housing as health care nph conference
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Housing As Health Care NPH Conference. Sharon Rapport, CSH October 3, 2014. Our Mission. Advancing housing solutions that:. CSH Social Innovation Fund. z. An Innovative & Effective Model - PowerPoint PPT PresentationTRANSCRIPT
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Housing As Health Care
NPH Conference
Sharon Rapport, CSH
October 3, 2014
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Our Mission
Improve lives of vulnerable
people
Maximize public
resources
Build strong, healthy
communities
Advancing housing solutions that:
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CSH Social Innovation Fund
GOAL: National replication of integrated supportive housing and health services model as a viable alternative to the “revolving door” for homeless people who are frequent users of crisis health care services
FUNDING: $1.15 M annual award from Corporation for National and Community Service (CNCS): 5 yrs
$425,000 annual award to Tenderloin Neighborhood Development Corporation $375,000 annual award to Economic Roundtable
A Solid Base of Evidence
A rigorous evaluation on supportive housing‘s effectiveness as a health care intervention for reaching Medicaid‘s high-need, high-cost individuals
A Blueprint for Scaled Replication
Develop a viable policy for Medicaid-funded intensive care management services are paired with federal, state, & local housing resources
zAn Innovative & Effective Model
Develop and refine a model of housing linked to care management and coordinated primary and behavioral care through community partnerships.
STRATEGIES:
SITES:SAN FRANCISCO, CA
LOS ANGELES, CA
HARTFORD, CT
ANN ARBOR, MI
TENDERLOIN NEIGHBORHOOD DEVELOPMENT CORP.
THE ECONOMIC ROUNDTABLE
CONNECTICUT AIDS RESOURCE CORPORATION
CATHOLIC SOCIAL SERVICES OF WASHTENAW COUNTY
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Kelly Cullen Community in San Francisco: Key Partners
TNDC SUPPORT
SERVICES
TNDC PROPERTY MANAGEMENT
SAN FRANCISCO
DEPT OF PUBLIC HEALTH
LUTHERAN SOCIAL
SERVICES
TENANT
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10th-Decile Model in Los Angeles
Apr 19, 2023
10th Decile triage tool
highest-cost, highest-need 10% of homeless
individuals
Collaboration hospitals, FQHCs, homeless services
Health Homes intensive case
management/ care coordination
Permanent Supportive
Housinghousing navigation
and retention
5
PRIMARY CARE
BEHAVIORAL HEALTHSUBSTANCE ABUSE
SUPPORTIVE HOUSING
NAVIGATORFREQUENT USERS
The Glue: Intensive Case Management i.e., Care Coordination + Housing Navigation
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Apr 19, 20236
Average cost avoidance per person: $59,415Largest individual cost avoidance: $2.2 million
25% of the cohort avoided costs in excess of $100,000
Source: FUSE/SIF hospital cost data, September 2013
ER utilization down 71%Hospital readmissions down 85%
Inpatient days down 81%
ER visits IPT admits IPT days
9.8 8.5
28.6
2.8 1.2 5.5
FUSE Hospital Utilization Pre- and Post-Enrollmentaverage per person, n=60
12 mos before 12 mos in program
ER costs IPT costs Total cost
$7,534
$65,799 $73,333
$2,527
$11,391 $13,918
Hospital Cost Avoidance Pre- and Post-Enrollment
Costs not charges $59,416 average per person, n=6012 mos before 12 mos in program
ER costs down 66% Inpatient costs down 83% Total costs decreased 81%
10th Decile Hospital Utilization and Cost Avoidance (Actuals): 81% Average Decrease In Total Costs Per Client Per Year
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AB 361. “Health Homes” Bill (Mitchell)
Health Home = Virtual “Home” for Addressing the “Whole Needs” of a Beneficiary
Uses an option under Affordable
Care Act to create a “Medi-Cal health home benefit” to Medi-Cal beneficiaries who are—
FREQUENT HOSPITAL USERS
and
CHRONICALLY HOMELESS PEOPLE
Bill signed by Governor Oct 2013
Frequent Hospital User Beneficiaries
Chronically Homeless
Beneficiaries
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Health Home ServicesServices to Address the Needs of the “Whole-Person”
COMPREHENSIVE CARE MANAGEMENT
CARE COORDINATION & HEALTH
PROMOTION
COMPREHENSIVE TRANSITIONAL CARE
INDIVIDUAL AND FAMILY SUPPORTS
REFERRAL TO COMMUNITY &
SOCIAL SERVICES
HEALTH IT, DATA AND EVALUATION
OUTREACH & ENGAGEMENT
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Implementation of AB 361
Define Services: Frequent face-to-face contact (1:20 ratio)
Comprehensive care management: Outreach/engagement Motivational interviewing to identify all needs (not just health)
& plan to meet all health-impacted needs Assist beneficiary get into housing Promote housing stability: help beneficiaries learn to manage
finances, pay rent, shop for or gain access to healthy food, maintain eligibility for benefits, communicate with neighbors & management, and participate in community
Care coordination & health promotion: Include HH staff advocacy with health providers
Referral to social services & supports: Include partnerships with permanent housing
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Next Steps on Health Homes
Webinar: Oct-Nov
Stakeholder Process
Draft State Plan
AmendmentImplement (mid-2016)
Concept Paper
Advocacy w/DHCS
Ongoing Stakehold
er Meetings