By Sarah Gallagher, CSH Director in Connecticut and SIF program manager
Over the past year, I have been working with four dedicated teams across the country in implementing CSH’s Social Innovation Fund Project to demonstrate that supportive housing is a solution to addressing the needs of Medicaid’s highest need, highest cost beneficiaries experiencing homelessness. This demonstration began in 2011 and over the past two years, we’ve had our share of challenges and successes.
When we started on the SIF journey, CSH was looking to develop housing solutions for the cohort of homeless individuals with chronic health conditions who are super utilizers of crisis health services. This group is highly vulnerable, having high rates of serious mental illness, issues with substance use, as well as higher rates of chronic medical conditions such as diabetes and hypertension.
They face the double-jeopardy of homelessness, which often exacerbates these complex health needs, increasing exposure to risky behaviors and preventing access to care and treatment adherence. The result is high utilization in emergency services with poor health outcomes and rising health care costs, particularly Medicaid.
Our solution to this complex problem which we are testing through the SIF brings together the best of what we know works in ending homelessness with some of the most innovative solutions for improving health and lowering health care costs. We are bringing together supportive housing, using a housing first approach that helps people move directly into affordable housing and then offers voluntary services to support housing stability, coupled with data driven targeting to identify and engage super-utilizers. Additionally, the model is underscored with the added component of care coordination, patient navigation, and direct linkages to primary and behavioral health care.
The development of the CSH Health and Housing model is a direct response to the expansion of Medicaid coverage, and the active search for solutions to achieve the Triple Aim of better health outcomes, better experience with care, and lower costs. We know that for Medicaid’s highest utilizers who experience unstable housing and homelessness, achieving the Triple Aim is only be possible if we can address housing needs. We want to know if supportive housing—adapted as a more intentional health care intervention—could be a strategy and solution for achieving better outcomes and Medicaid cost containment. In turn, we what to explore how can Medicaid become a means of solving at least one half of the supportive housing financing puzzle… services.
The Corporation for National and Community Service’s Social Innovation Fund seeks out innovative solutions to some of the toughest social problems in America. SIF aims to catalyze public and private investment to support, test, and scale data driven, effective solutions.
Through SIF, CSH saw a rare opportunity to broaden the conversation around the integration of health and housing and build the business case to a scale our efforts through new financing mechanisms available via Medicaid.
To date, 308 people have been placed in housing through SIF with a housing retention rate of 95% thus far. All sites have been able to utilize data driven strategies through, either data matching or predictive algorithms, to identify the target population and to date it seems as if these efforts are useful in identifying the highest utilizers. For example, in CT, the average annual per person Medicaid costs for the first 24 people placed in housing was $95,833—nearly $8,000 per member per month. Through direct experience, local teams are beginning to note observable impact on tenant’s ability to stabilize, achieve their goals and reduce the number of hospital and ED visits. For example, one individual, Scotty, in LA reduced hospital visits from 52 to 3 over a 12 month period once he was housed and working with the LA team.
And while each of our four sub grantees are working diligently to meet their targets, we know that our work does not end in 2015 when 549 high cost utilizers are housed….
The true goal in implementing SIF is to develop a model that we can replicate across the country… to create a blueprint for linking mainstream housing and health resources and scale the model until no vulnerable individual with a chronic health condition is living on the streets or in shelters.
This is what makes the evaluation component of SIF so crucial. Through analysis of administrative data, along with qualitative analysis, the evaluation will hopefully not only demonstrate positive impacts on individual lives in LA, San Francisco, Washtenaw and CT…but will also engage new systems, document the service delivery model and provide the lessons learned and policy recommendations needed to bring SIF to scale to improve health outcomes for “super users” in all communities.
Click here to watch a recording of the January 31 webinar hosted by CSH and the evaluation team from NYU – Steinhardt School of Culture, Education, and Human Development, the Robert F. Wagner Graduate School of Public Service, and the School of Medicine