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The Message is Clear: We Must Integrate Housing and Health Care

March 26, 2014

Last week, The Department of Housing and Urban Development (HUD) hosted Dr.  Jeffrey Brenner from Camden Coalition for Health Providers in Camden, New Jersey to engage HUD, Department of Health and Human Services (HHS) and national advocates, including CSH staff, in a conversation regarding the costs of poorly delivered health care and the connection to affordable housing.   To view the entire event - http://youtu.be/PvttLkMAWF4

Dr. Brenner is best known for being highlighted in a 2012 article in the New Yorker on frequent users with complex needs within the health care system called ‘The Hot Spotters’.

This HUD event highlighted Dr. Brenner and his staff’s ongoing work to identify health patients with high cost and complex needs in particular affordable housing buildings or experiencing homelessness and experiment with new service delivery models to reduce costs and improve outcomes.  One example shared explained that within one particular public housing building in Camden, 615 patients had 3,901 visits to the local hospital.  These patients cost the hospital system $83 million, with only $12 million of that reimbursed by health insurance.  Another building represented 332 residents who visited the hospital 1,414 times.  These residents amassed $92 million in total charges, with $15 million of this total reimbursed by health insurance.   These high expenditures did not result in residents being extraordinarily healthy, to the contrary, residents continued to be sick, frequent emergency rooms and accrue more health expenses.  Dr. Brenner conducted meetings with residents who were shocked that their care was so expensive given their poor results.   Data such as this allows Dr. Brenner and his team to target health interventions to particular residents in their building or home and study what works.  Unfortunately, to accomplish this, Dr. Brenner explained that you have to fight the health system because health providers are oriented and incentivized to want sick people, not healthy people.  They get paid for having people in their beds, use their equipment and take their pills.  Dr. Brenner argues that improving care can reduce costs but we need to re-orient the health system to breakdown silos, incentivize improved outcomes, target resources, support data sharing and create payment models that encourages integrated care.  In addition, his work has shown that without housing, all the health interventions in the world cannot improve outcomes.

CSH is particularly excited that HUD highlighted Dr. Brenner’s work.  CSH and the Camden Coalition of Health providers are hoping to soon begin in a frequent users project that will use housing first approaches and supportive housing to improve care for high cost patients.

Dr. Brenner’s acknowledgement that improved health outcomes cannot be achieved without housing was also expressed in Chicago at the Housing First Partners Conference earlier this month.  Barbara Edwards is the Director of the Disabled and Elderly Health Programs Group within the Centers for Medicare and Medicaid Services (CMS) and served as a presenter at the conference.  She oversees many of the Medicaid waivers, state plan amendments and other initiatives that provide Medicaid reimbursement for the service needs of patients with complex needs.   Ms. Edwards’ remarks also highlighted the need for health and housing to be integrated.  She shared lessons CMS is learning from initiatives such as Money Follows the Person and the need people have for supports in housing.  Services such as pre-tenancy supports (outreach and engagement), tenancy supports and case management are essential to ensure patients with complex needs remain housing and avoid homelessness or institutionalization.  She expressed CMS’ desire to identify ways that Medicaid can more routinely reimburse for these services.  In addition, she discussed the supportive housing industry’s desire for Medicaid to pay for rental assistance and capital housing costs.    Ms. Edwards explained that the challenge for CMS is to figure out how Medicaid can support people connecting to housing without becoming a permanent affordable housing subsidizer. CSH believes this is a challenge supportive housing providers and policymakers should leap to help CMS address.

Dr. Brenner closed his remarks by explaining that - Housing is the best pill, the best scan, more powerful than surgery.  If we don’t house these patients they will get sicker, older and die.  We are wasting money if we do not address housing for these high cost patients.  At CSH, we believe the evidence to support this sentiment is clear and we are excited that HUD and HHS are supporting this message.

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The Message is Clear: We Must Integrate Housing and Health Care



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