• Welcome and Introductions• 1000 Homes Update• Health Care’s Role in Ending Homelessness • Local Health Partners• Outlining next steps in your community

AGENDA

INTRODUCING FACULTY

Catherine CraigHealth Integration, Common Ground National Programs

Catherine has 13 years of experience in hospital- and community-based social work, mental health research, and systems improvement. Her role with the 100,000 Homes Campaign is to identify successful models that bring together health care, outreach and housing providers; pinpoint sustainable funding streams for services in housing; demonstrate the health impact of housing; and help communities to learn from each other’s successes.

Homelessness & HealthSCOPE

405,000+ Americans live on the streets and in shelters each yearRoughly 110,000 experience homelessness for >1yr: “chronic”1

MORTALITYThe most vulnerable of these individuals experience multiple chronic illnesses, substance abuse and/or a psychiatric disability

HEALTHCARE SYSTEM 3% of Medicaid patients incur 31.7% of costs2

2/3 of Medicaid patients with frequent admissions are homeless or unstably housed3

Lack of connection to primary care

Better Care, Lower CostPERMANENT SUPPORTIVE HOUSING LEADS TO…• Reductions in Emergency Department & inpatient ~ 60%• Increases in preventive care - CT: 71% decrease in inpatient care with increase in outpatient medical mental health and substance abuse care5

- ME: 41% decrease in total mental health costs with 35% increase in outpatient mental health services6

Healthcare savings range from US$1,130 to US$17,625

per member per year

Determinants of Health and Their Contribution to Premature Death

Social circumstances

15%

Environmental exposure

5%

Health care10%

Behavioral patterns

40%

Genetic predisposition

30%

Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. (2002). The case for more active policy attention to health promotion. Health Affairs, 21(2): 78-93.

Proportional Contribution to Premature Death

Illness Burden   N %

Frostbite 930 14.1%

HIV/AIDS 413 6.3%

Kidney 573 8.7%

Liver 1087 16.5%

ER 3X+ in 3 Months 1637 24.9%

Age 60 or older 1510 23.0%

Tri-Morbid 3226 49.0%

ER or Inpatient 3X or more in 1 year 2850 43.3%

Length of Homelessness Among Total: 4.74 years Among Vulnerable: 5.64 years

15,208 Surveys 6,579 Vulnerable

Risk Qualifiers Among Vulnerable

Hospital Provider to patient:

“Go home, take care of yourself,

get lots of sleep, take your medications,

make sure to stay dryGO SEE YOUR DOCTOR

and come back and see me in a couple weeks…”

Patient to discharge planner:

“I don’t have a home, I’d love to take care of myself,

but I can’t sleep all night went where I camp, my medications were just stolen,

my sleeping bag is soaked and lostI DON’T HAVE A DOCTOR

and I don’t have a phone or a way to get back up to the hospital…”

Created by Nic Granum, Central City Concern Recuperative Care Program, 2010.

Housing is a Resource for Health & Health Care   Permanent Supportive Housing helps to:

Reduce health care costs Tenants engage in primary and outpatient care, avoiding high cost of hospital-based and long term care (emergency rooms, inpatient care & nursing homes)

Promote healthy behaviorsTenants self-manage: eat better and more regularly, take medication, reduce risky behavior & are better able to keep appointments

Support engagement in health carePSH service providers can coordinate with health care providers & assist tenants to understand the treatment plan

The Model & Health Care’s Role

THE HEALTH CARE LANDSCAPE 

Which local hospital is a natural partner? - Public hospital - Not-for-profit hospital

Who are you not yet linked with?

What about community health centers? - Health Care for the Homeless Clinics - Federally Qualified Health Centers (FQHCs)

HEALTH CARE REFORM: Health Centers

  Goal: Double health center volume by 2015

20 million 40 million people

Community health centers are key community partners• For service collaboration• As venues of integrated care, “Health Home”• Health Care of the Homeless as a unique resource

Invests $11 billion over 5 years• $9.5 billion for new locations and services • $1.5 billion for capital

WHO WILL YOU TALK WITH NEXT? 

Who do you already have at the table?

How can these messages strengthen their participation in your registry efforts?

Who is your liaison at the local hospital?

What messages have your State Medicaid office and local health care providers not heard yet about homelessness and housing?

Potential Next Steps  

Meet with local hospitals to:Inform hospital officials of the 1,000 Homes initiative and ask: - that the Vulnerability Index be administered in the emergency room during Registry Week - them to participate on the leadership team - compare costs to the hospitals of people who are now in permanent supportive housing v those who are not - create a specific housing initiative targeted to housing people identified as frequent users of the emergency room - identify opportunities for funding services through Medicaid

Nonprofit Hospitals  Note: New IRS requirements to complete Community Needs

Assessments

How the 1,000 Homes Initiative can be a partner - Collaborate to complete community needs assessment (VI) - Ask for community benefit funds to pay for services in housing

HOUSING: Health Care Translation 

Advocacy Talking Points

Medicaid helps end homelessness by providing access to primary care and coordinating key services

PSH + Medicaid can be cost-effective for communities

Housing and health supports can fit together to improve lives and make a stronger safety net

Action Steps  Assign a health care “lead” in your organization or network

Tell your story, share your vision – concrete, visible, and compelling

Know your audience: Mainstream housing (for-profit developers, PHAs)Healthcare partners (local reform coalitions, nonprofit hospitals, clinics)Public agencies (health, housing, social services)Safety net advocates and providersLocal and state legislators

LOCAL CAMPAIGN RESOURCESCampaign Endorsers in HealthcareNational Association of Public Hospitals and Health Systems www.naph.orgNational Association of Community Health Centers www.nachc.orgNational Healthcare for the Homeless Council www.nhchc.org National Alliance on Mental Illness www.nami.org

To partner With a public hospital, community health clinic, or mental health resource in your

community, contact Catherine Craig ccraig@commonground.org

Health Integration Call Series – Join us June 21 at 2 EThttp://100khomes.org/resources/Health-Integration-call-series-archive