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CSH Improves Health and Lowers Care Costs for the Long-Term Homeless

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Logo of the Corporation for Supportive Housing

Individuals experiencing long-term homelessness also often suffer from medical fragility caused or aggravated by life on the streets and in shelters. Lacking stable access to housing and preventative health care services, they become “high-utilizers” of costly inpatient and emergency care.

The Corporation for Supportive Housing (CSH) advances high-quality solutions and cost-effective programs to improve the lives of the most vulnerable people in our society by supporting locally-based organizations that provide access to public resources that enable the chronically homeless to connect to homes, health care, and the community. As a Social Innovation Fund (SIF) intermediary, CSH is leading a project that integrates health care and housing for individuals with multiple, chronic health conditions who experience homelessness.

These individuals often fall into the gaps between systems of care. A shelter provider and a hospital, for example, seek to meet different needs of an individual. The shelter may overlook or be unable to help the individual with health problems, making it harder for him to find and keep stable housing. The hospital, in turn, may overlook non-medical factors such as housing instability that could make its treatment plans for a patient less effective.

CSH bridges these gaps by integrating supportive housing – affordable housing and comprehensive services – with special emphasis on health services to improve access and outcomes while lowering costs for public systems such as Medicaid.

“Using this integrated approach, both the health care and housing systems are able to develop coordinated service delivery that ensures greater access to care and better outcomes for individuals,” said CSH Director Sarah Gallagher. “We’re hoping to have a win for vulnerable men and women on a personal level, create healthier communities, and save resources and public funding in the long term.”

CSH utilizes a three-pronged strategy that makes use of:

  1. Data to identify individuals who are experiencing long-term homelessness;
  2. Focused efforts to locate them and help them access stable housing; and
  3. Guidance to help them remain housed and receiving the care they need to improve their health and reduce avoidable and costly acute inpatient hospitalizations, trips to emergency departments, and other crisis services.

In executing this strategy, CSH brings to bear its housing and service-coordination expertise and a holistic approach.

“We have been able to work with our SIF sites to either match existing data from health care administrative systems, such as hospital data or Medicaid data, with data on homelessness, or use a data-driven triage tool to identify the cohort of high utilizers who may be even more vulnerable because of their housing instability,” Gallagher said. “Through these data-driven targeting strategies, we are able to design unique solutions to meet their complex needs.”

CSH is coordinating its SIF-funded work through four organizations: AIDS Connecticut; Catholic Social Services of Washtenaw County in Ann Arbor, MI; Economic Roundtable in Los Angeles; and the Tenderloin Neighborhood Development Corporation in San Francisco.

“This mix of subgrantees enables CSH to test its model in a range of settings, from urban areas to small communities,” noted SIF Interim Director Lois Nembhard. “Their experience and the results of their rigorous SIF evaluation will be instructive for providers and funders of homeless and health services across the country.”

Recent successes include housing 476 individuals and achieving a 91 percent retention rate in housing for this cohort, especially notable given the population’s long-term homelessness and cycling in and out of institutions. In addition, around 85 percent of participants are connected to a primary health care provider.

“The supportive housing model intuitively makes sense: if you first stabilize someone’s housing situation they are better able to focus on addressing the other challenges in their life,” said SIF Program Officer Parita Patel. “During a visit to Columbus House, an AIDS Connecticut partner, a man who had been housed through this SIF-funded project told me, ‘The SIF program gave me back my health, and saved my life.’ This confirmed for me the value of the approach and validated that a key to a home opens new doors for individuals who have experienced long-term homelessness.”

CSH’s data-driven strategies have also given it a platform to work with partners to better align services.

“Sharing and comparing data across multiple systems really helps start conversations,” said CSH’s Gallagher. “They allow communities to see how clients are moving through their systems, and help to identify opportunities to coordinate services and remove barriers to better help those more in need.”

Showing hospitals how releasing patients to the homeless system increases the likelihood they will need additional, expensive care, for example, can encourage them to integrate housing plans into their discharge plans. Showing health care systems and Medicaid departments how expensive high utilizers can be builds the case for innovative solutions that meet client needs at a lower cost.

In Connecticut, for example, CSH and partners matched homeless data to state Medicaid data and found (PDF) that the top 10% of homeless, high-cost utilizers are nine times more expensive than the average Medicaid beneficiary. The subsequent work of CSH and its SIF subgrantee, AIDS Connecticut, to address this issue with supportive housing and integrated health care has improved outcomes for clients.

It has also garnered recognition from state policymakers. According to CSH’s Gallagher, the state and its governor allocated 150 state-funded rental-assistance vouchers for the program and are exploring efforts to sustain services past the end of the SIF-funded program.

Additional information about CSH’s SIF project can be found online.

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