From Hospitals and Health Networks/hhnmag.com
By Lola Butcher
Suffering significant health problems, the woman was in and out of hospitals constantly. She did not take prescribed medications because they made her groggy — an unsafe condition for a woman living on the streets.
“And, of course, within a week or two her medical condition would deteriorate again,” says Shannon Nazworth, executive director of Ability Housing, a nonprofit organization serving northeast and central Florida. “She was just cycling in and out of the hospital, not because anybody was not giving her good care or did not care about her, but because the system was broken.”
“In the year after she moved in, she went to the hospital once for a couple of days,” Nazworth says. “The other factors that were affecting her health were addressed by just getting her housing. She needed a place to sleep at night, a place to store her medicine and the security of a door to lock.”
Patients like this woman exist throughout health care, but, traditionally, most health systems have not seen a way to address homelessness and other social factors that exacerbate individuals’ health problems. That is changing as health systems pivot to population health management and new payment systems that reward them for proactively improving patients’ health status.
“Whatever has been done in the past has not been working, and we have to really think very differently,” says David Perlstein, M.D., president and CEO of SBH Health System in the New York City borough of the Bronx.
In his case, that means proactively reducing inpatient capacity, selling part of the SBH campus to a developer to build low-income housing and opening an urgent care center and other outpatient facilities in the new development. In other places, provider organizations are donating cash. For example, five hospitals and a nonprofit health plan in Portland, Ore., are donating $21.5 million to help build nearly 400 housing units for homeless and low-income people. Still other health care organizations are building apartments that they own and operate themselves, and some are paying the rent for homeless people to have a place to live.
What they all have in common: the goal of improving housing stability and thereby improving the well-being of their patients and their community.
“This is an opportunity that health systems are seeing,” says Donald Moulds, executive vice president for the Commonwealth Fund.
The best role for provider organizations is not yet clear; Moulds and other policy analysts are working to figure that out. But a growing body of research shows that addressing housing instability is a cost-effective approach to reducing avoidable health care utilization.
“A modest housing investment, coupled with supportive services, can actually keep people from needing much more expensive care in the long term, sometimes even in the shorter term, and can pretty dramatically improve outcomes,” Moulds said. “If you target it right, it can be a cost-effective choice for provider organizations.”
In 2014, Florida Hospital in Orlando committed $6 million over three years to address homelessness in central Florida. The donation coincided with big commitments — $4 million from the city of Orlando and $13.5 million from Orange County — during the same three-year period.
“Our mayor set a goal to house about 300 of downtown Orlando’s chronically homeless within three years and, without a doubt, we wanted to be in on this early,” says Yamile Luna, assistant vice president of Florida Hospital Community Impact and Volunteer Services.
The city engaged the Corporation for Supportive Housing, a national nonprofit group, to strategically identify vulnerable individuals and families who need supportive housing and are high users of emergency departments and other high-cost public services.
“We knew who our frequent-flyer homeless individuals were,” Luna said. “They would come in through the emergency department, and we knew there had to be a better way to care for them. We started determining case by case, person by person, what is it that they truly need.”
The work is benefiting not just high-need patients but the health system as well. By the time $1.6 million of Florida Hospital’s donation had been spent, the hospital had avoided an estimated $2.5 million in costs for six high-utilizers who had been placed in homes.
“This is not why we did it, but it was a very big moment of ‘wow’ when that information was shared,” Luna says.
Meanwhile, Florida Hospital’s commitment to addressing homelessness caught the attention of a local charity that had operated a transitional housing community for more than 15 years. Over that time, the “housing first” model — placing homeless people in permanent housing without requiring that they overcome addictions, get jobs or hit other milestones — had gained traction in the social service world, and the charity wanted to convert its apartments to permanent housing. So, earlier this year, it donated the Wayne Densch Center for the homeless to Florida Hospital.
The health system, in turn, is leasing the property to Ability Housing for $1 per year. With funding from Orange County, Ability is redeveloping the center to provide permanent housing for individuals and families.
“We are happy to be behind the scenes,” Luna says. “Housing is not our expertise, so in order for us to be successful, we knew we wanted to partner with Ability and also the Orange County government.”
The foremost goal for the renovated Wayne Densch Center is to provide permanent supportive housing for families, but some units may be designated as transitional care units for homeless patients discharged from Florida Hospital.
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