Agency Progress Report: Where We Are and Where We Are Going

Dear Friends, 

From COVID-19 to staff retention challenges and spiking inflation, a confluence of stressors has affected Howard Brown Health and many other nonprofit healthcare organizations in recent years.  

I want to personally thank our patients, community members, staff, elected officials, donors, volunteers, supporters, and partners for championing our mission in support of LGBTQ+ health equity.  

The purpose of this report is to share an update on the status of the organization and to show the progress we have made in our evolution as a Federally Qualified Health Center.  

Early in fiscal year ‘22, which started July 1, 2022, permanent changes in pharmacy and federal COVID-19 funding caused a sudden reduction in revenue. Due to permanent changes in these funding streams, we identified a $12 million structural deficit threatening to destabilize the organization. To stem losses that could adversely affect patients’ health care, the Board of Directors, agency leaders, and I initiated plans to reduce administrative costs, lower executive pay, slow capital improvements, and consolidate staffing in administration, operations, behavioral health, and social services. This included the difficult but necessary decision to reduce our workforce.  

Given the volatile national landscape LGBTQ+ people face, we know our work is more important than ever. We also know that we must continue to improve as an organization to meet the growing and changing needs of our patients and the communities we serve.  

In the following sections, I share how we are improving our core operations and charting a future path to ensure sustainability for the organization. This includes maintaining and improving our current levels of fiscal prudence and preparing for the continued decrease of pharmacy revenue, which made Howard Brown’s growth over the last decade possible.  

The report is organized in three sections: Stabilization, Continuous Improvement, and What’s Next.  

Our commitment to affirming, lifesaving, and high-quality healthcare for LGBTQ+ people and others in the neighborhoods we serve is unwavering.  With your support, we can help our patients achieve the highest level of health possible, a prerequisite to advance their goals and care for their families.   

In gratitude,  

David Ernesto Munar
President and CEO
Howard Brown Health 


Efforts to steady our finances are possible because of the dedicated efforts of staff members who extend high-quality and affirming healthcare to as many patients as possible. Efficient delivery of care reduces missed opportunities, maximizes the reach of scarce resources, and meets people where they are in their healthcare journey.  

As the organization reduces its dependence on volatile pharmacy revenue, we will maximize funding through the efficient delivery of healthcare, philanthropy, and other opportunities. Guided by the needs of our loyal patients, we are focused on efforts to improve patients’ quality of care and their overall customer experience. The cultivation of a loyal patient base that benefits from efficient and effective care is paramount to fulfilling our mission.  In doing so, we can also close the funding gap and secure the organization’s long-term sustainability.  

The financial measures we instituted in late 2022 have prevented approximately $4 million in deficit spending as of March 31, 2023. March financials recorded the lowest monthly deficit in nine months: $640,000 in monthly expenses over revenue. With continued fiscal discipline, and support for efficient patient care across the agency, we hope to exit monthly deficit spending by summer.     

Continuous Improvement

Across Howard Brown, we are pursuing process improvements to strengthen our ability to serve patients. The strategic initiatives we are pursuing this year are anchored in the following priorities: 

  • Safeguard and improve the organization’s ability to deliver effective and efficient patient care. 
  • Provide patients an excellent customer experience that results in improved health outcomes.  
  • Improve the workplace experience of our employees with enhanced learning, communications, and input mechanisms that fully utilize workforce talents, perspectives, and contributions. 
  • Build a stronger working relationship with our employees’ union, including achievement of a first-time contract for the broader bargaining unit formed in 2022.  

Guided by these objectives, teams across the organization are pursuing reorganization and improvement plans to meet the Centers for Medicare and Medicaid’s triple aim: deliver exceptional patient care at the lowest cost to realize the greatest possible gains in community health.  

Highlighted intiatives include:

What’s Next

Thinking ahead is crucial. By weighing potential outcomes and consequences, we aim to make informed, proactive decisions. As we move forward we want to identify potential challenges, risks, and opportunities, so that we can strategize and adapt accordingly. We aim to mitigate risks, minimize surprises, and maximize our chances of success so that we can grow to serve our city with confidence and resilience, ensuring that we are better equipped to shape the future of LGBTQ+ care in Chicago.


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