Health care study explores the impact of housing on health care use, costs and outcomes

Survey of residents at Bud Clark Commons shows a 55 percent reduction in health care costs
when individuals have stable housing and access to health care services

A recent study of residents at The Apartments (at Bud Clark Commons indicates a direct relationship between stable housing and both the reduction in health care costs and in improved health care outcomes for Medicaid members. The study, conducted by the Center for Outcomes Research and Education (CORE) at Providence Portland Medical Center on behalf of Health Share of Oregon and Home Forward, found that health care costs, including emergency room visits and hospitalizations, fell by over 50 percent in the first six months after a resident moved into stable housing, and continued to dip in the second and third years after moving in. Concurrently, residents reported significant reductions in unmet needs for physical and mental health care and better health overall.

The study, which was based on resident surveys and health care utilization data, included 99 of the 130 residents at The Apartments at Bud Clark Commons (BCC), a permanent supportive housing building in downtown Portland which serves residents who have been experiencing homelessness and complex health issues. Results showed that in the year before they moved into BCC, residents on Medicaid averaged total health care costs of $2,006 per month, or 4.4 times higher than the average adult Medicaid member. In the year after moving in, average costs were $899 per month, a 55 percent decline.

[Read the full study here.]

“The results of this study reinforce what we already know about what impacts an individual’s health outcomes,” noted Janet Meyer, chief executive officer of Health Share of Oregon. “You can’t begin to help someone get their chronic health conditions under control when they’re living in a doorway or under a bridge. Stable housing, along with other social determinants such as adequate food and transportation, is critical in improving outcomes by helping to manage chronic health conditions.”

The study indicates the average resident saw a reduction of over $13,000 in annual claims, which is an amount greater than the estimated $11,600 to house a resident at BCC. Additionally, the reduction in claims was maintained into and beyond the second year of their residency, suggesting that supportive housing has an ongoing impact on health care costs.

“The study certainly adds to evidence supporting a ‘housing first’ model,” said Bill Wright, associate director, Center for Outcomes Research & Education (CORE) at Providence Health & Services and principal investigator for the study. “We found that even when stable housing is not predicated on having already overcome addictions issues; it can produce dramatically better health care outcomes and reduced costs.”

Residents also reported significant declines in unmet health care needs, as well as improvements in their own physical and mental health after moving into BCC.

“The Apartments at Bud Clark Commons pair housing and health care to provide some of the most vulnerable residents in our community with a good place to call home.  We’re very pleased that the research results demonstrate the value of this innovative model,” said Steve Rudman, executive director, Home Forward) .

“This demonstrates that our investments in affordable housing and ending homelessness are key to reducing health care costs and improving health outcomes in our community. Housing is health care. We’re proud to partner in this work,” said Traci Manning, director, Portland Housing Bureau.

BCC is an innovative partnership among the Portland Housing Bureau, Home Forward, Transition Projects, Inc., and Multnomah County. The center provides vital resources, shelter and housing placement services to individuals and couples experiencing homelessness in Portland.

BCC apartment residents often have numerous health issues and complex psychosocial barriers that make them among the costliest patients to care for in the community. Coordinated care organizations such as Health Share are increasingly looking for new strategies to effectively care for these highly complex and costly patient populations.

“We’re looking forward to continuing our conversations with affordable housing stakeholders in the Tri-County area,” added Meyer. “Addressing the needs of these members, those who often receive the least benefit in terms of health outcomes, but who often use the greatest amount of health care resources, will be critical to the success of health care transformation.”

 

 

Community Advisory Council announces focus areas for Health Share of Oregon’s 2014-2015 Community Health Improvement Plan

Year-long assessment designates Behavioral Health and Chronic Disease as population health priorities

After nearly a year of inquiry and analysis, the Community Health Needs Assessment (CHA) Committee, a subset of Health Share of Oregon’s Community Advisory Council (CAC), has designated Behavioral Health and Chronic Disease as the two priorities for focus in Health Share’s Community Health Improvement Plan, which will be submitted to the Oregon Health Authority (OHA) in Spring 2014.

“While the process has been time consuming and sometimes overwhelming, it has been a privilege to work with the members of this committee who have been unwavering in their commitment to ensure that the needs and priorities of the communities are heard,” said Committee Chair Sonja Ervin. “Behavioral health issues and chronic disease related to issues of nutrition and physical activity are impacting so many in our communities.  We are hopeful that the work that is being done in Health Share and the Committee will begin to reduce the health disparities and build healthy communities.”

Under the direction of Ms. Ervin, the committee members Joseph Lowe, Tab Dansby and Ronda Harrison have, since February 2013, engaged in a comprehensive process to identify the population health issues Health Share, the state’s largest coordinated care organization, will address through 2015.

The goal of Health Share’s Community Health Needs Assessment is to reduce health disparities, promote health equity and improve overall population health. The regional Healthy Columbia-Willamette Collaborative (HCW) community health needs assessment served as a foundation for Health Share, which then used community-led self-assessments and health disparities from Health Share’s own member data to further prioritize needs. Health Share focused on finding community-led self-assessments from a wide array of communities.

“Health Share staff is excited to work with our Council members on population health,” said Janet Meyer, Health Share CEO,” because in order to improve health outcomes for our members we have to get ahead of the curve and begin to focus on prevention. We can no longer focus just on the individuals in a clinical setting, we have to move further out into the community to support health in our members’ families and neighborhoods.”

The Community Health Improvement Plan, which will be reviewed and approved by Health Share’s CAC and Board of Directors in May, will focus on addressing behavioral health and chronic disease within identified communities served by Health Share.

Community Health Improvement Plan
As a part of health care transformation in Oregon, the Oregon Health Authority asked the 16 coordinated care organizations (CCOs) throughout the state to collaboratively engage in a systematic approach to assessing the health of the populations they cover and the communities those populations live in, and then planning to improve the health of those communities by addressing health disparities. As part of this process, CCOs are developing a CHA and adopting an annual Community Health Improvement Plan.

Health Share’s Community Advisory Council will use the Community Readiness Model from Colorado State University’s Tri-Ethnic Center for Prevention Research as a basis for Health Share’s Improvement Plan. This model was chosen because it is measurable, multi-dimensional and allows matching of interventions to the community’s level of readiness which is critical for success. The process identifies community leaders and impacted communities, and solicits questions around the level of awareness and commitment to address community health.

Community Advisory Council holds next public meeting March 7 at the Edwards Center in Aloha

Health Share’s Community Advisory Council will hold their monthly public meeting beginning at 12:30pm on Friday, March 7 at the Edwards Center (34375 SW Edwards Place) in Aloha.

At the March meeting, the Council will discuss Health Share’s Cultural Competence Workgroup Assessment results and hear a report from the Oregon Health Authority on Medicaid expansion.

The meeting is open to the public and Health Share members are encouraged to attend.

Date:

Friday, March 7, 2014

Time:                         

Council Meeting:  12:30pm to 3:30pm

Public comment period:  3:10pm to 3:25pm

Location:

Edwards Center
34375 SW Edwards Place
Aloha, OR  97007

Agenda:

Posted to the Council’s website one week prior to each meeting

Reasonable accommodations will be provided as needed for persons with disabilities. Those needing accommodations should contact Rosa Klein at rosa@healthshareoregon.org or (503) 416-4974 at least 48 hours before the meeting.

Health Share holds next community open house Tuesday, March 11 at Pioneer Community Center in Oregon City

Our January community open house in North Portland drew a packed audience.

Our January community open house in North Portland drew a packed audience.

Health Share has been serving Oregon Health Plan members in Clackamas, Multnomah and Washington Counties for over a year.  As part of our efforts to improve health care delivery, Health Share is holding community open houses throughout the Tri-County area over the next several months to learn more from providers and the community about what we are doing well and what we can do better.

The next open house is on Tuesday, March 11 at the Pioneer Community Center in Oregon City.

When: 6:00 pm to 7:30 pm on Tuesday, March 11

Location: Pioneer Community Center; 615 5th Street, Oregon City, OR  97045

This event is free and open to the community.

Free dinner will be provided for participants.

Free child care, interpretation and closed captioning services available upon request.

Reasonable accommodations will be provided as needed for persons with disabilities. Those needing help or accommodations please contact Rosa Klein at (503) 416-4974 or rosa@healthshareoregon.org at least two days before the meeting.

Health Share receives $500k grant to launch mental health treatment program for former offenders in Multnomah County

First “forensic” ACT program will focus on justice-involved individuals diagnosed
with severe mental illness to reduce police contact by 75%

Health Share of Oregon has been awarded a $499,999 grant by the Addictions and Mental Health Division of the Oregon Health Authority to develop a Forensic Assertive Community Treatment (FACT) program to assist adults who experience the most severe symptoms of mental illness and the greatest functional impairment in major areas of life, including housing and employment. Correspondingly, with their serious mental illness, these individuals are often frequent users of emergency rooms and tend to have repeated contact with the criminal justice system.

“It’s always been a goal of Health Share to work with our partners to strengthen the mental health crisis system in the communities we serve,” said Janet L. Meyer, CEO of Health Share. “The FACT program, which provides community-based treatment, is an important step in this direction.”

Health Share will partner with Cascadia Behavioral Healthcare and the Multnomah County Department of County Human Services to develop the first FACT program in Multnomah County, providing intensive community-based treatment for up to 35 clients over the twelve-month funding period. The program, which will launch later this year, could receive future funding based on results.

“Data indicates that up to 40% of people jailed in Multnomah County are experiencing mental health issues,” said Deborah Friedman, Behavioral Health Director for Health Share. “Jail services to help individuals are at capacity. The result is that many of those most in need of mental health care do not receive an intake assessment, access to mental health services or transition planning before reentering the community. The FACT program will work with these individuals as they leave the justice system to ensure they receive the mental health treatment and social service support they need.” By stabilizing clients in their treatment and housing, the goal of Health Share and its program partners is to reduce both use of emergency room visits and interaction with the police and criminal justice system.

“This new team will fill a long identified gap in the community system of care to address the unique needs of individuals with mental illness who have frequent contact with criminal justice, public safety and hospitals,” added David Hildago, Mental Health Director for Multnomah County Department of County Human Services. “We know Forensic ACT services work and we will now be able to provide better care to meet the needs of individuals at the intersection of the mental health and criminal justice systems. With this new ACT program focused on the criminal justice population, Multnomah County and Health Share will have three 24/7 community-based ACT teams.”

As Health Share’s partner in the development of a FACT program, Cascadia Behavioral Healthcare is strategically positioned to leverage its existing resources and collaborative relationships with law enforcement, the criminal justice system and other community partners to meet the unique needs of these individuals. Community-based treatment includes an individualized plan with a network of providers, family members, spiritual leaders, indigenous healers and peer wellness specialists. The clients will be encouraged to have a voice in their own treatment plan and recovery.

“Assertive community treatment is a well-established and effective means of assisting people in their recovery,” noted Maggie Bennington-Davis, Chief Medical and Operating Officer for Cascadia Behavioral Healthcare.  “Cascadia is very excited about this opportunity to improve the mental health system experience for people served by Health Share.”

The twelve-month goal of the program for these individuals is to reduce their placement in the State Hospital, jail or contact with police by 75%; reduce emergency room visits and psychological inpatient admissions by 75%; and to increase their housing stability by 75%. By the end of the grant period, more than half of those served by the program will be living in affordable housing, 80% will have a primary care provider and 30% will have employment.

In addition to clinical case management, other facets of the FACT program will include crisis assessment and intervention, coordinating legal needs, housing and wrap around support, family support and education, substance abuse services, supported employment and other support services.

Copyright 2014 Health Share of Oregon · 503.416.1460 · 208 SW 5th Avenue, Suite 400, Portland, OR 97204

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