Transcript CSH - L.A. CARE Meeting

Housing As Health Care
NPH Conference
Sharon Rapport, CSH
October 3, 2014
Our Mission
Advancing housing solutions that:
Improve lives of
vulnerable
people
Maximize public
resources
Build strong,
healthy
communities
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
STRATEGIES:
An Innovative &
Effective Model
Develop and refine a
model of housing linked to
care management and
coordinated primary and
behavioral care through
community partnerships.
z
A Solid Base of
Evidence
A rigorous evaluation on
supportive housing‘s
effectiveness as a health
care intervention for
reaching Medicaid‘s highneed, 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
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
Kelly Cullen Community in San Francisco:
Key Partners
TNDC PROPERTY
MANAGEMENT
TNDC SUPPORT
SERVICES
TENANT
LUTHERAN
SOCIAL
SERVICES
SAN
FRANCISCO
DEPT OF
PUBLIC HEALTH
10th-Decile Model in Los Angeles
Collaboration
10th Decile triage tool
hospitals, FQHCs,
homeless services
highest-cost, highest-need
10% of homeless individuals
Health Homes
intensive case
management/ care
coordination
Permanent
Supportive
Housing
The Glue: Intensive Case Management
i.e., Care Coordination + Housing Navigation
housing navigation
and retention
PRIMARY CARE
BEHAVIORAL HEALTH
SUBSTANCE ABUSE
FREQUENT
USERS
20-Jul-15
NAVIGATOR
SUPPORTIVE HOUSING
5
10th Decile Hospital Utilization and Cost Avoidance
(Actuals): 81% Average Decrease In Total Costs Per Client Per Year
ER utilization down 71%
Hospital readmissions down 85%
Inpatient days down 81%
ER costs down 66%
Inpatient costs down 83%
Total costs decreased 81%
FUSE Hospital Utilization
Hospital Cost Avoidance
Pre- and Post-Enrollment
Pre- and Post-Enrollment
average per person, n=60
$59,416 average per person, n=60
Costs not charges
12 mos before
12 mos before
12 mos in program
$73,333
28.6
9.8
12 mos in program
$65,799
8.5
2.8
ER visits
5.5
$7,534
1.2
IPT admits
IPT days
$11,391
$13,918
$2,527
ER costs
IPT costs
Total cost
Average cost avoidance per person: $59,415
Largest 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
6
20-Jul-15
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
Health Home Services
Services to Address the Needs of the “Whole-Person”
COMPREHENSIVE
CARE MANAGEMENT
REFERRAL TO
COMMUNITY &
SOCIAL SERVICES
CARE COORDINATION
& HEALTH
PROMOTION
COMPREHENSIVE
TRANSITIONAL CARE
HEALTH IT, DATA AND
EVALUATION
INDIVIDUAL AND
FAMILY SUPPORTS
OUTREACH &
ENGAGEMENT
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

Next Steps on Health Homes
Webinar: Oct-Nov
Stakeholder
Process
Concept
Paper
Ongoing
Stakeholder
Meetings
Advocacy
w/DHCS
Draft State Plan
Amendment
Implement (mid2016)
[email protected]
(323) 243-7424 (c)
(213) 623-4342, x18 (o)
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