Magellan Health Conference, Lancaster PA, September 6, 2018 Fostering Collaboration in Housing and Health: Opportunities and Challenges Brenda C. Spillman, Josh Leopold, Eva H. Allen
Our Approach • Comprehensive scan of recent housing and health care collaborations and the role of health care delivery and payment reforms • Discussions with housing and health policy and program experts to identify and produce a brief on issues, barriers, and opportunities • Basic guidance documents on steps to initiate and plan a program • Blog post on the potential impact of current budget proposals on collaborations • Search for “Housing and Health” on urban.org
What is a housing and health collaboration?
Key to Health Care Terms Managed care organizations (MCOs) are care delivery and administrative entities that provide and manage health benefits for members through fixed per member payments. Accountable care organizations (ACOs) are a relatively new health care payment and delivery model in which an entity oversees provider networks coordinate and integrate health care services and is financially responsible for health outcomes under a global budget. Value-based payment (VBP) rewards providers for meeting quality of care goals rather than the volume of care provided; applies to public and private payers, MCOs, hospital systems, ACOs and other new care models Section 1115 demonstration waivers allow states to test Medicaid program innovations and delivery system reforms, for example, by expanding eligibility or providing services Medicaid does not typically cover.
New York Medicaid Redesign Team (MRT) Supportive Housing Initiative Key features Brief description A multi-pronged effort to connect vulnerable Medicaid enrollees to health care, housing, and related supports through implementation of health homes, investment of savings from Medicaid Redesign into housing construction and rent subsidies, and pilot grants to test new supportive housing models Geographic scope New York State Program start 2012 Partners State housing, health, and human services agencies Target population High-need, high-cost Medicaid beneficiaries, including those experiencing or at risk for homelessness Participants served More than 11,000 Services Care coordination and links to services and supports; supportive services Funding State Medicaid redesign-related savings, bonds for construction, health home program
Integrated Care for the Chronically Homeless Key features Brief description A collaboration among a Federally Qualified Health Center, a homeless services provider, and a housing provider to bring integrated health care and social supports to individuals who are experiencing chronic homelessness Geographic scope City of Houston and Harris County, Texas Program start 2014 Partners The Houston Health and Human Services Department, the Houston Housing Authority, and the City Housing Department Target population Individuals experiencing chronic homelessness who had at least 3 emergency department visits over past two years Participants served 200 Services Primary care, substance use and behavioral health counseling, health navigation, clinical case management Funding Medicaid 1115 Waiver DSRIP payments, HRSA Health Center Program, and various grants. Rental subsidies are provided through the Houston Housing Authority
Housing with Services Key features Brief description A Limited Liability Corporation of 9 partners established to coordinate health care and social services for seniors and people with disabilities living in subsidized housing Geographic scope Portland, Oregon Program start 2014 Partners Housing and social service providers, Medicaid health plan Target population Low-income seniors and people with disabilities living in HUD- subsidized housing who opt-in to the program Participants served More than 680 of 1,400 residents in participating buildings Services Health care navigation and care coordination, health screenings and education, links to mental health and dental care, medication management, wellness services, food insecurity prevention, peer support Funding LLC partners’ equity contributions, SIM grant, and grants from foundations and private organizations
Take-Aways • Collaborations can occur at any level: state, county, city, local • Leadership is critical • High-need, high cost populations are often the target • Careful planning and ongoing communication is critical • Funding opportunities for collaborations are varied • Managed care could play a big role • Acquiring, using data to support collaborations is difficult
Collaborations Can Occur at Any Level • Many successful collaborations are local, often small-scale, but many are scalable and replicable • Impetus may come from city, county, state agencies, or from housing or health care providers • States can play an important role • Supporting local initiatives through state policies or funding • Using state authorities and resources to enact statewide reforms and new programs
Leadership • Collaborations require engagement and commitment from a range of partners • Leader, or “champion,” is essential to bring partners to the table and keep them there • Basic leadership functions • Identify and convene key partners • Develop a shared vision for the collaboration • Enlist key decision makers and get buy-in • Garner resources and/or support from stakeholders • Keep partners and stakeholders motivated
Targeting High-Need, High-Cost Populations • Goals • Improve health and functioning outcomes • Reduce avoidable public costs for emergency room, hospital, and institutional care • Challenges • It’s hard to quickly improve outcomes for people with long-neglected, chronic health needs • Time is needed to achieve cost savings
Planning and Communication • Health care, housing, and social service providers often know little about each other • Careful planning process can support learning, relationship building, and minimize conflicts • Establishing trust and good working relationships with partners and staff requires: • Learning each other’s “language” • Championing change • Supporting staff development • Ongoing communication is critical for the long-term
Funding Opportunities • Potential funding sources • Federal demonstrations or pilots • Public-private partnerships (e.g., pay for success) • Grants from philanthropies and state and local governments • Equity and in-kind contributions from providers and others • Housing-related services may be covered by Medicaid for certain populations • Affordable housing units can be prioritized by housing agencies; public and private entities may invest in rent assistance, development • Health care services may be covered by Medicare, Medicaid, safety net providers for the uninsured
State Medicaid programs can play a big role in collaborations, but… • Over 75% of Medicaid beneficiaries are enrolled in managed care organizations (MCOs) • MCOs may see addressing housing needs as a way to improve health and reduce costs • MCOs often lack expertise, connections to housing and social service providers • MCOs may face financial disincentives to integrate housing through rate-setting methodology
Acquiring and Using Data • Data is key for planning, implementation, evaluation • To identify the scope of a problem, make the case for collaboration, develop an effective intervention • To identify and enroll eligible participants • To share information, coordinate services with partners • To monitor implementation progress and measure program effectiveness • Barriers to effective data sharing • Lack of infrastructure, compatible data systems • Health information privacy laws • Effective communication and good working relationships can support workarounds when necessary
Conclusions • Broad trend toward whole-person approaches to care, ACA provisions, and many pre-existing authorities have contributed to rise in housing and health collaborations • More work is needed on • how collaborations come together • what barriers prevent other jurisdictions from adopting them • what is needed to sustain them • how they affect individuals’ health and well -being • Federal, state, and local governments have tools to foster greater collaboration in housing and health
Urban Institute Resources Visit the webpage below to find: • An environmental scan of existing collaborations • An issue brief on lessons learned from successful collaborations • Two technical guides to help stakeholders identify and engage partners and plan a collaboration • A blog post on the potential impact of current budget proposals on housing and health collaborations http://www.urban.org/policy-centers/health-policy- center/projects/fostering-collaboration-housing-and-health
Additional Urban Resources • Emerging Strategies for Integrating Health and Housing : https://www.urban.org/policy-centers/cross-center-initiatives/social- determinants-health/projects/emerging-strategies-integrating- health-and-housing • How Housing Matters: https://howhousingmatters.org/ • Social Determinants of Health: https://www.urban.org/policy- centers/cross-center-initiatives/social-determinants-health/projects
Recommend
More recommend
