Targeting Health High Utilizers in Arizona and Michigan
CSH's six-year frequent user pilot in California demonstrated that homeless clients who were connected to permanent housing experienced deeper reductions in ER and inpatient hospital stays than those not in supportive housing. Since that initial pilot, we have expanded our FUSE work to other cities and counties across the country to connect individuals with supportive housing and health care in an effort to reduce overall hospital and emergency services costs. Maricopa County and Detroit are two examples of our FUSE work around health high utilizers.
In Maricopa County, Arizona, the Frequent Users Systems Engagement (FUSE) initiative is targeting 15 chronically homeless individuals who are the most frequent and costly utilizers of St. Joseph Hospital and Medical Center Emergency Room and county shelters. CSH assisted with the program development and will be conducting an evaluation of the program, which began housing people identified through a data match between St. Joseph’s and the county HMIS system in 2013. Clients are engaged in the hospital, respite care, or shelter setting by a Care Coordinator who coordinates service delivery between the hospital, mental health provider, and community health center. The goal of the Maricopa FUSE pilot is to create a programmatic model that links the target population to supportive housing and to develop a sustainable financing model and mechanism to fund hospital in-reach, housing and service provision for this population, all while reducing the costly and unnecessary utilization of hospitals and homeless shelters.
In Detroit, Neighborhood Service Organization (NSO), along with other local partners including hospitals, community mental health and homeless service providers are seeking to meet the needs of frequent users of hospital systems who are homeless. Together, CSH and NSO have designed a 100-person FUSE Initiative. With CSH and foundation support, this initiative intends to demonstrate the effectiveness of supportive housing and integrated care in reducing health care costs and improving outcomes. Participants are identified and recruited at area hospitals and randomly assigned to receive enhanced services and housing or to receive “services as usual”. Utilization for the two groups will be tracked for two years to determine the effect of the FUSE intervention on utilization, cost and outcomes. The rigorous research element of this initiative will demonstrate the efficacy of supportive housing with enhanced service coordination. The FUSE service model provides subsidized housing and services provided by a Social Worker, Registered Nurse and Peer Support Specialist using Critical Time Intervention (CTI). The focus of treatment will be to stabilize any health conditions, coordinate outpatient care and ensure housing stability. The Detroit FUSE project began recruitment in May 2013 and to date has 8 enrollees.