There is an abundance of evidence that housing impacts health. People who lack stable, safe housing, or who have no place to live at all, experience poor health outcomes. In turn, they generate additional costs for the healthcare system.
Historically, it’s been difficult to make a difference for these vulnerable populations. But that’s changing as plans, providers, and policymakers increasingly devote attention and resources to social determinants of health.
At AHIP’s National Conference on Medicaid on Wednesday, Toby Douglas, senior vice president of national Medicaid programs at Kaiser Permanente, discussed some of the work the healthcare giant is doing to care for homeless populations.
Kaiser clinicians screen patients for housing needs and, if necessary, refer them to community resources, Douglas said. And amid efforts to improve the coordination of medical care, Kaiser is also coordinating social services for members in need.
The Oakland-based insurer has close to 1 million members in its Medicaid plans. Across all of its plans, 30% of members are at risk of becoming income, food, or housing-insecure, Douglas said. Plus, of the ten cities with the highest rates of homelessness, six are in areas Kaiser serves, he noted.
Integrating medical care and social services can make a difference, said John Lovelace of the University of Pittsburgh Medical Center (UPMC) Health Plan.
Working with nurses, community health workers, and staff from the Department of Housing and Urban Development (HUD), UPMC was able to house 85% of members with high healthcare expenditures that it identified as homeless (per HUD criteria).
As a result, unplanned medical costs and facility days among those members decreased considerably. Planned office visits, however, increased—signifying better access to preventive and disease-management services.
These initial efforts are like “shiny pennies that will get the attention of the whole field," said Jennifer Leimaile Ho, a consultant who worked in managed care for Blue Cross Blue Shield of Minnesota and United Health Group and, more recently, worked in multiple roles to prevent and end homelessness under the Obama administration. Those isolated investments "will surely improve the lives of each person that they reach," she said.
But industry players can do more to focus on issues like homelessness, she added
"We might need to do this work in a radically different way," she said. "Undistracted by shiny pennies, medical loss ratio, member retention, swings in Congress, or anything else."
Health disparities are “something of a euphemism for racial disparities,” Ho noted. She encouraged the healthcare sector to work directly with—and invest in—leaders and organizations in affected communities to make the biggest impact.
Moreover, she added, AHIP is one of the strongest lobbying forces on Capitol Hill. Member organizations have the power to tell Congress to invest in affordable housing, food assistance, transportation, and other programs that are critical in the fight against poverty.
“Over the long term,” she believes, we can learn “how to get it right.”