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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.

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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.

Read more on our work in Maricopa County, AZ.

Read more on our work in Detroit.

 

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Frequent Users Programs Seeing Positive Early Results in Los Angeles

Comprehensive solutions are needed to effectively bend the health care cost curve, improve quality of care and advance population health. In Los Angeles, hospitals, Federally Qualified Health Centers, housing developers and homeless service providers are collaborating on innovative ways to improve health outcomes of patients who are identified as chronically homeless.

In Los Angeles we are optimistic because the program model of intensive case management and supportive housing placement for frequent users of emergency systems is already seeing results. With 47 participants enrolled to date, recent hospital utilization data for the first 20 patients referred out of California Hospital Medical Center shows a 74% decrease in hospital costs for these 20 (from $282,157 to $73,954). By housing chronically ill patients and helping them find medical homes and mental health services, emergency department visits have decreased 57%, inpatient readmissions have gone down 67% and inpatient days have decreased 80%.

FUSE
(May 2011-present)
Baseline
(1 year prior to enrollment)
1 Year post enrollment in FUSE Change
Average ED Visits 2.5 1.1 ↓57%
Average ED Charges $1,423 $580 ↓59%
Total ED Charges $28,450 $11,606
Avg. Inpatient Admits 2.0 0.6 ↓67%
Avg. Inpatient Days 10.0 2.0 ↓80%
Avg. Inpatient Charges $12,685 $3,117 ↓75%
Total Inpatient Charges $253,707 $62,348


The Frequent Users Systems Engagement pilot program in Los Angeles
links 80 frequent users of hospital emergency rooms directly to supportive housing with intensive case management to ensure that they are finding homes and stabilizing their physical and mental health. Five sites are implementing these programs utilizing“navigators” who coordinate all housing and social services. The program is being funded by the Conrad N. Hilton Foundation and UniHealth.In the current economic and health care environment, these kinds of costs savings are critical. Hospital, FQHC and the supportive housing sector are finding ways to steward resources link care management and supportive housing to not only realize stabilization of our most chronically ill homeless patients, but also reduce emergency department and inpatient readmissions and health care cost savings. Work like what is being done in Los Angeles can inspire other communities to work together to effectively address the social and economic complexities of homelessness.

CSH’s Social Innovation Fund Initiative expands this model to new communities. The pilot program managed by the Economic Roundtable, is a substantial cross-sector collaboration that will be working together to integrate healthcare and supportive housing for hundreds of individuals over the next five years.

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CSH and the National Association of Counties Advance Supportive Housing Initiatives for Frequent Users of County Public Systems

On June 7-8, CSH and NACo joined forces to co-host a day-and-a-half long forum to showcase how counties can advance supportive housing initiatives for individuals involved in the criminal justice system and other county public systems.  Held at the beautiful Hennepin County Library in Minneapolis, MN, county representatives from more than 20 counties and 11 states attended.  The forum highlighted how the Frequent Users Systems Engagement (FUSE) model and its three essential pillars – data driven problem solving, policy and systems reform, and targeted housing and services – can help communities break the cycle of incarceration and homelessness among individuals with behavioral health needs.  We were also delighted that Commissioner Chris Rodgers from Douglas County, NE, the incoming President of NACo, joined us for the event as well.  CSH looks forward to working with county officials from states like Texas and Nebraska as they begin to plan and implement frequent user supportive housing initiatives in their counties.

VISIT NACO’S WEBSITE FOR THE agenda and slides from sessions,

Read more about CSH’s Partnership with NACO.

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Supportive Housing: A Solution for Re-entry & Reducing Recidivism

CSH applauds USICH recent focus on creating alternatives to the criminalization of homelessness.  At CSH, through our Returning Home Initiative, we are working hard with communities across the country to end the cycle of homelessness and incarceration through supportive housing.

In communities like Denver, Bridgeport, Minneapolis, San Diego and many more, our Frequent Users Systems Engagement (FUSE) programs are integrating the policies and resources of the criminal justice, behavioral health and housing systems, and are partnering with providers in the community to reduce the criminalization of homelessness and end homelessness.

CSH is also working at the national and federal levels with the Department of Justice, HUD, USICH, and other stakeholders to promote policies and direct resources to support efforts that end the cycle of homelessness and incarceration.

To learn more, read our report on emerging evidence and lessons learned.

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Two Funding Opportunities in LA County

With support from Conrad N. Hilton Foundation, the W.M. Keck Foundation and the UniHealth Foundation,  CSH recently announced the availability of funding for two programs: Transition Age Youth and the Frequent Users Systems Engagement (FUSE) Program.

Find more information about funding opportunities for Transition Age Youth.

For more information about funding opportunities through LA’s FUSE program.

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New RFP Opportunity: Integrating Health Care and Supportive Housing for Homeless Frequent Users of Hospitals in Los Angeles

CSH, with support from the Conrad N. Hilton Foundation and the UniHealth Foundation, is pleased to announce the availability of funding to support the creation of, access to and stability in supportive housing for frequent users of hospital emergency and inpatient departments in Los Angeles County. The goal of CSH’s Frequent Users Systems Engagement (FUSE) pilot identifies and houses 60 homeless frequent users through regional hospital-FQHC-housing collaborations using the Economic Roundtable’s 10th Decile Triage Tool.  Collaboratives to date include the Westside and Downtown Los Angeles.

CSH is seeking to fund a new healthcare–housing collaborative between a homeless service provider, housing provider, federal qualified health care center (FQHC) and a hospital, that partners to identify, support, and house 10 chronically homeless frequent users of health services during the project period. Target geographic regions include South L.A., South Bay, San Gabriel Valley, and San Fernando Valley. Project proposals may range from $90,000 – $100,000 over a grant period of one year. CSH is seeking proposals from teams of homeless service providers, hospitals, FQHCs, and housing developers.

The FUSE collaborative  will be selected through the Home for Good Spring 2012 Request for Proposals (RFP).  As part of the Los Angeles Home For Good plan, public and private funders have created a Funders Collaborative to align funding for permanent supportive housing.  The Home For Good Funders Collaborative has created a single request for proposals, aligned values and priorities, and will make funding decisions collaboratively.  To access the online portal, please go to www.partnerunitedla.org and enter basic information about your organization. Once we have received your request for a user ID, United Way will email your organization a log in name and password to the online portal.

Online applications must be submitted by April 20, 2012 at 5:00 p.m. The successful team will be notified by June 14, 2012.

For more information please contact Susan Lee at susan.lee@csh.org.

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CSH Partners with the National Association of Counties (NACo)

CSH has begun a collaboration with NACo, the national organization that represents counties in the United States.  The goal of our partnership is to foster and strengthen efforts to end the cycle of homelessness and incarceration in county jails through placement in supportive housing. We have formed a workgroup of member counties, and are providing technical and advisory assistance around forming criminal justice supportive housing initiatives.

We’re focusing on the population of frequent users of (usually) county-funded public services, such as jails, hospital emergency services, mental health servces and shelters. These men and women have chronic health coniditons that cause them to cycle in and out of crisis sytems of care and homelessness–at great public expense and with limited positive human outcomes.  Placing these people in supportive housing will improve their life outcomes, more efficiently use public resources, and likely create cost-avoidance in crisis systems.

CSH is very excited about the opportunity to work with counties in states all over the country, from Florida and Georgia to Nebraska, Oregon, Texas and beyond.  Expanding our FUSE supportive housing model, which has demonstrated positive human and cost outcomes in several ongoing evalations, will help promote systems change in the criminal justice and emergency response systems.

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Frequent Users of Public Services: Ending the Institutional Circuit

2009

 

In October 2008, CSH convened over 60 leaders from 25 different communities to share their unique perspectives and expertise regarding research as well as policy and program innovations to end the institutional circuit for frequent users of these systems.

A result of this forum is concise, yet informative summary that can be used to help generate new discussion or deepen existing conversations in your communities about frequent users and the systems they touch.