The third and final session of Impact Engine’s 9th annual Chicago Impact Investing Showcase wrapped up our series with a great discussion on health equity in Chicago, moderated by Elizabeth McCluskey. In reference to our 5P Framework, this session focused on Product-based impact where the product or service a company is providing will directly create impact and connect growth and revenues with positive social and environmental impact. Joining Elizabeth for the event were panelists Justine Mitchell (SVP of AtHome at Array Behavioral Care), Nate Pelzer (the CEO and Co-Founder of Clinify Health), and Will Boeglin (the CEO and Co-Founder of TimeDoc Health).

To frame the day’s discussion, Elizabeth referenced a study on life expectancy published by the NYU School of Medicine. According to their findings, Chicagoans who live in Streeterville have a life expectancy of 90 years, while 9 miles to the south in Englewood the average life expectancy plummets to just 60 years. The researchers studied life expectancy in America's 500 largest cities, and that 30 year gap represented the nation’s largest disparity. Clearly there are acute problems around both health care delivery and health equity when people only a train ride away are living 30 fewer years. More recently, the Black and Latinx populations in Chicago were disproportionately affected by COVID-19. During the fall, majority Latinx zip codes in Chicago were experiencing the highest rates of infection and Black residents were experiencing death rates 2x that of White residents. Here are some highlights from the discussion:

Q: What is driving disparities in health and why is values-based care so important for serving underserved for providers to facilitate their care?

Nate Pelzer: The simple answer is it’s historically systemic racism at its core. Over the last few centuries through things like redlining, busing, Jim Crow, you have had disinvestment in certain geographic areas in the country. And as these areas have had less investment in health care and fewer employment opportunities, the result is that people have less access to primary and preventive care. Over time, those things that were once just social factors begin to impact their health outcomes. Moving to values-based care is important in Medicaid because it shifts the focus from patients coming in when they need something acute in nature to instead putting the onus on physicians to be more aware of what the population health needs of their patients are in general.

Q: What are you seeing in terms of disparities in conditions that patients are suffering from and ways you’re finding to intervene?

Will Boeglin: We see a high incidence of both chronic medical conditions and behavioral health conditions in the dual eligible population (people that qualify for both Medicare and Medicaid). But even more so than clinical intervention, often what is needed is social work to address social determinants of health. In this patient population, 40% don’t have a smartphone and 25% don’t have access to WiFi. When you think about the transition to telemedicine that the pandemic has necessitated, that creates some really serious barriers to receiving care. A significant percentage of the dual eligible population don’t have a caregiver at home, they live alone. That means no one is advocating for them, encouraging them to stay on track, reminding them to pick up their prescriptions, or helping them get scheduled for vaccines. In one instance, one of our care managers was speaking with a patient that was homeless and currently living in their car. They didn’t have the paperwork or authorizations from the health center to get admitted to a local shelter. So the care manager worked with the health center to make sure they completed all the correct forms, shared that with the patient and the shelter, and was able to get the patient admitted. There are lots of examples like that of our care manager engaging to help ensure positive interventions, whether it’s connecting someone to Meals on Wheels, trying to find discounts on medication to make their meds more affordable, or referring patients to resources the local community centers on aging.

Q: What have you seen in terms of mental health throughout the pandemic? What populations have seen an increase in need?

Justine Mitchell: It’s well documented that there is a widespread increase in need for mental health services because of COVID. Social isolation, anxiety, lack of control, job loss, disruption in the home and grieving over loss of loved ones have really driven people to need and utilize behavioral health services more. From a forced adoption point of view, at CMS (Centers for Medicare & Medicaid Services) a lot of federal regulations have been relaxed this year around telehealth and licensure across state lines. Also, hospitals and health systems who may have had some utilization of telehealth, and comfort with it, have been forced to move to telehealth and accept it as a standard of care. We’ve been seeing an increase across multiple business lines. On the direct-to-consumer (D2C) side, utilization has grown month-over-month sometimes as much as 18%. It reflects an increase in need for behavioral health services which is a negative, but on the other hand it’s good that people have access to the behavioral care they need via telehealth – it’s broken down some of the old barriers. In behavioral health there is a supply/demand problem, there simply aren’t enough licensed clinicians to meet the needs of the patient population. Given that, telehealth and video bridges that gap and increases access to care for patients in underserved areas, both urban and rural, even in their home in a more effective way. Combining a D2C product plus more access in clinical settings has been the way to take a bite out of behavioral health deserts.

The entire Impact Engine team is grateful to Justine, Nate, and Will for taking the time to share their perspectives on these important issues that affect all of us. We’re glad that the talented teams at Array Behavioral Care, Clinify Health, and TimeDoc Health are all so passionate about health equity and working hard to develop solutions that address these disparities in health. We’d also like to thank the MacArthur Foundation for their continued support of this annual Chicago showcase event. See you next year!

Missed this session or want to revisit the full discussion? Visit here for a full recording.