The country’s largest managed care organization has reduced costs and improved member outcomes by focusing on housing.
In less than a decade, Cardinal Innovations Healthcare—serving more 850,000 members with complex needs in North Carolina—has made a 71% reduction in crisis services costs for members of its new community housing program.
Officially launched in 2013, the Transitions to Community Living (TCL) program, in partnership with the state Department of Health and Human Services (DHHS), ensures individuals with mental health illnesses have access to safe and affordable housing along with community support to become responsible renters. TCL also teaches participants and their friends and family about recovery and activities to control symptoms and promote wellness.
So far, the program has moved about 850 people—214 in 2018 alone—from adult care facilities into independent housing. Of those who have moved, 72% did not have any emergency department or inpatient admissions last year after they moved into the new residences.
It takes a team of nurses, physicians, social workers and housing specialists to make the program work successfully. Participants are given a $2,000 housing subsidy for transition (and an additional $3,000 if needed).
The TCL program was born out of a settlement between the state of North Carolina and the federal government over a violation of the American Disabilities Act. Mike Bridges, director of TCL at Cardinal Innovations Healthcare, says the state had built a system of putting too many people with mental health issues into a restrictive, inpatient setting, giving the individuals almost no choice on where to live.
So through the settlement, Cardinal began building a program where members could be helped in living independently. So, how does the program work?
First, Cardinal employs a team of certified peer specialists that have experience or knowledge with mental illness to go into homeless shelters and inpatient facilities.
If after a conversation a patient seems at all interested in the services, a team goes through a diagnostic test to make sure the patient is healthy enough to be living alone. The idea is not to place these adults in a housing complex with others with similar issues, but rather to mix them into the general population.
“We want to be very inclusive, so we’re competing with the private housing market,” Bridges told FierceHealthcare. Therefore, Cardinal has developed a relationship with landlords, which includes educating the population on the stigmas of public health, he said.
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Once a place is chosen, Cardinal makes sure that the housing is ready and installs any necessary tools for mobility issues, such as a shower bar or wheelchair ramp. If home healthcare is also needed, it is arranged.
“Bear in mind we are a health plan trying to offer support, but we can’t be successful without provider partnerships,” Bridges said.
Cardinal offers intense support over the first six months of placement, with the idea that on month seven, the providers will take over a bulk of the in-home care. With that said, Cardinal maintains a telephonic health model, which includes monthly calls to members in TCL. At any time, if a patient is having a problem, a face-to-face meeting is scheduled.
Of the 800 people placed in homes through TCL, 620 continue to live on their own. The other 23% have either returned to an adult care facility or passed away.
“What we’ve heard from regulators is that the death rate in adult care homes is actually higher than our members living independently,” he said.
Thus far, members are reporting a better quality of life and less isolation than before moving into independent housing.
But the program is still a work in progress. Bridges notes the team was surprised at how many participants wanted to move after a few years into a different home. The members don’t necessarily want to stay planted too long. Cardinal is also learning about how to help members live with co-morbid mental and medical conditions, as it turns out many patients with mental health issues also have chronic illnesses.
A future challenge is that Cardinal will need to employ creative methods to develop properties and secure units in the private housing market. One of the biggest networks of its members in North Carolina resides in Charlotte, where housing competition is currently high.
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Plus, Cardinal is piloting a program in which members move into a Bridge House, a place where the program can assess an individual’s ability to perform daily activities, such as cooking, cleaning and riding public transportation, on their own. It’s a 120-day trial of skills to see whether the person is ready to live independently.
Overall, Bridges has been amazed by the positive response to TLC.
“We were worried they [TCL members] would report feelings of isolation and the data has not shown that,” he said. In fact, enrollees report a 20% to 30% increase in socialization.