Housing As Health Care

NPH Conference

Sharon Rapport, CSH

October 3, 2014

Our Mission

Improve lives of vulnerable

people

Maximize public

resources

Build strong, healthy

communities

Advancing housing solutions that:

CSH Social Innovation Fund

GOAL: National replication of integrated supportive housing and health services model as a viable alternative to the “revolving door” for homeless people who are frequent users of crisis health care services

FUNDING: $1.15 M annual award from Corporation for National and Community Service (CNCS): 5 yrs

$425,000 annual award to Tenderloin Neighborhood Development Corporation $375,000 annual award to Economic Roundtable

A Solid Base of Evidence

A rigorous evaluation on supportive housing‘s effectiveness as a health care intervention for reaching Medicaid‘s high-need, high-cost individuals

A Blueprint for Scaled Replication

Develop a viable policy for Medicaid-funded intensive care management services are paired with federal, state, & local housing resources

zAn Innovative & Effective Model

Develop and refine a model of housing linked to care management and coordinated primary and behavioral care through community partnerships.

STRATEGIES:

SITES:SAN FRANCISCO, CA

LOS ANGELES, CA

HARTFORD, CT

ANN ARBOR, MI

TENDERLOIN NEIGHBORHOOD DEVELOPMENT CORP.

THE ECONOMIC ROUNDTABLE

CONNECTICUT AIDS RESOURCE CORPORATION

CATHOLIC SOCIAL SERVICES OF WASHTENAW COUNTY

Kelly Cullen Community in San Francisco: Key Partners

TNDC SUPPORT

SERVICES

TNDC PROPERTY MANAGEMENT

SAN FRANCISCO

DEPT OF PUBLIC HEALTH

LUTHERAN SOCIAL

SERVICES

TENANT

10th-Decile Model in Los Angeles

Apr 19, 2023

10th Decile triage tool

highest-cost, highest-need 10% of homeless

individuals

Collaboration hospitals, FQHCs, homeless services

Health Homes intensive case

management/ care coordination

Permanent Supportive

Housinghousing navigation

and retention

5

PRIMARY CARE

BEHAVIORAL HEALTHSUBSTANCE ABUSE

SUPPORTIVE HOUSING

NAVIGATORFREQUENT USERS

The Glue: Intensive Case Management i.e., Care Coordination + Housing Navigation

Apr 19, 20236

Average cost avoidance per person: $59,415Largest individual cost avoidance: $2.2 million

25% of the cohort avoided costs in excess of $100,000

Source: FUSE/SIF hospital cost data, September 2013

ER utilization down 71%Hospital readmissions down 85%

Inpatient days down 81%

ER visits IPT admits IPT days

9.8 8.5

28.6

2.8 1.2 5.5

FUSE Hospital Utilization Pre- and Post-Enrollmentaverage per person, n=60

12 mos before 12 mos in program

ER costs IPT costs Total cost

$7,534

$65,799 $73,333

$2,527

$11,391 $13,918

Hospital Cost Avoidance Pre- and Post-Enrollment

Costs not charges $59,416 average per person, n=6012 mos before 12 mos in program

ER costs down 66% Inpatient costs down 83% Total costs decreased 81%

10th Decile Hospital Utilization and Cost Avoidance (Actuals): 81% Average Decrease In Total Costs Per Client Per Year

AB 361. “Health Homes” Bill (Mitchell)

Health Home = Virtual “Home” for Addressing the “Whole Needs” of a Beneficiary

Uses an option under Affordable

Care Act to create a “Medi-Cal health home benefit” to Medi-Cal beneficiaries who are—

FREQUENT HOSPITAL USERS

and

CHRONICALLY HOMELESS PEOPLE

Bill signed by Governor Oct 2013

Frequent Hospital User Beneficiaries

Chronically Homeless

Beneficiaries

Health Home ServicesServices to Address the Needs of the “Whole-Person”

COMPREHENSIVE CARE MANAGEMENT

CARE COORDINATION & HEALTH

PROMOTION

COMPREHENSIVE TRANSITIONAL CARE

INDIVIDUAL AND FAMILY SUPPORTS

REFERRAL TO COMMUNITY &

SOCIAL SERVICES

HEALTH IT, DATA AND EVALUATION

OUTREACH & ENGAGEMENT

Implementation of AB 361

Define Services: Frequent face-to-face contact (1:20 ratio)

Comprehensive care management: Outreach/engagement Motivational interviewing to identify all needs (not just health)

& plan to meet all health-impacted needs Assist beneficiary get into housing Promote housing stability: help beneficiaries learn to manage

finances, pay rent, shop for or gain access to healthy food, maintain eligibility for benefits, communicate with neighbors & management, and participate in community

Care coordination & health promotion: Include HH staff advocacy with health providers

Referral to social services & supports: Include partnerships with permanent housing

Next Steps on Health Homes

Webinar: Oct-Nov

Stakeholder Process

Draft State Plan

AmendmentImplement (mid-2016)

Concept Paper

Advocacy w/DHCS

Ongoing Stakehold

er Meetings

Sharon.Rapport@csh.org(323) 243-7424 (c)

(213) 623-4342, x18 (o)

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