Payer Housing Programs Address Social Determinants of Health

November 15, 2017 - Addressing housing insecurity, a commonly challenging social determinant of health (SDOH), may help health plans transition at-risk beneficiaries to stable housing situations while lowering spending on healthcare services.

A new report from the Association of Community Affiliated Plans (ACAP) explains how health plans, including those that serve Medicaid populations, are bolstering their efforts to transition elderly and homeless beneficiaries into affordable housing in an effort to forestall downstream spending.

Beneficiaries can experience homelessness because the cost of admission into hospitals, skilled nursing facilities, or long-term care. High care costs may subsequently cause beneficiaries to lose their homes, the report explains. If beneficiaries lose their homes, they may not be able to be discharged from their inpatient settings, which drives up the cost of their healthcare utilization.

“In the context of our rapidly changing demographics in the US, transitional homelessness is a vital issue,” ACAP said. “Addressing it requires an effort that stretches beyond the traditional boundaries of health care. It requires a social, housing and whole-person care perspective.”

ACAP provided several case studies of health plans that are tackling the issue by partnering with nonprofit housing specialists, state organizations, and other community stakeholders that can improve the circumstances of at-risk individuals.

Health Plan of San Mateo (HPSM)

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HPSM is a local California plan that provides care to 150,000 residents through five programs including Medi-Cal, Care Advantage Cal MediConnect (a dual demonstration program), Healthy Kids, San Mateo County Access, and Care for Everyone (ACE)/Health Worx.

HPSM developed a pilot program with the Institute on Aging (IOA) and Brilliant Corners (BC), a housing services specialty organization, that helped transition the 192 people into the community from nursing homes.

The Community Care Settings Pilot (CCSP) allows IOA to provide transitional care management to HPSM beneficiaries, while Brilliant Corners delivers housing services and improves housing retention for beneficiaries.

HPSM also partners with other key housing organizations including affordable senior housing developers, county agencies, hospital and nursing facility discharge planners, social workers, and a network of assisted living facilities.

“The impact of the program on individual members’ lives is significant, and without such supports over the long term most individuals would return to a long-term care setting, which would lead to cost growth and a decrease in quality of life for members,” ACAP said.

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“It would also exacerbate issues around capacity, as long-term care beds are in especially short supply in the Bay Area.”

HPSM developed the CCSP by stratifying appropriate enrollee populations.

HPSM leverages numerous different funding and resources to finance the CCSP, such as benefits under the state’s CalMediConnect Medicare and Medicaid demonstration, home and community-based waivers, county partnerships, and the health plan’s strategic investment fund.

CSSP has continuing challenges in funding, data-sharing, and available housing for transitional beneficiaries. As the program grows, HPSM and CSSP will need to evaluate future costs, determine further target populations, and housing needs to keep the program sustainable.

CareSource

CareSource is non-profit managed care plan based in Dayton, Ohio that serves roughly two million Medicaid, Medicare Advantage, CareSource MyCare Ohio (CareSource’s Dual Demonstration), and Exchange members in five states.

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CareSource is currently developing a permanent supportive housing model that targets frail and older adults residing in nursing homes or long-term care rehabilitation centers, but who could be living in lower level of care settings. The model also targets individuals living in substandard housing who are isolated from social services.

The pilot is a collaboration with the Brown, Gibbons, Lang & Company Investment Bankers group. CareSource and the Gibbons organization will renovate a housing complex in Euclid, Ohio, into a living environment for 30 to 40 targeted individuals.

Program success will be evaluated on pre-and post-pilot Medicaid spending for the selected residents, member satisfaction and quality-of-life survey results during the pilot duration, total cost of care, and ED visit rate and readmissions compared to the rates of MyCare regional populations.

While CareSource is reporting a one-third reduction in nursing home stays in the preliminary stages of the pilot, the payer faces challenges with fragmented data reporting that prevent a holistic view of housing-related healthcare outcomes.

Inland Empire Health Plan (IEHP or Inland Empire)

IEHP is a nonprofit Medicaid and Medicare Managed Care Health Plan that serves more than 1.2 million members in the California counties of Riverside and San Bernardino.

Of the plan’s 3500 members in custodial care, 500 are ready to transition back into the community.

IEHP is working to create a transitional service that provides housing assistance for people who are willing and able to transition out of institutions and back into communities. IEHP has also partnered with the Institute on Aging and Brilliant Corners to facilitate the program.

Program goals include successfully identifying additional services such as in-home supportive services (IHSS) and funding for members through systems like Social Security payments.

Previously, IEHP helped successfully transition 570 members to the community between January 2016 and September 2017 by partnering with case coordination and case management organizations. The payer believes their new program will further the successes of their housing transitions initiatives.

Finding affordable housing for transitioning beneficiaries is a constant challenge of IEHP, especially as rent costs continue to increase. Other challenges include siloed IEHP data and housing data that make it difficult to monitor and predict program outcomes.

Vulnerable beneficiaries with significant housing needs require significant assistance to address their housing challenges. This includes greater participation from stakeholders across the country.

“The elderly population, individuals with disabilities and individuals experiencing homelessness are growing at an unprecedented rate,” ACAP concluded.

“When all stakeholders come together to create holistic, national policies that bridge the health and housing gap, we will see real progress towards improving the lives of Americans today and tomorrow.”