Start somewhere, even if it’s small. You never know when a global pandemic will strike. With data sharing agreements in place, communities are able to exchange social services data and public benefits data and share this with the case managers from a range of different organizations. This helps them actively cultivate a culture of collaboration and sharing and make data-sharing and collaboration the norm. No matter when you make that kind of investment in systems change, you will be very grateful you did at a later date.
As a part of my series about “Heroes Of The Homeless Crisis” I had the pleasure of interviewing Ted Quinn, CEO and Co-founder of Activate Care and one of their Partners, Karen Zangerle, Executive Director of PATH Illinois.
Ted Quinn is the CEO and Co-founder of Activate Care, a digital health company helping everybody engaged in the healthcare system — clinicians, patients, families, and communities — act together to make health happen, wherever they are.
He co-founded Activate Care alongside Ken Mandl, MD and Zak Kohane, MD, both nationally renowned healthcare informatics experts. They wanted to start the company as ACT.md, which was a play on words for the concept of ‘Accountable Care Transactions’ which is a way of thinking about those handoffs happening in a more reliable way. They also saw the relationship between healthcare organizations undertaking value-based contracts and needing to rethink how they delivered integrated care with all their health and social care partners. Integration can be built around accountable care transactions, with their platform at the center. So, they created the company, now called Activate Care, as an operating system for team-based care that drives action across health and social care systems, toward improved outcomes and reduced costs.
Activate Care® provides a platform for social workers and doctors to easily collaborate and determine a patient’s needs. It also considers the patient’s Social Determinant of Health (SDOH) to help stay on top of outliers with a high risk of impacts of physical and mental health.
Throughout the interview series, Karen Zangerle will share insights on the homelessness crisis in the state of Illinois and how working with Activate Care has benefited the community.
Karen Zangerle has worked at PATH since starting as a volunteer in 1984. In 1985 she was hired to start a new outreach program for seniors. Currently Executive Director, Karen oversees operations that provide a 24/7 crisis response, information and referral hotline, services for the homeless and adult protective services for those age 60 and older and for individuals with disabilities ages 18–59. Over the years Karen has been a part of community changes in the areas of domestic violence, homelessness, sexual assault, prisoner reentry and mental health court, sits on a number of boards and task forces and has received a numerous award including the Women of Distinction and the National Association of Social Workers, Illinois Chapter, 2008 Public Citizen of the Year. Karen has been actively involved at the state and national level with the development of 2–1–1, an easy access number that connects a caller to local information and referrals. The state of Illinois selected PATH as the first 2–1–1 center to operate in the state.
Thank you so much for joining us! Our readers would love to ‘get to know you’ a bit better. Can you tell us a bit about your personal background, and how you grew up?
Ted: I grew up on the upper foothills of Utah’s Wasatch Mountain range. In the winter, snowstorms roll across the Great Salt Lake Valley and dump massive amounts of snow all over the region. When my 11 siblings and I were kids, my father never bothered to buy an automatic snow blower, but he did make clear that it was our automatic duty to shovel the driveway with each passing storm. When my youngest brother moved away to college, one of the first things my father did was purchase an automatic snow blower. After all, his students had graduated. I didn’t fully realize what he was teaching us until I was older. That gives you a sense of my strong family upbringing and how it has informed my life.
Karen: I have lived most of my life in central Illinois. I am the oldest of seven children and had the role of helper early on. Due to my experience growing up and acting as a leader in my family, I was heavily influenced to make the decision to pursue a career in social services. I developed an interest at an early age to work with the local community and help others.
Is there a particular story or incident that inspired you to get involved in your work helping people who are homeless?
Ted: Early in my professional career, I worked in New York City and had an experience in understanding the challenge of homelessness. One particular gentleman — I will call him John — left an impression on me. John was homeless and showed up at our community center looking for support. Part of our mission was to help those in need and provide all the support we could. Working with a small group of dedicated individuals, we began a process of providing food, clothing, shelter, and other personal needs for John. Our initial engagement and support were welcome, and it felt like we were making real progress in his personal situation.
After a few weeks of support, John decided that the setup wasn’t what he wanted, and we lost contact with him. I’ve come to believe that we were working based on what we thought he wanted and the life situation we interpreted would be the best for John. I’ve looked back and thought about that experience — particularly when I think about our Whole Person Care customers working to end homelessness.
Karen: Throughout the evolution of my career, I grew more aware of the ongoing homelessness crisis which further drew me to the impactful work I was doing but cannot name a single incident that propelled my interest — truly it’s been something that started early in my life and has been a growing desire and motivation to help over the years.
Homelessness has been a problem for a long time in the United States. But it seems that it has gotten a lot worse over the past five years, particularly in the large cities, such as Los Angeles, New York, Seattle, and San Francisco. Can you explain to our readers what brought us to this place? Where did this crisis come from?
Karen: I don’t think there is a simple answer to how our country has enabled the homelessness crisis. Those experiencing chronic homelessness may have a behavioral disorder, mental illness, substance addiction or been faced with challenges related to social determinants of health… the list goes on. People in the United States affected by these issues often are unable to maintain housing. On a federal level, the current trend is not to build new shelters, but to house people.
A question that many people who are not familiar with the intricacies of this problem ask is, “Why don’t homeless people just move to a city that has cheaper housing?” How do you answer this question?
Karen: It’s not a question of housing; it is a question of functioning with long-term behavioral problems. The issues with homelessness may be financial, but more often than not, a deeper issue is present. So, until services are provided to assist the whole person, or perhaps a mental illness or behavioral problem, the homeless won’t be able to come up with the funds for housing.
Can you describe to our readers how your work is making an impact battling this crisis?
Ted: Imagine if our health and social care systems could seamlessly coordinate together to meet all our physical, behavioral, and social needs as unique individuals. The impact of this approach to care is clear: higher-quality care, more humane service delivery, reduced costs and duplication of efforts, and better outcomes for all. Those who stand the benefit the most are those who experience complex, chronic health and social needs — especially those who are homeless in our communities.
Combining community coordination, referral management and data analytics, Activate Care offers a cloud-based software as a service (SaaS), called the Activate CareHub. For nearly a decade, we have providing our software to large organizations like hospitals, health care systems and insurance companies so they can coordinate a patient’s needs seamlessly. Activate Care also partners with local social service agencies like school systems, homeless shelters and hunger organizations to provide a well-rounded health care plan.
How has the COVID-19 pandemic affected the homeless crisis, and the homeless community? Also how has it affected your ability to help people?
Ted: We have never experienced a large-scale human tragedy like COVID-19 in contemporary history. While the illness presents an immediate medical crisis, public health strategies like social distancing, self-isolation, and quarantine are keeping us apart when we need each other the most. These strategies, while necessary, will, unfortunately, cause long-term and persistent disruption to people’s lives. Given the scale of this crisis, it is time to look deeper at the impact of the pandemic on the social services that we will need in our communities, now more than ever.
A community’s ability to coordinate care is a key social determinant of health. New research published this month in the American Journal of Public Health identifies a clear line between the strength of relationships between health and social care organizations in a given community, and the health of residents in that community. “Cross-sector fragmentation is a powerful determinant of health, because it can lock in inequality and prevent communities from steering available resources to the people and problems that need these resources most,” said Glen Mays, Ph.D, professor in the Colorado School of Public Health and senior author of the study.
The work of creating a fully functional cross-sector ecosystem can be daunting, but it’s important to note that this work takes several years. California’s Whole Person Care program is an example of a cross-sector effort that has achieved strong and lasting outcomes for people in need, especially those who are chronically homeless. Strategies like Whole Person Care, which deliberately integrate medical with non-medical services such as housing, social services, and long-term services and supports, are better positioned to meet their goals and help individuals in lasting ways.
Karen: Unfortunately, the number of shelter beds have been limited in an effort to keep social distance measures intact to help curb some of the virus spread amongst this specific population.
Can you share something about your work that makes you most proud? Is there a particular story or incident that you found most uplifting?
Ted: For the past several years, one California initiative has been undertaking this challenge. California’s Whole Person Care (WPC) pilot is a five-year, 3 billion dollars waiver program that includes 25 counties working to integrate care for specific Medicaid beneficiaries in their communities. These programs most often serve individuals who have multiple chronic conditions, as well as those who are experiencing homelessness or other social and behavioral health crises.
One lesson that our work has taught us is that poverty can be overcome. It is expensive, laborious, and time-consuming work, but communities are making progress. In Marin County, California — where they have a goal to end chronic homelessness by the end of 2022 — their system of care has already reported dramatic improvements in some of poverty’s leading indicators:
- 28% reduction in chronic homelessness across the county.
- 40% decrease in homelessness among people with a serious mental illness.
- 28% decrease in family homelessness, and 10% decrease in youth homelessness.
- 10% decrease in homelessness among people with substance-use disorders.
- 54% decrease in the use of emergency medical service personnel by the chronically homeless who have been housed, and 86% decrease in 911 police calls.
- 44% reduction in hospital stays among the homeless.
Karen: We developed a day center for people experiencing homelessness with the business, religious, education and social service communities. A local shelter was not a 24/7 facility, and people had to leave at 7:00 a.m. We opened the service and kept it open for seven years until a new facility was built. It was a place to drop-in, take classes, do laundry, eat lunch, visit with a therapist, etc.
Without sharing real names, can you share a story with our readers about a particular individual who was impacted or helped by your work?
Ted: The team at Marin County, California’s Whole Person Care pilot put together a really impressive video that tells their story. I’d encourage readers to check this out on YouTube.
Karen: I connected with a person who had a diagnosis of schizophrenia, and his world had relatively no ties to reality. He would not stay in a shelter because of paranoid delusions. When the temperatures dropped, I would go out looking for the individual in their favorite haunts, making sure he had a sleeping bag or blankets, and provided food from their favorite fast-food restaurants. I worked very hard to place this person into an apartment, and I felt on top of the world. However, he taught me the hard truth about mental illness and homelessness. Within weeks, the individual was certain there were people living in the walls waiting for him. He threw a TV out a second-story window because of what the voices were telling him. As I watched him worsen every day, I knew that simply providing housing, even with support, was no match for the power of mental illness. He ended up setting a fire as a punishment to others and was evicted. Here’s the great part — we stayed connected for the next 20 years until that person’s death five years ago. I took care of what I could but lived with the knowledge there were no permanent answers.
If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?
Karen: Pour funding into discovering treatments that work for mental illness and substance abuse.Increase the number of people working with people with severe behavioral disorders, e.g., ensuring medications were taken, problem-solving day-to-day issues.Increase disability dollars to enable a person who is homeless to have enough food, rent, and medical care.
I know that this is not easy work. What keeps you going?
Karen: It’s impossible to walk away, knowing you truly are making a difference, although sometimes small — in someone’s life.
Do you have hope that one day this great social challenge can be solved completely?
Karen: I have hope that organizations work to continue to lean on support systems to connect people to facilities for proper care, such as Activate Care. Most healthcare organizations spend countless hours building their own community networks and resource guides, which need to be regularly updated, costing time and money. Organizations like PATH Illinois offer an entry point to help. It takes a community to help our people in need. We have to work together to improve capacity of social services and track people through the system, until they get the help they need. Because of this, I believe Activate Care offers huge value to the healthcare system. To be able to work with a company that is willing to expand a hospital’s ability to follow through is wonderful. Simply put, we want more people to find answers to their problem before it negatively impacts their health. Leaning on platforms and other services to help provide best possible care is start, but I’m not sure I will see these issues “solved” completely in my lifetime.
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
- Not all problems can be solved but not at the expense of hope; see the above scenario.
- The extent that serious mental illness keeps people from meeting necessary needs. One person, who had money, would only live-in abandoned cars. He refused to accept that he had a trust fund and could buy food or a home. I asked him how he kept fed and warm. He would visit restaurant dumpsters and collect what was thrown away. He would take it back to the vacant car lots, get in his favorite car to sleep in (he varied it), ate some of the food but would place it around his body. The cats would come to eat, and their warmth got him through Illinois winters.
- People do live on the streets and survive. One person has been on the streets for more than 20 years. She is in her 80’s. She would come and see me when she needed something. We haven’t seen her for a long time and will probably never know her fate, but she was a positive person and quite innovative in her own thinking. She did not want to be called “homeless” but rather “street person.”
- Substance abuse is a cruel fate. A person, drinking from their teens into their late forties, desperately needed oral surgery. He had rotting teeth that needed to be pulled. We worked very hard to keep him sober so that the dentist could do the surgery, even hiring someone to sit with him in a hotel room to keep him from drinking. Nothing worked. Ultimately, he used pliers and pulled out some of the teeth. He eventually passed away in a nursing home at age 49 from complications of alcoholism.
- A person’s history cannot be denied. I knew of a woman who was sexually abused from a young age by guardians and siblings. They started drinking at age 12. I met this person at age 18. She had already had two children with fetal alcohol syndrome who were taken when born. She was a prostitute, had violent episodes, would go with anyone who promised a drink — multiple suicide attempts including having to be talked down from a high structure. The only time she could stop drinking was when she was in prison. Filled with undeniable rage, she could not sustain efforts towards change. Subsequent health outcomes eventually landed her in a wheelchair in her 40’s. She still drinks.
Can you share three things that the community and society can do to help you address the root of this crisis? Can you give some examples?
Ted: The challenge is so encompassing. I have a great deal of respect for the efforts of our partners who daily work to take on the challenge of homelessness in their communities. This makes me think that three things are needed:
- Move from a fractured service network to a coordinated care ecosystem. Going into this work, we know that it’s hard to get everyone working together. It takes a huge amount of culture change and systems change work to get to the point of true collaboration.
- Put in place a central “command center” that can convene stakeholders across the community. The team that sits in the center of a community effort can act as a “command center.” One of the most important things they can do is make possible the legal and compliance permissions, the release of information (ROI), and data-sharing agreements among agencies that allow them to use an innovative platform like Activate Care in daily operations across all these different organizations.
- Start somewhere, even if it’s small. You never know when a global pandemic will strike. With data sharing agreements in place, communities are able to exchange social services data and public benefits data and share this with the case managers from a range of different organizations. This helps them actively cultivate a culture of collaboration and sharing and make data-sharing and collaboration the norm. No matter when you make that kind of investment in systems change, you will be very grateful you did at a later date.
You are both people of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
Ted: For too long, the status quo in our healthcare system has been to screen people for mental health or social service needs, then simply refer them out to other providers in the community. Numerous peer-reviewed studies now show this fails up to 80% of people in need.
We know for a fact that its rarely just food insecurity affecting someone’s health, or an anxiety disorder, it’s almost always more than one issue facing a family. And when we look to the future with a keen eye on how the effects of the Covid-19 pandemic will certainly increase incidents of homelessness, food insecurity, mental health, and many other SDOH, deploying large-scale interventions to these intersecting challenges will require an integrated ecosystem more than ever. It’s time to prepare for these predictable challenges to actually make a positive impact for our vulnerable populations.
We believe the intervention is everything, so we launched our Screen-to-Intervene initiative to engage communities in all 50 states in an effort to link these systems of care around the individual patient or client, rather than just the activities of the care coordinator or case manager.
Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why? He or she might just see this, especially if we tag them. 🙂
Karen: Former President Barack Obama. I would like to learn his vision of how we can make changes in human issues, be it racism or homelessness.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
I have a quote that I often recite in the office: “Done beats perfect.” I assume some people will naturally agree with that statement. But some people need to be reminded that speed is a virtue in start-ups.
We placed a long bet on Activate Care, and we have a long time to make our offering more perfect. But at the end of the day, we are here to continually ship a product that people can use right now to improve the health and well-being of their community. That goal is too important to leave to the whims of perfection. We’ll never be accused of not moving swiftly.
How can our readers follow you online?
This was very meaningful, thank you so much!