthy Community Model focused on primary and specialty care access, preventive and chronic care management, care coordination and management, provider collaboration, community engagement, and a connected digital and technological infrastructure. The coalition expects that through this approach, Chicago has the potential to be a national model in community health transformation.
Introduction
During its first year, the South Side Healthy Committee Organization is looking to develop interventions that improve the following metrics:
1. Access to Preventative Care
2. Controlling High Blood Pressure
3. Follow-up after hospitalization for Mental Illness
4. Follow-up after ED for alcohol/substance abuse
5. Focus on Maternal Health
To achieve improvements in these areas, the SSHCO will deploy a “Care Team Model” comprised of Clinical Providers, Social Work, and Care Navigators, who follow the patient no matter where they receive care within the 13 collaborative sites.
Improving access to health care is essential to improving these metrics however, they are not the only focus of our efforts. The SSHCO recognizes that it must treat the “social determinants of health” with as much intentionality as providing clinical care to benefit our patients.
The specific social determinants of health that the SSHCO is focused on include (but are not necessarily limited to) the following:
· Transportation needs
· Employment / Financial Resource Strain
· Technology
· Education
· Healthy foods/Grocery store access
· Care navigation support
· Depression / Substance use / Alcohol
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