In 1991 the United Nations declared housing to be a fundamental human right, and the United States has worked to reduce overall homelessness by over 20 percent between 2005 and 2013. However, homelessness continues to persist across the country, with the highest concentration in mid-to-large metropolitan areas, and disproportionately impacts those living in poverty, people of color and immigrants.

Those experiencing homelessness also have the highest rates of chronic mental, behavioral and physical disease have significant barriers to health care and affordable housing and a lower life expectancy. Their use of the emergency services for episodic care also leads to higher treatment costs.

In this episode, I’m talking with Clarita Santos, Executive Director of Community Health Initiatives at Blue Cross and Blue Shield of Illinois. As Executive Director, Clarita advances Blue Cross and Blue Shield of Illinois’ investment strategy in alignment with the Plan’s vision and enterprise imperatives to address critical community health issues, focusing on access to care, health equity and population health.

We’ll be talking today about how the FHP brings value and impact to those served by Blue Cross and Blue Shield of Illinois, and the vision for the health plan on investing in housing to improve population health outcomes.



By the most recent report from the Chicago Coalition for the Homeless, in 2017, 86,324 Chicagoans were homeless.

  • 81% of these homeless residents lived doubled-up in the homes of others
  • 56% were African American
  • 28% were Latinx

Homelessness in Chicago also impacts the working poor, with:

  • 21% of those experiencing homelessness over the age of 18 are employed
  • Another 28% attended college or earned an associate’s or bachelor’s degree

And many Chicago families with children and youth are also experiencing homelessness:

  • A total of 34,870 families with children experienced homelessness
  • 86% were doubled-up in the homes of others
  • 24% were minor children experiencing homelessness
  • CPS served 16, 451 homelessness students during the 2018-2019 academic year

In March of this year, the City of Chicago and its partners collaborated to align funding towards a common goal through the Flexible Housing Program or FHP. Through FHP, Cook County is able to rapidly house and provide supportive services to some of Chicago’s most vulnerable populations, including individuals experiencing homelessness who cycle through the criminal justice system and utilize hospital emergency rooms for care.

FHP achieves this through pairing wraparound health and social services with a housing subsidy to support residents experiencing homeless. The Program focuses on frequent-utilizers of crisis response systems such as hospital emergency rooms, police stations, paramedic calls, jails and shelters.

In August, Blue Cross and Blue Shield of Illinois was among the first private funders to invest in FHP at the level of $1 million over two years.



What was the genesis of the BCBS IL’s decision to invest in the FHP? 

My background is in public health, and I bring that with me as we think about, as an organization, what is it that we do to impact the health of the community.  So when you think about impacting the health of a community, you’ve got to think broader than:  let’s get rid of that bacteria, let’s get rid of that virus, and think about what are some of the things that really impact health.  And as we worked with some of our partners in the community, and also with some of our partners internally – we are an organization of doctors and nurses, case managers and care coordinators, and with our Medicaid business, what are some of the things that we’re seeing in order to address some of the health issues. 


Time and time again, whether you look at it from a public health perspective, or the research that you just quoted, Kuliva, and what we see as an organization, it comes down to housing, right?  So we wanted to really understand what can we do in that space, and to really think about addressing health issues, because if you’re coming from an environment of instability,  you’re not in a stable environment where you have housing, how can you then think about taking your medication?  How can you then think about getting a job?  How can you then think about getting self-care when you’re constantly in a state of instability.   


How does the FHP align with BCBS IL Community Health Initiatives and the health plan’s population health targets? 

That’s a great question.  We think about our work around community investments and we’re very intentional about using the word “investments”, because we think about how do we build from the strength already in the community.  Or, how do we build upon the strengths already within the system?  And so we looked at the Flexible Housing Pool as a way to leverage all different players, and to think about housing in a different way.  As you mentioned [about] the collaboration that we’re in, it brings together many different entities, right?   So from Cook County Health to Advocate Aurora Health, UI Health and several departments; Department of Family Support Services, Department of Housing and the Chicago Housing Authority.  And then we work in collaboration with the community; the Center for Housing and Health, and they partner with Debora’s House, Thresholds, Renaissance Social Services and Housing Forward.   


So what we wanted to do was, the Flexible Housing Pool allows us to fund housing, but also to provide wrap-around services, right?  It goes beyond housing, to what are the other services that we could provide, or supports that would provide stability and address health issues. 


There are many ongoing efforts across the City and County to increase affordable and supportive housing for the most vulnerable residents.  Why did BCBS IL invest in this particular housing initiative? 

So, part of it is, as you know, when you work in partnership it’s about who are those partners and who are those organizations that have done the work.  The Center for Housing and Health was one of those partners that we work with, right?  As I talked about with community investments, what we look for is who are the partners or organizations already doing the work, because we see ourselves as “how do we support good work that’s [ongoing].  So what we liked about the Center for Housing and Health through this collaborative was partnering with hospitals.  Particularly, we were noticing as an organization, a lot of individuals who were homeless were presenting in shelters or presenting in the ER.  So one of our natural partners are the hospitals, and so how can we add to that relationship?  You mentioned that we’re the first private investors in this, because we see it as not only good for the community, but also good for business as well.  Our HSCS President, Maurice Smith says that all the time; what’s good for the community is also good for business, as we see this as that.    By looking to stabilize our homeless brothers and sisters, and getting them the services that they need and wrapping around it with case management on the social service and health side, gives the complete picture around what is needed to uplift and to able to adjust health issues.   


The current grant is for $1 million dollars over two years.  Beyond the two year investment, how does BCBS IL view its role as a sustainability partner for the FHP? 

We started funding housing in 2017 and the reason that we started doing that was, we had to step back as an organization and, as you know Kuliva, it’s all about what is it we’re looking to do as an organization.  We wanted to impact health, but how do you do that?  So we stepped back and worked on a strategic plan, and we specifically identified housing, and identified housing as a health issue.  As a very large organization, we thought by us saying that, we’re leveraging the assets that we bring as a large organization.  So for us it makes an important point that, as a big organization, we draw a line in the sand that says this is important [and] that housing is a health issue.  What we’re looking to do is extend beyond that, so we’re looking to see what are the lessons learned through this partnership.  As you can see, it’s a partnership model and its looking at building sustainability because it’s not just us.   


So one of the things we learned is how to share the knowledge, and you do that by working in partnership. We’re looking to build upon what we’ve learned during these two years.   


In what other ways is BCBS IL investing in the social determinants of health? 

The other things we looked at [in the strategic planning process] is violence as a public health issue.  That’s another issue that we’re looking to address as an organization and as part of the system.  We’re also looking at behavioral health, because one of the gaps we see is, even today as we think about health, people are very comfortable thinking about physical health, but really think about our brain as part of our body.  As we think about health, we’ve got to normalize and be comfortable in addressing all parts of our bodies.  So we behavioral health as one of those issues we’re looking to address.   


The other issue we’re looking to address is general access to care.  That’s a big bucket, but we also understand that access to care can mean different things.  It can be physical access; do you have access to services?  It can also mean language access; do you have the information you need in order to make decisions around your health care?  As you can see, we have specific issue areas, but then we have a broader one, and that was intentional so that as things come up we can adjust.   


What programs and services at the Blue Door Neighborhood Center in the Pullman community addressing the social determinants of health? 

I do want to talk about how we entered Pullman.  I think, a lot of times, the normal way of doing things is build it and they will come.  But how we approached it was very different.  Kuliva, you were there as part of doing the town hall meetings and the research to truly understand and hear from the community, what are the needs and what are the assets within Pullman.  Part of our job is to understand, and I think that comes from a place of humility.  Even the word, understand, means there are some things you don’t know, and to be able to stand, you need to understand what’s going on.  That’s how we present.  We want to understand, and from there, that’s how we have the types of services we have at Blue Door Neighborhood Center.  So, for example, diabetes came up at the town hall meetings and during the one-on-one sessions. And at the Blue Door Neighborhood Center we have health educators there all the time to talk about diabetes, heart disease, asthma.  We also have care coordinators, [who] I think of as your health care concierge.  So, you have diabetes, and you want research on how do I navigate that?  Where do I go?  The care coordinators are there to help you with that.   


We also see the Blue Door Neighborhood Center as a way for community members to feel that [its] their center.  We have three community spaces for 501(c)3 organizations to enjoy the company, and to come there and talk about the health issues happening in the organization.  We also have zumba classes.  We also have yoga.  So all these different things that the community has shared with us as:  “these are how you can build upon the assets in Pullman”.  These are the things that you can provide as an organization.  Blue Door, specifically, was about being in the neighborhoods.  We want to be where health is happening.  In the neighborhoods.  In Pullman.  We’re very excited to be able to be part of that.   

And we’re rolling; we’re opening a second Blue Door Neighborhood Center as part of a larger commitment in Morgan Park.  Again, I want to give credit to our HCSC President, Maurice Smith, who had the vision of taking that space, which was a former Target, and turning it into a multi-function, multi-purpose space, which will have some of our customer service lines of business.  So it’s going to bring, like, over 500 jobs to the community.  As part of that multi-purpose center, we’ll have a Blue Door Neighborhood Center, continuing to provide health education, health literacy and care coordination with the community.   


What has changed, though, is that we needed a bigger space for our community rooms, so we’re actually doubling our community room space, so that even more community organizations can use that space for the work that they’re doing.  

Learn More: 

Blue Door Neighborhood Center
Blue Cross Investments in the Flexible Housing Pool

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