Cook County explores Planned Parenthood partnership in Englewood
With Englewood's Planned Parenthood clinic set to shut its doors late next month, Cook County officials hope to figure out how to save the South Side center, which serves thousands of patients seeking reproductive care.
'It is, we believe, a deeply needed service, especially in that area, and we are going to see what we can figure out,' Cook County Health CEO Dr. Erik Mikaitis told reporters earlier this month.
Citing a 'financial shortfall,' Planned Parenthood of Illinois announced in January that it would close four clinics across the state. Besides Englewood, clinics in Ottawa, Bloomington and Decatur are on the closure list.
Illinois, already a haven for reproductive care, saw an influx of out-of-state patients seeking abortions after the U.S. Supreme Court overturned Roe v. Wade in June 2022. The increase in patients, 'coupled with low reimbursement rates from insurers and rising costs of providing care,' helped contribute to the organization's shortfall, Planned Parenthood said in a previous statement.
A partnership with the county could help maintain care for thousands of Englewood patients while potentially bringing new patients into Cook County Health and its Medicaid managed care insurance program, CountyCare. The need is especially acute in Englewood, where HIV and other sexually transmitted infections, infant mortality and the teen birth rate are higher than the city average.
But at this stage, officials with the county and Planned Parenthood aren't sure what form a partnership would take: a direct grant, merger, or the county overseeing operations. A follow-up meeting with leaders from both organizations is planned after the Presidents Day holiday.
It's also unclear whether Planned Parenthood would maintain the same location. CCH already operates its own Englewood Health Center roughly two miles north of the Planned Parenthood clinic. That center offers primary care, reproductive health services like birth control prescriptions, sexually transmitted infection testing and treatment and family planning education.
Planned Parenthood's Cristina Villareal told the Tribune 'we're still in early conversations and looking at all options. I think there's the immediate need of wanting to keep staff in place and stay open, and then I think there's an opportunity to really partner in new ways in the future and create this model that's different… we also know that we need to kind of move quickly.'
'We have not done anything like this before; we're looking to see if there are other models like this,' Villareal said. 'It's different, but the times are different. This is a unique time with so many insecurities on a national level, with a higher, increased cost of health centers. And so it's a perfect time to be innovative and creative and try something new.'
Among those insecurities: potential cancellation of the FDA approval of the abortion pill mifepristone. President Donald Trump has already signed orders ending funding for international aid organizations that 'perform or actively promote' abortion and taxpayer funding for American programs that promote elective abortions.
House Republicans also are exploring significant cuts to Medicaid, potentially booting millions off of government health insurance coverage for low-income and disabled people.
'We're all going to have to learn to do things differently in a world where there might be less funding available for the health care safety net, so we all have to be better and smarter,' said Cook County Commissioner Bridget Gainer, who encouraged CCH to step in.
'If you're a government that relies on federal funding, you have to be looking two steps ahead,' Gainer said. 'The county health system has access to new patients, we don't lose the really important care happening that was incredibly trusted at Planned Parenthood,' and the county can offer additional health care to Planned Parenthood patients and their families.
The Englewood clinic dates back 20 years and sees about 4,000 patients a year. It connects pregnant patients to prenatal care, teaches sex education and recently held a community baby shower for expectant parents. The clinic provides 6,000 annual STI tests, about 1,500 birth control visits and gives out free condoms.
Planned Parenthood does not disclose abortion numbers for specific clinics, but the Englewood clinic does provide medical abortions, more commonly known as the abortion pill, officials said.
Other Planned Parenthood-operated clinics are miles away in the Loop, on the Near North Side and in Far South Side Roseland. When PPIL announced the closures, it said it planned to expand its telehealth offerings to help fill the gap, particularly to offer the abortion pill.
Cook County Health offers the abortion pill through the 10th week of pregnancy and surgical abortion procedures at Stroger Hospital through 13 weeks and six days.
Villareal estimates it would cost $1.5 million a year to keep open the Englewood location, which the organization hopes to maintain for three years 'to figure out a longer solution.'
Cook County Commissioner Michael Scott, whose district includes Englewood, said he's 'very interested in making sure' the clinic stays open. 'In communities of color, we know that there's great health disparities, so anything that resembles health and service within that community is needed.'
Only 26% of people living in the neighborhood have employment-based health insurance, according to the Chicago Department of Public Health, compared to 55% citywide. Roughly 50% are covered by Medicaid. Just under 54% of Englewood mothers received early and adequate prenatal care, compared to about 70% citywide.
The Planned Parenthood clinic also provides care to sex workers, 'and making sure that they have opportunities to make sure they're being healthy in the work that they do I think is really important.' Scott said.
Though there isn't a concrete plan for the partnership, it appears to have broad support, in part because 'it really jibes with the commitment not only of Cook County Health but my colleagues on the board and the president's office to invest in communities which have traditionally been disinvested,' said Cook County Commissioner Bill Lowry, who is also vice chair of the CCH Board and chair of the county's Health and Hospitals Committee.
'I don't know if a deal will be submitted by March, but I do know there will be meetings and discussion much before (then). We'll see where that leads… The urgency of this is not lost on Cook County Health.'
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By 2018, they had formed a nonprofit, Riverton Medical District, and one of the board members, Vivian Watkins—the former head of commercial lending for U.S. Bank's 14 branches across Wyoming, and the kind of person who can't leave the grocery store without stopping four times to ask about someone's kids or their neighborhood drama—began cold-calling hospital CEOs across Wyoming, looking for advice on where to start. One told her that she should go straight to Stroudwater Associates, a Maine-based consultancy with a specialty in rural-health-care finances. The Riverton nonprofit was not Stroudwater Associates' typical client. The company's chairman, Eric Shell, and his team usually work directly with rural hospitals, or occasionally with a larger chain looking for system-wide strategic planning. Gose, Watkins, and their allies didn't have a hospital, didn't have concrete plans for a hospital, didn't even have any money for a hospital. Still, Shell was intrigued by the brazenness of what they were dreaming up. After nearly 30 years working with rural hospitals, Shell believed that rural hospitals could survive, but that too few hospital executives think creatively about solutions. Over and over, he's seen cuts damage a hospital's business further: 'You win the battle, but you lose the war,' he told me. Instead of cutting costs by 'doing more with less' (to use the corporate jargon for layoffs and overworking employees), making rural hospitals run in the 21st century means increasing profits by expanding a hospital's business. One of Shell's go-to examples is Mahaska Health in Oskaloosa, Iowa, a nonprofit hospital in a city slightly bigger than Riverton. When the pandemic hit in 2020, hospitals across the country were overwhelmed with critically ill COVID patients, but also saw a decline in other types of cases. The result was a huge, unexpected loss of revenue for many hospitals, and a correspondingly huge number of layoffs: 1.4 million health-care workers lost their jobs in April 2020 alone. At Mahaska, though, CEO Kevin DeRonde—a former NFL linebacker—ran in the opposite direction: He hired many of the providers who had been laid off from other area hospitals, Shell said. His hospital took a short-term financial hit, but DeRonde wagered that patient volume would recover once the worst of the pandemic eased up. The bet paid off. After the drop in 2020, the number of non-COVID patients skyrocketed. Now many hospitals were understaffed, but not Mahaska. The hospital hadn't been doing well even before the pandemic, losing more than $5 million in 2017. By 2023, it made $7.5 million in net income, according to Shell and Mahaska Health officials. Growth, though, is more difficult at hospitals owned by private-equity firms, because of the need to keep shareholders happy through quick returns. 'When I look at what they're doing in Lander and Riverton, I shake my head and say, 'That's not the way I'd be running the company,'' Shell told me. 'But I'm not running the company, and they're driven by an external force. If they're not beating the market rate of compensation for their investors, their investors are going to walk.' Shell agreed to conduct a feasibility study for Riverton Medical District, and Stroudwater spent months digging into every aspect of Riverton's economy, population, and existing health-care options. Just 44 percent of Medicare recipients in the area who needed hospital treatment got it at either Riverton or its sister hospital, leaving an opening for a new hospital to quickly capture market share. The presence of the Wind River Reservation, which surrounds Riverton, boosted the financial case: The Eastern Shoshone and Northern Arapaho Tribes, which share the reservation, both provide private insurance to their members. In June 2019, Shell's firm handed over its report. Its takeaway: The area had the ability to 'support a financially viable rural health system with a range of medical, surgical, and specialty services.' The Riverton Medical District team had the answer they wanted, from a company with real bona fides in the rural health-care world. Gose and Watkins were jubilant. They were going to build a hospital—if they could find the money, that is. Friends and neighbors had banded together to cover the $150,000 Stroudwater study, but a whole new hospital was going to cost tens of millions. Shell didn't think they could pull it off. He told them so outright. He's an accountant, which means always assuming the worst. He couldn't fathom why a bank or a government would give Riverton Medical District a loan, considering the competition risk. The group, though, was unanimous: Shell's fears weren't going to stop them. They were the ones who lived there; they were the ones who, in Gose's words, felt an obligation to leave Riverton better than they found it. After months of looking into every other source of funding they could think of, Riverton Medical District turned to what the group considered the 'lender of last resort'—the U.S. Department of Agriculture, the primary government funder of projects affecting rural Americans. A community hospital in an underserved rural area fit the portfolio, which could qualify Riverton Medical District for low-interest loans. Applying for government money, however, required navigating government bureaucracy. In an email exchange that stretched over months, the USDA rural-development regional director for Wyoming, Lorraine Werner, was encouraging but exacting. Every time Werner needed more documents, including a third-party audit that cost an additional $50,000, the group would scramble to get them to her. Then she would ask for even more. It took Riverton Medical District more than a year to have its application accepted—not for funding, just for consideration. Yet somehow, Riverton residents never seemed to grow tired of what looked to many outsiders like a quixotic scheme. To house the hospital, the Eastern Shoshone Tribe agreed to sell eight acres on the north end of town and donated four more acres outright. People kept handing over money, frequently $5 or $10 at a time. Finally, after an application process that took nearly two years, USDA announced its ruling. The federal government agreed that a new hospital in Riverton could be financially viable, committing to fund the lion's share of the costs—more than $37 million. It was the largest USDA rural-development loan ever awarded in the state of Wyoming. The money would fund a hospital offering every routine service Rivertonians had lost. It would have 13 inpatient beds, a full surgical department, two labor-and-delivery rooms, two rooms equipped for intensive care, and space for physical and speech therapy. It would be staffed to perform surgery and deliver babies 24 hours a day. And the building would be designed to accommodate future growth, with the potential to add 11 new patient rooms, additional surgery space, and more parking, board members told me. In its report, USDA was more bullish than Shell and Stroudwater had been; the agency's official assessment of the project barely referenced the threat of competition from the existing hospitals. Citing numbers provided by the Riverton Medical District board, USDA found that the hospital could break even with just 30 percent market share, far less than SageWest's 44 percent. The Riverton Medical District project, evaluators wrote, had generated a remarkable level of local support; the agency noted donations from individuals and businesses that added up to more than $1 million, and more than 200 letters of support. Several of the letters said that without a new hospital, they would move out of Riverton. Multiple business owners wrote that the lack of a fully functioning hospital left them unable to recruit and retain workers. Most of the USDA report was written in bureaucracy-speak, but at one point the author slipped into first person: 'The applicant started a true grassroots movement to bring back essential services to the community and has exhibited a level of community support, both monetarily and otherwise, that is unseen in my experience.' In December 2024, just before the soil froze for the season, work crews broke ground on Riverton's new community hospital. In early June, 400 people turned out for a community celebration, cheering for state-government officials and Riverton Medical District board members and signing a beam that will be installed into the new facility. Building a new, locally owned hospital isn't a scalable way to help every community where hospitals owned by private-equity firms are providing less health care. The particular combination of ingredients in Riverton Medical District's recipe baked into something resembling a miracle. But to Gose's mind, following Riverton's example doesn't require building a community hospital in every rural county in the country. What it requires is people with knowledge of, and investment in, one specific community making decisions for that community—the exact opposite of the private-equity ethos of consolidation at all costs. 'Often you'll see a lot of people get excited and involved in something for two or three months or six or whatever, but then they get disillusioned and quit,' Gose told me. 'And I think that's what LifePoint thought we were doing. And they underestimated that failure was not an option.'
