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Housing = Health: The Optum Perspective

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By Monica E. Oss, Chief Executive Officer, OPEN MINDS

Over 580,000 people are homeless in the United States according to the U.S. Department of Housing and Urban Development (HUD). This figure was an annual increase of 2.2% from 2019 to 2020, a rate that had increased over the previous four years. Furthermore, the incidence of homeless was more profound among people of color, where 39% were Black or African American and 23% Hispanic or Latino.

With evictions on the rise the pandemic moratoriums end, more people are at-risk of losing their homes, and housing insecure consumers use more health care resources than those who are stably housed.

And still the big question is—what to do about it? What are health plans’ roles in finding solutions for their members who are at risk of homelessness? At Optum Health, they focus on five points: data, policy/systems reforms, investments, partnerships, and new clinical models.

  1. Data: Using integrated data to identify shared populations, track outcomes and impacts, target and coordinate resources, and increase systemwide collaboration.
  2. Policy/System Reforms: Support changes in Medicaid 1115 waivers to pay for tenancy supports and aligning HUD vouchers to connect with health care.
  3. Investments: Make investments to drive development with Stewards for Affordable Housing for the Future (SAHF), pay-for-success initiatives, and low interest loans for safety net services.
  4. Partnerships: Engaging in multi-sector partnerships to increase Medicaid supports for housing-related services and developing value-based reimbursement (VBR).
  5. New Clinical Models: Delivering data-driven, evidence-based solutions that stabilize high-need members experiencing homelessness through the Housing + Health: intensive wraparound care onsite through care management, patient-centered health coaching, addiction recovery support, employment navigation, and non-emergency transportation assistance—transitioning medically stable and financially self-sufficient members to market-rate housing with ongoing support.

There are many ways in which specialty providers can find opportunities in initiatives like the Optum’s. First, providers should ask payers if they offer special funding streams that support service line expansions of health care and social service programs. Providers that can offer hybrid models—virtual and onsite—at housing sites are in particularly high demand for new contracting opportunities.

The need for medical respite services for people experiencing homelessness is also on the rise from pandemic-related stress and illnesses. In addition, holistic health and social services partnerships—from tenancy supports to transportation—across the continuum of care are valuable for alternative payment models, for providers that can offer primary care and behavioral health services) for homeless services with public housing authorities, health plans, state housing finance agencies, transportation sources, etc.

Andy McMahon, Vice President, Health and Human Services Policy at UnitedHealthcare, advised provider organizations seeking new opportunities in the housing market to “Come knock on the door and ask us how you can partner,” he suggested. Do your research and focus your outreach efforts on specific functions and/or departments of the payer organization such as population heath management, community partnerships, and complex care coordination. He cautioned that provider organizations need to come to the table with data on program efficacy and how they will affect outcomes and expenses. “The worst thing for an MCO to hear is that we spent all this money and nothing happened,” said Mr. McMahon. At the end of the day, payers are looking for partners who will help them understand the “shared population,” build relationships, and work across the continuums of care.

For providers and payers willing to come to the table with ideas—community engagement, population health management, complex care coordination, data and outcomes—can find new ways to collaborate to help solve and old and rapidly growing problem. And deliver better care and services for consumers who need affordable housing and supports.

For people with complex needs, medical treatment is primary but can’t occur without housing. Many people with complex needs end up not being able to stay employed and must rely on sponsored disability payments for income. The vast numbers of people with mental illness experiencing homelessness in major cities are a testament to this problem. Different communities address this need for safe humane housing for people with severe mental illness (SMI) in different ways with varying levels of success. Social workers and case managers employed through city government and community mental health centers help patients to find and maintain housing options. But adding housing support and housing programming to the treatment planning for people with complex needs can both save money in the long run and also help people get stabilized so that they can manage their recovery and wellness journey.

The people living with multiple behavioral health and physical conditions, their needs for supports and services straddle multiple programs to address these needs. For example, an individual experiencing homelessness and living with HIV may also be coping with mental health and substance use issues. It is therefore important that effective care coordination and care management services be readily available.

Successfully connecting people to care and services in their own communities requires a commitment to strong social support services. States like New York have fulfilled this commitment by reinvesting savings from the closure of vacant and unnecessary inpatient beds into community services, helping individuals with mental illness to access services in the right service, at the right time, in the right setting.

It is hoped that programs like Optum’s and New York’s will serve as models to encourage other physical health payers and Behavioral Health programs to take on the issue of housing as part of the treatment plan for people with complex needs.