When David Munar took the reins at Howard Brown Health in 2014, the health agency was recovering from an extended period fraught with management issues, financial difficulties and low employee morale. Under Munar's watch, Howard Brown Health eventually received a coveted Federally Qualified Health Center designation.
The agency could now compete for funds that, along with additional monies made possible by the Affordable Care Act, brought on an aggressive expansion greatly increasing the organization's footprint across the Chicago region.
Windy City Times spoke with Munar and Howard Brown Health Board President Mario Treto, who began his term in 2017, to discuss the work that has gone into the agency, and the work that lies ahead.
Windy City Times: David, how has Howard Brown changed in the time you've been here?
David Munar: Our system of care has certainly improved. We're seeing more people. We've more than doubled in size in terms of patients relying on Howard Brown for services. We've improved the financial standing of the organization and are in a better position financially. We actually have about 54 days of cash on hand in reserves, which is one measure of operating revenue. Services and staff size have increased. We're citywide, with sites from Rogers Park to the South Side. We've also earned recognition from the federal government, approving Howard Brown as a Federally Qualified Health Center, which is a notable distinction that has also helped us grow dramatically.
After your hiring, there was a great deal of excitement since the Affordable Care Act ( ACA ) was on its way, and that would help fuel much of Howard Brown's expansion along with the accreditations. How do you see this current hostility toward the ACA from the federal government, and work your way around that?
DM: The uncertainty around federal policy on ACA appropriations has been constant, particularly since the presidential election. We've been monitoring [both] policy development and funding development closely. It's been difficult to predict, at least from the business side.
About 35 percent of our patients have Medicaid. Not all of them are ACA-expansion, but the majority are. We've done some scenario-planning around that. If the Medicaid expansion were to go away, that could mean a loss in revenue for us of 10 or 15 percent. It could be anywhere around a 9 million [dollar] loss of services. It's a worry, and we have been thinking about how we would reposition ourselves around that. A 10 percent loss in revenue would mean fewer services.
Mario, what made you decide to join the board and eventually become its president?
Mario Treto: I'd moved back to Chicago and went to my old health provider and had an unpleasant experience when I'd decided to come out to them. I did some research on my own—I was living in the suburbs at the time—and I was looking for a place that provided LGBTQ culturally competent health care. I was fortunate to find Dr. Al Torrence's name, so I set up a visit with him, and was really just blown away by the quality of care that I received. I saw him as his patient for a while, and then, after a few visits, he asked if I'd ever thought about joining the Howard Brown Health board. The thought hadn't occurred to me at the time. I did some research and applied.
When it was time for Duke [Alden, the previous board president] to step down, I did some self-reflection and thought it was a good way to step up my service in volunteering for the organization. Also it was a way to work with good-quality people on the board and the executive leadership team.
How has Broadway Youth Center been doing in its new location?
DM: The BYC's new home has been phenomenal. It has achieved and exceeded what we've wanted it to do. One of the motivating factors to move BYC was that we had insufficient space, and the wrong kind of space.… It was not sufficient for what we needed. So we built out the space to provide all our service-lines concurrently.
MT: It really becomes a one-stop shop and really shows our commitment to focusing on LGBT youth and the youth of our community. If you look at it from an architectural standpoint, it's bright, warm and inviting—it really encourages people to stop by.
Speak a bit about the women's health operations here.
DM: Our strategic plan makes a commitment to reinvigorate women's health. We have a new women's health director, Amy Miller, who's very dynamic. We've been doing drop-in nights—evening hours, no appointment needed—where we do all our clinical lines, social services and cultural services. … Our strategic plan asks the organization how we should be reaching out to expand those services, particularly through the LGBT community, so we've been working with the Morten Group [consultancy] to do a needs assessment.
How have services for transgender and intersex persons progressed?
DM: We just completed a five-year project with the federal government, focusing on systems of care to support care-adherence for transgender women of color living with HIV. These were pilot programs developing service models that could be replicated after the grant ends. Through that, we have integrated trans cultural competency throughout the entire agency. … We're now seeing about 3,500 trans patients in clinic—about 10 percent of our patient base identifies as transgender of gender non-conforming.
David when you took over, interventions such as PrEP [pre-exposure prophylaxis] and TasP [Treatment as Prevention] were not as well-known as they are now. How have those affected the HIV-treatment and -prevention strategies at Howard Brown?
DM: Our HIV program has really flourished, and it follows the scientific progress around HIV. Today we're one of the nation's leading prescribers of PrEP, and we've seen some data that says, on a national basis, we're about 10 percent of PrEP prescriptions in the country. Chicago is doing much better at helping people who are at risk of infection benefit from PrEP. Howard Brown has really been at the core of that. We've about 4,000 patients we've started on PrEP, and we do a lot of PrEP counseling. At the beginning, it was about whether PrEP is a good choice; now it's mostly about the insurance and the financing.
What vision do you each have for Howard Brown over the course of the next five years, with and without an ACA?
DM: Howard Brown will continue, with or without it. The amount of charity care we provide and the range of services we provide may be affected if there is no ACA, but we also still believe that there is bipartisan support for the community health center networks across the country, because we're one of 4,000 around the country. There may be changes, but we're braced for change.
MT: It was exciting to open up our Englewood and Hyde Park locations. There was a need we were able to meet by expanding down south. My personal goal would be to expand to the West Side. … I'm excited that we're going to be open to a new location in Fall of 2018 in Humboldt Park, to reach out to other community members. In continuing these relationships, we're pretty fortunate to have elected officials who are supportive of Howard Brown, as well as [other] community members and companies.
