evaluation of the new york/new york iii supportive …...interim evaluation results for the new...

Interim Evaluation Results for the New York/New York III Supportive Housing Program

Corporation for Supportive Housing Eastern Region Conference

March 28, 2014

Amber Levanon Seligson, Ph.D.

Bureau of Epidemiology Services

New York City Department of Health and Mental Hygiene (DOHMH)

1

NY/NY III Evaluation Questions

• Do NY/NY III tenants have fewer instances of avoidable health care utilization and more instances of preventive health care utilization?

• Do NY/NY III tenants use fewer public resources?

2

3

Methods • Evaluation Population

o Tenants who lived in NY/NY III housing for at least one year o Unplaced eligible applicants who did not live in any

government-subsidized housing tracked by the evaluation

• Analysis accounts for differences between placed and unplaced eligible applicants during 2 years prior to move-in or eligibility

• Services and benefits tracked by the evaluation o Medicaid costs and health care utilization o Cash assistance o Food stamps o Jail o Family shelter o Single adult shelter o New York State psychiatric facilities

4

NY/NY III placed and unplaced eligible applicants with > 12 months of follow-up time (2007-2009)

Placed Unplaced

Pop A Homeless and with serious mental illness (SMI) or mental illness & a substance use disorder (SUD)

431 1,366

Pop B Had been in State-operated psychiatric facilities and at risk of homelessness

26 906

Pop E Homeless and had an SUD 456 335

Pop F Homeless and treated for an SUD 509 782

Pop D Heads of family with SMI or dually diagnosed with mental illness and an SUD

41 111

Pop G Heads of family had an SUD, a disabling medical condition, or HIV/AIDS

113 131

Pop I Young adults leaving foster care and at risk of homelessness

122 299

Pop H Single adults with HIV/AIDS and SMI or an SUD* 320 341

*Pop H placed tenants were included in analyses if they had 7 days of NY/NY III housing or more.

Pop H unplaced applicants were included in analyses even if they were housed in non-NY/NY III housing,

since very few people in Population H did not get housed during the follow-up period.

Health care utilization

5

• Preventive health care events aim to avert declining health and a rise in future health care utilization

• Avoidable health care events could have been avoided had the patient had high quality outpatient care

• Analysis is based on Medicaid fee-for-service claims and monthly managed care capitations, without data from specific encounters o 34% of placed tenants had >6 months of managed care, compared to

22% of unplaced applicants

Kruzikas DT, Jiang HJ, Remus D, Barrett ML, Coffey RM, Andrews R. Preventable Hospitalizations: A Window Into Primary and Preventative Care, 2000. Agency for Healthcare Research and Quality, 2004. HCUP Fact Book No. 5; AHRQ Publication No. 04-0056.

Avoidable utilization measures during 12 months after NY/NY III placement or eligibility

6

Odds for placed tenants were…

At least 1 hospitalization during 1st year in NY/NY III: 34%↓

A psychiatric hospitalization: 41% ↓

A substance use-related hospitalization: 38% ↓

An emergency department (ED) visit: 32% ↓

A psychiatric ED visit: 32% ↓

A substance use-related ED visit: 48% ↓

Data sources: NYC Department of Homeless Services (DHS), NYC Department of Correction (DOC), NYC Department of Health and Mental Hygiene (DOHMH),NYC Human Resources Administration (HRA), New York State Office of Mental Health (OMH)

Utilization and cost analysis

7

Differences in average number of days of institutional use per person 12 months after NY/NY III

8 *Statistically significant Data source: DHS, DOC, DOHMH, HRA, OMH

-7* -4*

-135*

-2*-4* -1* -5*

-144*

-6* -2*

-118*

0

-7* -3*

-57*

00

-170*

-2*

0

-7*

-170*

-6

0

-4* -4*-9* -7*-5*

-14*

-74*

-25*

-180

-160

-140

-120

-100

-80

-60

-40

-20

0

Jail Family shelters Single adult shelters State psych.

Nu

mb

er o

f d

ays

A: SMI

B: From State psych.

E: SUD

F: Treated SUD

D: Family with SMI

G: FamilySUD/medical/HIV

I: Young adults

Combined

Combined NY/NY III populations: Differences in average cost per person among placed and unplaced

9

Jail-$1,298*

Single adult shelter-$5,427*

Family shelter-$1,492*

State psychiatric centers -$18,668*

Medicaid-$935

Food stamps$436*

Cash assistance-$281*

Total costs including NY/NY III housing

-$10,100*

-$20,000

-$15,000

-$10,000

-$5,000

$0

$5,000

Nu

mb

er o

f d

olla

rs d

iffe

ren

ce b

etw

een

an

ave

rage

pla

ced

vs

. un

pla

ced

per

son

1,695 placed tenants; 3,700 unplaced applicants

*Statistically significant

Data sources: DHS, DOC, DOHMH, HRA, OMH

Population A (homeless and had SMI or were dually diagnosed with mental illness and an SUD): Differences in average cost per person among placed and unplaced

10

Jail-$1,776*

Single adult shelter-$9,916*

Family shelter-$393*

State psychiatric centers

-$1,424*Medicaid-$2,956

Food stamps$217

Cash assistance,

$307

Total costs including NY/NY III housing

-$878

-$12,000

-$10,000

-$8,000

-$6,000

-$4,000

-$2,000

$0

$2,000

Nu

mb

er o

f d

olla

rs d

iffe

ren

ce b

etw

een

an

ave

rage

pla

ced

vs

. un

pla

ced

per

son

431 placed tenants; 1,366 unplaced applicants



Population B (had been in State-operated psychiatric facilities and at risk of homelessness): Differences in average cost per person among placed and unplaced

11

Jail-$1,048*

Single adult

shelter-$389*

Family shelter-$74*

State psychiatric centers -$105,987*

Medicaid,$11,926*

Foodstamps$1,179*

Cash assistance

$1,895

Total costsIncluding NY/NY III

housing-$77,425*

-$120,000

-$100,000

-$80,000

-$60,000

-$40,000

-$20,000

$0

$20,000

Nu

mb

er o

f d

oll

ars

dif

fere

nce

bet

wee

n a

n a

vera

ge p

lace

d

vs. u

np

lace

d p

erso

n

26 placed tenants; 906 unplaced applicants



Population E (homeless and had an SUD): Differences in average cost per person among placed and unplaced

12

Jail-$1,348*

Singleadult

shelter-$8,576*


State psychiatric centers $10

Medicaid-$8,710*

Food stamps$245*

Cash assistance

$1,525*

Total costs including NY/NY III

housing $1,651

-$10,000

-$8,000

-$6,000

-$4,000

-$2,000

$0

$2,000

$4,000

Nu

mb

er o

f d

oll

ars

dif

fere

nce

bet

wee

n a

n a

vera

ge p

lace

d

vs. u

np

lace

d p

erso

n




Population F (homeless and treated for an SUD): Differences in average cost per person among placed and unplaced

13

Jail-$1,784*

Singleadult shelter

-$4,174*

Familyshelter-$308*

State psychiatric

centers-$25

Medicaid-$1,499

Food stamps$204*

Cash assistance -$23

Total costs including NY/NY III Housing

$8,948*

-$6,000

-$4,000

-$2,000

$0

$2,000

$4,000

$6,000

$8,000

$10,000

Nu

mb

er o

f d

oll

ars

dif

fere

nce

bet

wee

n a

n a

vera

ge p

lace

d

vs. u

np

lace

d p

erso

n

509 placed tenants and 763 unplaced applicants



Population D (heads of family with SMI or dually diagnosed with mental illness and an SUD): Differences in average cost per person among placed and unplaced

14

Jail -$17 Singleadult

shelter -$142*

Family shelter -$18,280*

State psychiatric facilities $0

Medicaid -$4,758

Food stamps -$290

Cash assistance -$10,111*

Total costsincluding NY/NY III

housing -$7,611

-$20,000

-$18,000

-$16,000

-$14,000

-$12,000

-$10,000

-$8,000

-$6,000

-$4,000

-$2,000

$0

Nu

mb

er o

f do

llar

s d

iffe

renc

e b

etw

een

an

ave

rage

pla

ced

vs.

un

pla

ced

pe

rso

n




Population G (heads of family with an SUD, disabling medical condition, or HIV/AIDS): Differences in average cost per person among placed and unplaced

15

Jail-$1,576*

Singleadult

shelter-$436

Family shelter -$18,193*

State psychiatric

facilities$0

Medicaid $281

Food stamps $1,334*

Cash assistance -$7,061*

Total including NY/NY III housing

$380

-$20,000

-$15,000

-$10,000

-$5,000

$0

$5,000

Nu

mb

er o

f d

olla

rs d

iffe

ren

ce b

etw

een

an

ave

rage

pla

ced

vs

. un

pla

ced

per

son




Population I (young adults leaving foster care and at risk of homelessness): Differences in average cost per person among placed and unplaced

16

Jail-$878*

Singleadult

shelter-$626*


State psychiatric

Centers-$4,694*

Medicaid-$4,628*

Food stamps$450*

Cash assistance

-$200

Total costs including NY/NY III housing, $11,808*

-$6,000

-$4,000

-$2,000

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

Nu

mb

er o

f do

llars

dif

fere

nce

bet

wee

n a

n a

vera

ge p

lace

d

vs. u

np

lace

d p

erso

n




17

Limitations

• Analyses do not include o Health or social outcomes that are non-monetized o Health care not covered by Medicaid o Medicaid encounters paid for by managed care o Prison stays o New York State Office of Alcoholism and Substance Abuse Services

(OASAS)-funded substance use services o New York City Housing Authority (NYCHA) housing o Section 8 housing

• Only 12 months of follow-up time • Analysis based largely on scattered-site housing rather

than single-site

Strengths

• Rigorously constructed comparison group • Analyses accounted for differences during 2 years prior to

NY/NY III placement or eligibility • Broad picture of services and benefits used • Wide spectrum of populations housed

18

Summary • Placed tenants had fewer avoidable health care events than unplaced

applicants

• Placed tenants spent fewer days (and incurred fewer expenditures) than unplaced applicants in jails, shelters, and state psychiatric centers

• There were Medicaid savings for the populations with a substance use disorder and young adults aging out of foster care

19

Acknowledgements

• New York City Human Resources Administration

• New York State Office of Mental Health

• New York City Department of Health and Mental Hygiene

• New York City Department of Correction

• New York City Department of Homeless Services

• New York City HIV/AIDS Administration

• New York/New York III Evaluation Working Group

For more details see:

• Levanon Seligson A, Lim S, Singh T, Laganis E, Stazesky E, Donahue S, Lanzara C, Harris TG, Marsik T, Greene CM, Lipton FR, Myers R, Karpati AM. New York/New York III Supportive Housing Evaluation: Interim Utilization and Cost Analysis. A report from the New York City Department of Health and Mental Hygiene in collaboration with the New York City Human Resources Administration and the New York State Office of Mental Health, 2013. http://www.nyc.gov/html/doh/downloads/pdf/mental/housing-interim-report.pdf

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http://www.nyc.gov/html/doh/downloads/pdf/mental/housing-interim-report.pdf





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