Understanding Medicaid Managed Care – Housing

How Safety Net Health Plans Use Housing to Improve Health for High-Utilizing Patients

Care Management | Housing | Jobs | Community Partnerships

Safety Net Health Plans are taking a new tack in the effort to address high use of health services by reaching out beyond the walls of the doctor’s office to address root causes of high utilization. 

One of the biggest drivers of high health utilization is homelessness. Homelessness leads to a significant number of avoidable emergency room visits and hospital readmissions. Hospital admissions or readmissions sometimes have more to do with a patient’s lack of stable housing and other supports than chronic health conditions which require care — and unstable housing situations complicate efforts to provide care management for patients with chronic health conditions.

In some cases, for patients who frequently visit the emergency room or are admitted to the hospital, a connection to stable housing can have a profound influence for the better on a patient’s health, and at the same time contain spending by preventing costly, avoidable hospital visits.

Here’s a real-life example of how addressing housing needs can improve overall health care: through better-coordinated care and an effort to address the needs of the whole individual, Metropolitan Health Plan, the managed-care arm of the Hennepin County (Minn.) Department of Health and Human Services, launched a program to connect members in need of housing to community resources, including stable housing.

The below video profiles Tonya and Richard, two members of Metropolitan Health Plan who came to the plan with unstable housing situations. It shows the dramatic difference that stable housing can make in a patient’s life, and how it can tangibly improve their health while at the same time containing costs.
(Note: This video starts at the 12:50 mark.)  

ACAP-member plan UPMC for You understood intuitively that for a small number of its members, stable housing could have an outsized positive influence on their health status–more so than extra visits to physicians. But given the fierce competition for scarce Medicaid resources, UPMC for You knew that providing housing alone wouldn’t be enough: there had to be a solid business case for providing stable housing to a select set of members, and the numbers had to clearly demonstrate that providing housing led to better health and reduced costs.

A pilot program, called Cultivating Health for Success, served 26 UPMC members who were selected on the basis of their their eligibility via enrollment in UPMC for You’s Medicaid or Dual Eligible Special Needs Plan, their demonstrated need for housing and their history of inpatient hospital stays and/or emergency room visits.

Program participants agree to use a specified primary care practice, and to receive case management support for physical and behavioral health conditions from UPMC.  In exchange, members receive support from the U.S. Department of Housing and Urban Development for stable housing within Allegheny County, and help in finding transportation assistance.

The preliminary results of UPMC for You’s pilot suggest a savings of more than 6 percent in overall costs, while at the same time maintaining or improving the quality of care delivered. In fact, the program’s savings exceeded the costs to operate the program, resulting in net savings for the Medicaid program. One participant in Cultivating Health for Success, Randy Farris, described the difference that access to stable housing made in his health and quality of life. His story follows: