In March of 2018, Esperanza Health Centers broke ground on a new clinic in Brighton Park. When it opens this spring, the clinic staff, community partners, and potential patients want it to break ground in community healthcare delivery as well.
Esperanza, a community healthcare provider, is partnering with Mujeres Latinas en Acción, an advocacy and social services organization for Latinas, to establish the clinic that will provide primary care and mental healthcare for adults and children in the same facility, while also housing specialized health and social services programs for survivors of domestic violence and sexual assault. Integration of these services, and the partnership between a health provider and a local advocacy organization, has rarely, if ever, been tried before.
“With this project we want to create a new model of how a community primary care and mental healthcare provider like Esperanza can work with a social services and advocacy organization like Mujeres,” said Linda Tortolero, president and CEO of Mujeres Latinas en Acción. “How can we move the needle on this approach?”
Currently, residents of Brighton Park find it difficult to access high-quality primary care or mental healthcare in their own neighborhood. “I used to go to a clinic on the North Side of Chicago, but when I moved to the South Side, I struggled to find a clinic that would accept my health plan and had good doctors,” said Sugey López, thirty-three, a current patient at another Esperanza clinic.
In a 2018 report by the Collaborative for Community Wellness on health needs of the Southwest Side, residents reported that geographic access was one of the top barriers to receiving mental healthcare—not stigma, as it is commonly assumed.
Esperanza Health Centers chose Brighton Park as its newest location in order to be closer to its patient population. The other Esperanza clinics are located in Marshall Square, Little Village, and Marquette Park. “Brighton Park is a healthcare desert,” said Esperanza CEO Dan Fulwiler. “Ninety-five percent of physician capacity is north of the Stevenson Expressway and fifty percent of our patients live south of the Stevenson Expressway, so while doing our strategic plan, Esperanza decided to build in Brighton Park.”
Residents dealing with unique mental health issues like sexual assault or intimate partner violence have the additional burden of traveling to several different locations to access trauma-focused mental healthcare, primary care, and social services, since no organization offers all three at the same site.
“Domestic violence is a public safety and public health issue,” Tortolero said. She hopes that the clinic will better support survivors on their path to healing and empowerment by offering mental healthcare that includes specialists in domestic violence recovery. “The Chicago Battered Women’s Network is helping hospitals scale up their awareness of signals that domestic violence is taking place, but this project is more about how healthcare providers can scale up the wellness path, and seeing if it will lead to better outcomes.”
Mujeres Latinas en Acción already offers specialized mental health services for domestic violence survivors, and is one of three free supervised visitation programs in the city. It is the only one providing services in both English and Spanish.
In 2016, the Chicago Metropolitan Battered Women’s Network, together with Loyola University Chicago Center for Urban Research and Learning, reported that while emergency shelter needs decreased among survivors after receiving assistance from Chicago-area agencies, survivors’ needs for counseling, healthcare, and divorce-specific help went largely unmet.
Once completed, the Esperanza clinic will be the only clinic in Brighton Park that provides primary care, mental health, and community health programs for both children and adults in one setting. The clinic, with thirty exam rooms, eight counseling rooms, and the capacity to serve approximately 20,000 patients, will have internal medicine, ob-gyn services, counseling, and psychiatry. The clinic grounds will house a playground, community kitchen, and community garden that will be available to the broader public, not just to those being treated at the clinic. These additions came about in response to feedback from focus groups made up of Brighton Park residents, and are part of Esperanza’s push to integrate many forms of community wellness.
Esperanza is breaking ground not only in what services it will offer, but in how it will offer them. According to Dan Fulwiler, Esperanza Health Centers accepts almost any insurance, including Medicaid plans, Medicare, and private insurance. For uninsured patients, they offer income-based fees: thirty to eighty-five dollars for comprehensive healthcare services, and five to forty-five dollars for mental health counseling. For those without income, such as people experiencing homelessness, the fee is waived. Last year, twenty-nine percent of Esperanza’s patients were uninsured, according to Ricardo Cifuentes, vice president of external affairs.
The new Brighton Park location will be supported through federal funding, individual and foundation donations, and program service fees. According to Esperanza’s 2017 annual report, the organization received fifty-three percent of its revenue from patients, fifteen percent from pharmacy revenue, and the rest from a combination of grants, private donations, and other revenue sources.
Providing care on a sliding fee scale for uninsured patients is one of several requirements that Esperanza Health Centers must meet as a Federally Qualified Health Center (FQHC). FQHCs like Esperanza receive funds from the Health Resources and Services Administration to provide primary care services in underserved areas. Other requirements include operating under a governing board, of which fifty-one percent must be patients.
Esperanza is also one of twelve members of Medical Home Network, an Affordable Care Organization (ACO) in Chicago. ACOs are groups of health care providers that voluntarily coordinate care of their patients. Because a coordinated network is able to provide care more efficiently—by not duplicating medical procedures, for examples—they may spend less money per patient. When those savings come from patients on Medicare, the money is given back to the ACO by the federal government. The goal of ACO contracts, ultimately, is to reduce healthcare spending while increasing health outcomes.
Although the new clinic is being built to meet the needs of an underserved area, the clinic administration does not anticipate difficulty in meeting demand. “Despite the need in the community, we don’t actually anticipate exhausting this capacity for quite some time,” said Cifuentes. “Increased demand at our other sites has usually been addressed by hiring additional providers or making additional clinical space available on site.”
However, the integration of healthcare services and social services presents a challenge to the new Esperanza clinic. For starters, Esperanza must abide by privacy rules set by the Health Insurance Portability and Accountability Act (HIPAA), and Mujeres Latinas en Acción are bound by other privacy policies. Under HIPAA, healthcare providers are only allowed to share the minimum amount of medical information necessary to coordinate care with social services agencies, unless the patient authorizes the provider to share additional data. As pioneers in integrated services, Esperanza and Mujeres will have to figure out how to track patient consent while maintaining confidentiality.
Despite these uncertainties, Tortolero is eager for the clinic to open. “We believe that primary care and mental health need to embrace a more holistic approach, with regards to what most people in the public consider social services,” she said. “Once we get in the space, I think we are going to see so many new ways we can work together.”
Sugey López also has hopes for the new clinic. “We live paycheck to paycheck and sometimes it is difficult to afford appointments and care. I hope the new location has more health services, like a little hospital.”
Amelia Aldred is a writer and fundraising researcher in Chicago. This is her first piece for the Weekly.