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About the Team

The Illinois team seeks to align resources and programming to provide housing and housing tenancy support for persons with complex health needs who are experiencing homelessness. The team is comprised of several organizations:

Linking Quality & Equity

The Illinois team’s AHE initiative focuses on housing. All of the partnering organizations on the IL team are invested in intervening in upstream health interventions. CCH has developed and participated in a range of housing-focused initiatives. HFS implemented a program to increase behavioral health support for children and families.

Designing and Implementing Change

At the start of their project, the team explored several potential intervention and payment strategies, The COVID-19 pandemic disrupted those efforts, however. In response, HFS pivoted its annual quality pay for performance program toward a Community Reinvestment fund to encourage MCOs to invest in resources that address social determinants of health. As a result, CountyCare invested $5 million in the Flexible Housing Pool (FHP). The investment provides tenancy support, rent, and associated housing costs for 67 members for three years.

The initial investment is a kickstart to a potentially sustainable payment innovation. CountyCare has joined a growing group of public and private investors in the Flexible Housing Pool; as the pool of investors grows, the FHP has the potential to support more residents of Cook County.

Creating Cultures of Equity

The team is integrating a racial justice lens into each program component that acknowledges and mitigate Illinois’ long history of racial discrimination and segregation and its impact on homelessness.  This case study shares more details on how the team has embedded a racial justice lens within their work. Additionally, each of the partnering organizations continue to improve their internal cultures of equity. For example, CCH and CountyCare have established equity committees, hired and continue to nurture diverse staff and leadership, require staff equity training, and recently created new DEI leadership positions.

Diagnosing and Prioritizing Root Causes

The word “home” often conjures up an image of the place where our memories and mementos reside. More than simply shelter, however, not having a safe and welcome place to lay one’s head at night can severely impact one’s ability to establish and maintain primary care, to store and create healthy meals to eat, to escape the stressors of life that can have deleterious impact on one’s mental and physical wellbeing. In Cook County, IL, alone, there are nearly 9,000 people who are considered home unstable.

The Illinois team realized that Improving residents’ health needed to go hand-in-hand with improving access to long-term housing. Its four-team coalition worked in tandem to create a strengths-based approach that focused on relationships with those they served, understanding where gaps in service occurred and addressing them, and creating a metric for ongoing monitoring.

Improving the health of the home unstable is incredibly complex. Housing discrimination against People of Color is a national problem that is particularly acute in Chicago. In many redlined neighborhoods, a lack of resources—from green spaces to exercise and relax with family and friends, to grocery stores with fresh produce, to well-funded schools that educate and inspire future generations—can lead to higher rates of chronic diseases and truncated lifelines.

Design a Care Delivery Transformation

Strengthening working relationships across the partnering organizations will not only streamline communication among the organizations, it will also make it easier to assess and help the families they serve.

Lessons Learned


Working with multiple stakeholder agencies can provide rich results, especially when those organizations are aligned. Getting all of those agencies on the same page when they may have competing priorities, however, requires dedicated time and effort. The Illinois team remains committed to the initiative and to connecting individuals and families in need with housing and resources so they can achieve the best health possible.