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Health in Housing The intersection between housing and health care OHCS Housing Stability Council Amanda Saul, Enterprise Community Partners July 8, 2016
Center for Outcomes Research and Education
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Research Questions
? What is the effect of stable, affordable housing on health care outcomes in a low-income population who has experienced housing instability?
?
What role do integrated health services play in health care expenditures and quality?
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What’s different about this study
• Uses claims data to assess health care costs and utilization
• Looks across several different affordable housing types
• Looks at the effect of integrated health services
• Analysis of impact in a Medicaid plan that serves more than 10,000 residents in major metropolitan area
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Health staff
145 properties:
Resident Services Coordinator 88%
Community Health Worker or Health 11% Navigator
Social Worker 8%
Doctor, Nurse, or Nurse Practitioner 6%
Activities Coordinator 6%
Other Health Professional 11%
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Health services
145 properties:
Food Resources 68%
Medical Resources 54%
Insurance Assistance 36%
Mental/Behavioral Health Resources 35%
Fitness Resources 29%
Nutrition/cooking Resources 23%
Transportation Resources 19%
Dental Resources 15%
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Prevalence of physical health diagnoses (claims data)
20%
9% 10% 12%
3%
14% 18%
8%
17%
3%
42%
21%
17% 20%
15%
54%
20%
28%
21% 19%
0%
10%
20%
30%
40%
50%
60%
Hypertension Asthma Diabetes Obesity COPDHypertension Asthma Diabetes Obesity COPD
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13% 10%
2% 2%
17%
13%
2% 3%
51%
34%
11%
15%
34%
26%
9% 10%
0%
10%
20%
30%
40%
50%
60%
Affective Disorder Depression Chemical Dependency Non-Organic PsychosisAffective Disorder Depression Non-Organic Psychosis Chemical Dependency
Prevalence of behavioral health diagnoses (claims data)
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Analyzing changes in health care cost & utilization
MOVE-IN DATE
Date each individual moved into
included property
BASELINE DATA
All available claims
prior to key date
FOLLOW-UP DATA
All available claims
since key date
• Medicaid claims of 1,625 residents
• Includes all physical, behavioral, mental, and dental claims
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KEY FINDING
Health care costs went down significantly
Per member, per month costs
Before move-in: $ 386
After move-in: $ 338
$ 48
Overall Cost Reduction: 12%
Extrapolated annual cost reduction: $936,000 a year across 1,625 residents
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Costs down across all housing types
$0
$100
$200
$300
$400
$500
$600
$700
Overall FAM PSH SPD
-12% *
Avg
. pre
/po
st c
ost
(P
MP
M)
* Statistically significant change, paired t-test, p<.05
-8%
-14% *
-16% *
Pre
Post
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KEY FINDING
Residents used health services differently when they had housing
Emergency Department
-20%
Primary Care +18%
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0.0
0.2
0.4
0.6
0.8
1.0
1.2
1.4
1.6
Overall FAM PSH SPD
Avg
. # E
D V
isit
s (P
MP
Y)
Emergency Department use down across all housing types
-18% *
* Statistically significant change, paired t-test, p<.05
-37% *
-18% *
Pre
Post
-10% *
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0.0
0.5
1.0
1.5
2.0
2.5
3.0
3.5
4.0
4.5
5.0
Overall FAM PSH SPD
Avg
. # P
CP
Vis
its
(PM
PY)
Primary care visits up across all housing types
+20% *
* Statistically significant change, paired t-test, p<.05
+23% *
+19% *
Pre
Post
+17% *
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0%
10%
20%
30%
40%
50%
60%
70%
Overall FAM PSH SPD
Ability to get care same or better across all housing types
40%
% o
f Su
rvey
Res
po
nse
s 50%
4%
27%
64%
4% 6% 3%
59%
32% 35%
54% B
ette
r
Sam
e
Wo
rse
Wo
rse
Wo
rse
Wo
rse
Bet
ter
Bet
ter
Bet
ter
Sam
e
Sam
e Sa
me
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0%
10%
20%
30%
40%
50%
60%
70%
Overall FAM PSH SPD
Quality of care same or better across all housing types
38%
% o
f Su
rvey
Res
po
nse
s 48%
7%
23%
62%
8% 7% 6%
46%
40% 42% 43%
Bet
ter
Wo
rse
Wo
rse
Wo
rse
Wo
rse
Bet
ter B
ette
r
Bet
ter
Sam
e Sa
me
Sam
e
Sam
e
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Analyzing impact of integrated services
• Bucketed staff and services into three categories to assess impact
• Health Staff & Services – Includes medical, mental health, and dental staff and services
• Social Staff & Services – Includes Social Workers, Community Health Workers, Health Navigators
• Wellness Staff & Services – Includes food/cooking services, fitness services and other residential activities
• Utilized multivariate regression models to measure impact of each service category
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KEY FINDING
Integrated health services drove outcomes
…even though awareness was low
Adjusted impact of health services
Expenditures $ 115 per member per month
ED Visits 0.43 visits per year
Awareness of select services
Medical 33%
Mental Health 26%
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Emerging Best Practices
Housing With Services – A collaboration of 3 housing owners, 5 services providers and funders have come together to serve 1400 senior and disabled residents in 11 buildings located in downtown Portland. Services include:
• A Resident Services Coordinator • Health Navigators funded by a Medicaid insurer, available to all
residents, even if not insured by them • A health and wellness center • Primary and urgent care • A Providence ElderPlace PACE program • Prescription medication management
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Emerging Best Practices Northwest Housing Alternatives partners with Mount Hood Community College’s School of Nursing. Student nurses provide onsite preventive health care visits twice a month at senior affordable housing projects. Services include:
• foot and nail care • medication management • oral hygiene screenings • heart and lung checks • blood pressure screenings • BMI measurements • health literacy & food insecurity assessments • depression & vision screenings • blood sugar monitoring
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Emerging Best Practices Central City Concern’s Housed and Healthy (H+H) Program – a collaborative project which coordinates communication and services between Resident Service Coordinators in affordable housing and care teams at local health clinics. The program includes: • Needs assessments at move-in to identify high-need
individuals • Standardized Release Of Information forms • Streamlined referral processes • Increased coordination between service providers, and in-
housing programming to improve residents’ health
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What’s Next?
Share findings & recommendations with decision makers including CCOs, hospital systems, Oregon Housing and Community Services, the state legislature and the Oregon Health Authority to increase the use of Medicaid used for housing supports.
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What’s Next?
Work with philanthropic funders, Family Care, OHA, Human Solutions, Home Forward and service providers to pilot a Flexible Benefits fund. The funds will be used for rental assistance, eviction prevention, rapid rehousing and other coordination services for people experiencing a health and a housing crisis.
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What’s Next? Work with the Oregon Health Authority on its Medicaid 1115 Waiver. The draft waiver includes Medicaid funds for a targeted number of at-risk adults, families, and adults eligible for both Medicare and Medicaid programs including: • Homelessness prevention - care coordination at exit • Tenancy supports – 1st/last month rent • Housing sustaining services – eviction prevention • Incentivize CCOs to use Flexible Benefits Funding by
considering them “health related expenses” rather than administration expenses
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Amanda Saul Enterprise Community Partners Senior Program Director [email protected] www.EnterpriseCommunity.com
Maggie Weller, MS Center for Outcomes Research and Education, Project Manager [email protected]
Center for Outcomes Research and Education