Insurers are joining efforts to address the social determinants of health as one of the most effective ways to take cost out of a healthcare system that is increasingly holding providers responsible for outcomes.
Hospital admissions and emergency room visits are three to four times higher for people who are homeless, according to America's Health Insurance Plans, citing a study by the American Public Health Association.
On a single night in 2017, more than half a million Americans were homeless, according to AHIP.
AHIP released a report Thursday on housing and homelessness and what health insurers, especially those who specialize in managed Medicaid, are doing about it. Strategies include combining housing assistance with community-based support and on-site healthcare.
AmeriHealth Caritas in the District of Columbia has invested $250,000 in organizations that provide housing support, crisis and transitional housing and programs to address substance use disorders as well as education and employment. It is also working with several community-based organizations to establish a Housing Acquisition and Resource Team to provide assessments, housing plan development and integration of psychosocial and medical needs, coordination with core service agencies and existing service providers.
Anthem Indiana Medicaid launched the Blue Triangle Program in May 2017 to provide short-term and transitional housing through 50 single room units in downtown Indianapolis. The program also helps residents through Housing First to gain access to recovery services. The Blue Triangle program has resulted in an $872 monthly average health cost decrease per participant. Since the program launched, 266 people have been referred to the program.
CareOregon has invested more than $4 million to build more than 370 affordable housing units in Portland. It has a specialized team of housing case managers who work with landlords for placement. The insurer also works with Central City Concern to provide recuperative care for homeless members after they leave the hospital. CCC then connects them to a housing network for permanent housing.
Kaiser Permanente invested $200 million to address housing stability and homelessness to prevent displacement and to make affordable homes healthier and more environmentally sound. In 2016, the system invested in Central City Concern development of more than 370 affordable housing units in Portland.
Kaiser Permanente has also supported housing efforts in Denver, providing help for a feasibility study for the creation of an $8.6 million social impact bond to fund a housing program for 250 people who had a history in the criminal justice system.
Molina Healthcare has a Rapid Housing Protocol in Washington State where case managers assess for housing needs and make connections to community resources. It also works with King County Jail to identify individuals with housing needs and with community-based shelters and respite programs.
MVP Health Care offers the MVP Harmonious Health Care Plan in New York which covers adults who are eligible for services for behavioral health and substance use. Eligible members also get access to community-based services for assistance with employment, schooling and stress management, and they can choose to be part of Health Home which helps them find suitable housing. Of 166,000 Medicaid members in New York, close to 4,700 are eligible for Harmonious Health Care Plan.
UPMC Health Plan has partnerships with Community Human Services, a local HUD contractor, to launch the Cultivating Health for Success Program for permanent supportive housing, an assigned medical home and case management service. As a result of the program which began in 2010, medical costs have declined and access to primary care and specialists doubled, along with an increase in pharmacy costs. During the first five years of the program, 51 of 60 enrollees were successfully housed with medical cost savings of $8,472 on average per year and pharmacy cost increases of $2,088 per year, due to better medication adherence. This resulted in overall cost savings of $6,384 for each housed member.
Earlier this year, AHIP also issued a related report on food insecurity and social determinants.