Health Care for the Homeless Training Hawaii Primary Care Association June 27, 2013 Brenda...
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Health Homes for the Homeless: National and Local Opportunities Health Care for the Homeless Training Hawaii Primary Care Association June 27, 2013 Brenda Goldstein, MPH [email protected]
Health Care for the Homeless Training Hawaii Primary Care Association June 27, 2013 Brenda Goldstein, MPH [email protected]
Hospitalizations/re-hospitalizations Average 4 days longer
inpatient ($2,414) attributable to homelessness Incarcerations For
mental health, drug and alcohol use related behaviors or simply for
sleeping on the street or loitering Emergency Services (ambulance,
ER use) Increased costs of unmanaged chronic disease
Slide 8
Affordable Care Act: Expanded Coverage and Access Medicaid
Health Home Funding Opportunity for States Triple Aim Improve
health and reduce mortality Improve the experience for patients and
quality of care Control costs Bending the Cost Curve Reduce
avoidable ED visits, hospital admissions/re-admissions Avoid
unnecessary nursing home stays Focus on small number of consumers
with highest cost Patient Centered Health Homes Better health care
for people experiencing homelessness is a strategy for achieving
these goals
Slide 9
Slide 10
Model and payment to support intensive services Flexible
service models Who provides care (non-licensed staff can be highly
effective) Where care is provided (office, home, streets) What care
is (medical, psychosocial, flexible funds) Fast access to
supportive housing and other housing resources Linkages to
benefits
Slide 11
Slide 12
Integrated team approach High frequency of interaction: need
determines intensity of services Strong linkages to community-based
services, especially housing Low Caseloads Non-licensed staff can
be the most effective case managers Close communication with
partners (primary care, behavioral health, benefits advocates, ED,
discharge planners)
Slide 13
Housing First Rapid re-housing Health Centers and HCH programs
obtain housing resources for homeless clients Partnerships with
non-profit housing providers/public housing authorities Align
resources for housing, health care, and behavioral health
Prioritize access to permanent housing Chronic homelessness
Vulnerability Index Frequent users of crisis services Family
reunification
Slide 14
Permanent, affordable housing with combined supports for
independent living Each tenant may stay as long as rent is paid and
compliance with terms of rental agreement Affordable - tenant pays
no more than 30-50% of household income Access to support services,
but participation is not required Different housing options are
available Housing First models provide access for people with high
risk behaviors and long histories of homelessness
Slide 15
Supportive Housing Cost-Effective Every Day
Slide 16
Reduces costly care 29% fewer inpatient admits and 24% fewer ED
visits in Chicago 56% fewer ED visits and 44% fewer inpatient
admits in San Francisco 77% fewer inpatient admits and 60% fewer
ambulance rides in Maine Improves health outcomes Access to primary
care and engagement in recovery services Medication adherence and
enhanced motivation to change Improved health indicators for HIV +
patients Reduced drug/alcohol use Improved mental health
status
Slide 17
Change is Possible CA Frequent User 2 Year Results Medicaid
Population *Indicates statistically significant
Slide 18
Creating homeless friendly health centers Services in
Supportive Housing Respite care Frequent ED user programs Hospital
discharge/care transition models Veterans programs Educate and
enroll homeless in Medicaid
Slide 19
Slide 20
FQHCs - desirable partners Healthcare: linked to housing
embedded in mental health service sites staff located in supportive
housing provided at shelters, transitional housing, board and care
Home visits Mobile/street services
Slide 21
HUD grant opportunities Managed Care Contracts Hospital
Contracts FQHC billing for behavioral health services Partnering
with specialty mental health
Slide 22
High risk patients impact clinic productivity Staff training to
serve the population Cultural differences when working
collaboratively with housing providers Clients need intensive,
extended follow up strain on resources
Slide 23
Payments to primary care for intensive services and incentives
for reducing overall cost Managed care plans adopting appropriate
care and reimbursement models Case management as a recognized
medical service Eliminate barriers to qualify for SSI/Medicaid
Housing subsidies as cost effective health benefit Discharge
policies and funding for medical respite
Slide 24
National Health Care for the Homeless Council www.nhchc.org
www.nhchc.org SAMHSA-HRSA Center for Integrated Health Solutions
http://www.integration.samhsa.govhttp://www.integration.samhsa.gov
Opening Doors, Federal Strategic Plan to Prevent and End
Homelessness www.usich.orgwww.usich.org Corporation for Supportive
Housing www.csh.orgwww.csh.org Technical Assistance Collaborative
www.tacinc.orgwww.tacinc.org Contact:
[email protected]@lifelongmedical.org