AHIP Addresses Social Determinants of Health, Aims to Improve Housing Stability
“Social determinants of health” is a buzz phrase that is being bandied about a lot in the managed care industry, and for good reason. Payers who give them short shrift risk having sicker, costlier members. The CDC defines social determinants of health as “conditions in the places where people live, learn, work, and play [that] affect a wide range of health risks and outcomes.”
Determinants that negatively impact health can also be called—perhaps more appropriately--barriers. There may be no more complicated barrier than insufficient housing—specifically, housing instability and homelessness. America’s Health Insurance Plans (AHIP) recently release a report entitled Safe & Affordable Housing: Social Determinants of Health that defines the issue, summarizes research on the topic, and presents success stories.
In the meantime, we asked Rashi Venkataraman, AHIP’s executive director of Prevention and Population Health, to point out the common themes seen in programs that successfully address the housing barrier.
She offered these three best practices:
- Consider the needs of the members you are serving, as well as how local regulations impact them.
- Determine the best type of housing for your members.
- Form partnerships that deliver appropriate, affordable, and sustainable housing.
It is important to approach the housing challenge in that order, explained Ms Venkataraman. “There is no one-size-fits-all approach. Housing instability, availability, and affordability look very different as you move through various markets. What works in New York City is not necessarily going to work in the rural Midwest or even in another urban market, like Los Angeles.”
The other reason to tackle the issue chronologically: “Often, federal and state resources are narrowly defined for specific populations with strict eligibility requirements,” noted the AHIP report. “Innovations in housing must be tailored to local needs–some cities may have a critical shortage of affordable housing, while for others, the bigger issue may be the quality of the available housing.”
Success in Action
The AHIP report points out how plans employ different strategies based on the population and eligibility requirements. For example, Anthem Indiana Medicaid recognized that its members who were at risk of becoming homeless could benefit from a temporary solution that would catch them before they ended up on the streets. Anthem established the Blue Triangle Program to provide short-term, transitional housing and health care through single room units in downtown Indianapolis. The program not only works to connect members with long-term permanent housing, it also provides mental and physical health care, often on site. Anthem relies on expertise through partnerships formed with municipal officials, a housing organization, and a mental health center.
Since its inception, 105 individuals have moved into the program, and 9 in every 10 have received services, including case management, peer support, life skills training, and medical care. Inpatient stays have declined by 40%, and Anthem is seeing a cost reduction of $872 per participating member per month.
Meanwhile, the UPMC Health Plan learned from providers and hospital discharge planners that up to half of its dual eligible special needs plan members might be homeless at any time. In 2010 it established the Cultivating Health for Success (CHFS) program with a local HUD contractor. The program integrates permanent supportive housing, an assigned medical home, and case management services to coordinate health care. Eligibility is based on the HUD definition of homelessness. Participants must also have a medical disability and at least one year of high health costs.
Over the first five years of the program, 51 of 60 members were successfully housed through CHFS. UPMC saved nearly $8500 per participating member per year. Moreover, pharmacy costs increased by more than $2000 per participating member per year, an indication that patients were taking their medicines as prescribed.
Additional examples are provided in the report.
Ms Venkataraman said the savings should be no surprise, since studies show that health outcomes are influenced much more by health behaviors than by genetic factors—by a margin of 4-1, according to some research. Viewed through that prism, establishing partnerships to assist vulnerable populations is crucial. “Health insurance providers do not work in a vacuum to address social determinants of health and health disparities. They assess their local market needs and partner with community organizations” that have unique insights into members’ socioeconomic challenges through a different prism than the health plan.
“Ultimately, strategies to address the social determinants are about improving consumer health, reducing consumer costs, and improving customer satisfaction. So this isn’t only the right thing to do,” said Ms Venkataraman, “it’s the smart thing to do.”
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