Day in and day out, Howard Brown Health’s first concern is to ensure that our integrated system of health is tailored to each individual. In 2015, the 20% increase in our patient base afforded us opportunities to better address health issues in Chicago. When our patients are successful in addressing their health goals, Howard Brown is successful.
Howard Brown meticulously monitors quality measures, and we rely on patient outcome data to pursue ongoing practice improvements.
Every patient has a story. People vary by age, sexual orientation, and gender identity. Our providers design care to meet the specific needs of each individual.
The Broadway Youth Center (BYC) is a Howard Brown Health program that provides underserved young people, many of whom are experiencing homelessness or housing instability, with essential services in a low-threshold, drop-in setting tailored for adolescents and young adults. The model is designed to meet basic needs, support paths out of homelessness, and reduce barriers to care. Participants are able to obtain health insurance, receive sexual and preventative healthcare, and connect with a primary care provider. Additional support services in behavioral health, education, and resource advocacy help youth meet their life and health goals.
Young people living in poverty are more likely than any other age group to be uninsured or have suboptimal coverage. Providing greater access to these resources increases our clients’ overall wellness and helps them improve their lives.
Howard Brown Health coordinates the complex care for LGBTQ older adults who have even fewer social support and options for nursing home care and culturally competent specialty care providers than the general population. With good treatment options, people living with HIV are living longer. As a result, HIV providers need to understand how comorbidities that are common in older adults (for example, diabetes and hypertension) impact those living with HIV. Howard Brown has the insight to continue to serve people living with HIV throughout the lifespan.
To ensure engaging, coordinated care, Howard Brown developed specialized services including care coordination, care planning, behavioral health integration, and risk assessment. Our board-certified geriatric medicine physician leads comprehensive geriatric assessments for those who need them.
Howard Brown offers gender-affirming care to support an individual’s gender identity and expression. Gender-affirming care is critical for health and wellness promotion; by engaging patients who have experienced gender-based discrimination and unequal treatment, we continue to strengthen our commitment to eliminating health disparities for trans and gender non-conforming (TGNC) people at individual and community levels.
After Hours is a biweekly drop-in night for TGNC clients to see medical providers without an appointment, eat dinner, access hygiene and clothing supplies, and connect with the
community. In the last two years, Howard Brown has served 330 TGNC patients in this innovative program. This intergenerational group pairs with two smaller support groups for TGNC youth and adults, creating multiple entry points to connect with accessible care. Transgender Youth Resource and Advocacy Group (TYRA) is a weekly support group for TGNC and questioning youth, 24 and under, to meet people, get informed, and be supported by their peers. TYRA is located at Howard Brown Health’s Broadway Youth Center.
T-Time is a twice-monthly open support and discussion group for TGNC and gender questioning individuals.
We use the term “trans and gender non-conforming (TGNC)” to refer to people whose gender identity and/or expression differs from or is more expansive than the gender they were assigned at birth. We respect each individual’s right to self-identify using whatever term they choose, and use TGNC to be as inclusive as possible.
Howard Brown Health constantly strives to meet the ever-changing needs of our city. With improved population health strategies, we are addressing new health challenges proactively, such as hepatitis C and bacterial meningitis. In order to expand capacity and bridge gaps, Howard Brown has also actively partnered with other health organizations and community groups to have wider impact in Chicago.
Howard Brown Health’s services across the HIV care continuum – paired with our longstanding history of providing high-quality, interdisciplinary primary care – contributes to our success in testing and care linkage, and supporting patients in achieving viral load suppression. Howard Brown’s HIV services include outreach services that normalize HIV testing and provide an easy link to medical care for people who test positive. We also offer culturally competent care tailored to the needs of TGNC people, youth, and women, resulting in a high linkage-to-care rate.
In 2015, Howard Brown tested 76% of primary care patients who were eligible for HIV testing, with only an 8.4% decline rate. As a result, Howard Brown identified 32 new positives through primary care testing (.9% positivity ). We were able to seamlessly link all of these patients immediately into HIV care. Establishingsystems for linking patients living with HIV into care both maximizes the benefits of early treatment and minimizes transmission risk.
Howard Brown leads national efforts to increase access to Post-Exposure Prophylaxis (PEP) and Pre-Exposure Prophylaxis (PrEP), which have changed the landscape of HIV prevention. PEP is a medication regimen that can prevent HIV from infecting the body if taken within 72 hours after exposure to HIV. PrEP is a once-daily medication that can reduce the chance of HIV transmission. Recognizing the ongoing need for clear, accessible, and empowering information, Howard Brown staff continue to educate diverse audiences nationwide on PEP and PrEP. In 2015, Howard Brown developed print materials for PrEP, including palm cards and brochures, which are distributed at clinics and outreach events. We developed materials in consultation with the Community Advisory Board. Our commitment to affirming, patient-centered model informs all aspects of HIV care at Howard Brown, from prevention and testing, to care across a patient’s lifetime.
Howard Brown’s case management and home visit program for patients living with HIV/AIDS is another area where we tailor our care options to meet the needs of every individual. Our reporting infrastructure enables staff to identify patients at risk of falling out of care or patients with an unsuppressed HIV viral load. Our successful HIV linkage and retention programs have resulted in an 83% retention-in-care rate and an 82% rate of viral load suppression in 2015.
Howard Brown’s case management team developed a drop-in AIDS Drug Assistance Program (ADAP) clinic, helping 211 patients complete 253 applications for cost assistance for health insurance deductibles and life-saving medications for HIV, hepatitis C, and cardiac and psychiatric conditions. ADAP is one of the important components of the Ryan White HIV/AIDS Program supporting those in need of financial assistance for medications, in addition to vital HIV services not covered by insurance.
An estimated 2.7 to 3.2 million people in the United States are living with the hepatitis C virus (HCV). HCV-related deaths exceed HIV-related deaths, according to the Centers for Disease Control and Prevention (CDC). Our commitment to patients living with HCV highlights the importance of treatment and education focused on sexual health and sterile needle use within the communities we serve.
Howard Brown has successfully tested and linked patients to care by adding hepatitis B and C virus panels to existing lab orders, focusing on Baby Boomers, and increasing access to affordable hepatitis (A, B, and C) treatments. We use a multidisciplinary approach to HCV screening and treatment, including screening in primary care and sexual health walk-in settings, nurse education, case management, and pharmacy support.
To expand access to high-quality HCV treatment, all Howard Brown physicians, nurse practitioners, and physician assistants participate in the Extension for Community Healthcare Outcomes (ECHO), a model to train medical providers in effectively treating HCV in the primary care setting. In addition, nursing and case management staff offer patients support in accessing medication.
Howard Brown’s sexual, reproductive, and prevention health services work together to address the sexual health needs of LBQ women and TGNC patients. Services include pelvic exams and pap tests; medication guidance appointments and follow-up care; breast or chest exams and cancer screenings; alternative insemination; immunizations; integration of acupuncture and chiropractic care; chronic disease management; education on abortion and adoption options; and emergency contraception. In addition, Howard Brown offers sexual and reproductive health drop-in nights.
In 2015, we participated in the Illinois Breast and Cervical Cancer Program, providing free breast and cervical cancer screenings to 1,975 patients. The women’s health program also helped 23 patients navigate alternative insemination programs by holding information sessions and support groups.
Howard Brown provides comprehensive sexual health services to address the high rates of syphilis, chlamydia, and gonorrhea in Chicago, paired with case finding and partner notification services to test patients who are at high-risk for HIV infection and link those who test positive to care. Outside of the Chicago Department of Public Health (CDPH), we are the only provider in Chicago to offer partner notification services for HIV and syphilis. Because active rectal gonorrhea and chlamydia may increase the odds of patients acquiring HIV, we offer extra-genital testing at all clinical locations. In 2015, Howard Brown tested 4,864 patients for rectal gonorrhea/chlamydia, resulting in a positivity rate of 9%. We also tested 11,146 patients for syphilis, a 20% increase from 2014, and diagnosed 648 syphilis cases in Illinois.
In partnership with the University of Chicago Medical Center and Project VIDA, Howard Brown was granted a five-year award from the CDC titled the Better2GetherNetwork (B2GN). This funding allows Howard Brown to conduct services city wide with a significant focus on south side communities with crucial need for HIV/STI services.
In spring 2015, a meningococcal disease outbreak hit Chicago, disproportionately impacting African-American men who have sex with men. Howard Brown Health responded rapidly, vaccinating 4,220 individuals with a total of 5,139 vaccinations in 2015, accounting for one-third of Chicago’s total vaccinations. Clinic staff provided focused and culturally competent community outreach and education, responded to patient inquiries and concerns, and followed up with patients about next steps to support their health. Our successful vaccination efforts were monumental – a more widespread outbreak of meningitis would be devastating for Chicago.
Beyond contributions to the city’s infectious disease control, Howard Brown supports healthcare professionals who serve older LGBTQ adults, arming the region in and around Chicago with cultural competence. Over the last two years, HEALE has provided valuable education to over 1,500 nurses and medical assistants caring for older adults in nursing homes, primary care facilities, and hospitals around the Midwest.
Howard Brown expanded patient access in 2015 by increasing clinical hours at all locations. To accommodate patients’ busy lives, we added 11 hours per month to our sexual health walk-in clinic, 14 hours per month of primary care coverage, and increased Saturday hours. To facilitate youth engagement in primary care, we brought clinic services to the Broadway Youth Center, adding 16 hours per week of primary care staff time and 40 hours of nurse time. Howard Brown also now offers same-day appointments and drop-in services to meet the growing needs of our patients.
In 2015, Howard Brown Health changed and upgraded key capacities to intentionally meet the needs of a growing community. Our approach has been to streamline service access, expand hours, and upgrade our core data capabilities.
Preparing the organization for population health management and managed care coordination, Howard Brown continues developing our call center and referrals. Over the last year, Howard Brown decreased clinic no-show rates to 16%. We also submitted and navigated over 8,000 referrals to help patients access specialty care.
In spring 2015, Howard Brown’s walk-in clinic adopted Healthvana, an innovative patient-engagement platform supporting HIV/STI services. With the Healthvana app, patients can access test results on their smartphones and use the app to find HIV/STI testing clinics. Healthvana also includes easy-to-use functionality for healthcare providers, allowing us to more easily communicate lab results and follow up with patients.
Trust between primary care providers and their patients increases patient engagement, prevents fragmented care, lowers costs, and improves health outcomes. Howard Brown strives to schedule patients with a consistent provider to facilitate stronger therapeutic relationships. On top of that, over 76% of patient visits take place with the patient’s responsible provider, supporting patient-provider communication and continuity.
As a Federally Qualified Health Center (FQHC), a majority of our Board of Directors is composed of patients, which is a direct way to bring patient voices to the center of the management structure. We monitor patient satisfaction with semi-annual satisfaction surveys, anonymous comment boxes, and the inclusion of the Community Advisory Board (CAB) in program discussions, ensuring that patient voices are heard and taken into consideration in making decisions.
Howard Brown coordinates patient care by working with specialty providers and hospitals for results and discharge papers. With this coordination of care in place, Howard Brown reduces medical errors, unnecessary hospital readmission, and emergency room visits.
In 2015, the National Committee for Quality Assurance (NCQA) designated Howard Brown Health as a Level 2 Patient-Centered Medical Home (PCMH). As a medical home, a patient is assigned a specific care team which consists of a nurse, behavioral health consultant, medical assistant, and provider. These care teams work together to gain insight and support the individualized needs of each patient.
Howard Brown’s mental health and substance abuse programs, co-located with primary care, facilitate communication between behavioral health professionals and patients’ primary care providers. Howard Brown offers therapeutic services, specializing in LGBTQ-specific mental health issues, trauma, HIV, and intimate partner violence. In addition, Howard Brown offers outpatient therapy and an intensive outpatient program for patients who want to change their relationship with drugs or alcohol.
Since 2014, Howard Brown has embedded Behavioral Health Consultants (BHCs) in primary care teams at its clinic locations. BHCs provide extra support to patients who are experiencing mental illness, using substances, or would benefit from additional support to meet their health goals. While primary care providers help set clinical goals, BHCs assist patients with chronic conditions (i.e., hypertension, depression, diabetes, or HIV) in deciding how to make lifestyle changes to attain these goals. Integrated behavioral healthcare also allows for seamless referrals for additional care, including psychiatry, traditional therapy, substance abuse counseling, and intensive outpatient programming.
Howard Brown’s talented nursing staff contributes to the chronic disease management program by educating patients about hypertension, diabetes care, and medication adherence. Nursing staff also assist in diabetes management with patient-centered care plans and referrals to specialists. In 2016, we expanded this program to offer rapid HbA1C tests to increase diabetes education and telephone visits for patients with acute needs who are unable to come to the clinic.