Housing As Health Care NPH Conference

1. Housing As Health CareNPH Conference Sharon Rapport, CSH October 3, 2014

2. Our Mission Advancing housing solutions that:

3. CSH Social Innovation Fund z An Innovative & Effective Model Develop and refine a model of housing linked to care management and coordinated primary and behavioral care through community partnerships. A Solid Base of Evidence A rigorous evaluation on supportive housing‘s effectiveness as a health care intervention for reaching Medicaid‘s high-need, high-cost individuals A Blueprint for Scaled Replication Develop a viable policy for Medicaid-funded intensive care management services are paired with federal, state, & local housing resources GOAL:National replication of integrated supportive housing and health services model as a viable alternative to the “revolving door” for homeless people who are frequent users of crisis health care services FUNDING:$1.15 M annual award from Corporation for National and Community Service (CNCS): 5 yrs $425,000 annual award to Tenderloin Neighborhood Development Corporation $375,000 annual award to Economic Roundtable STRATEGIES: SITES:

4. Kelly Cullen Community in San Francisco: Key Partners

5. 10th-Decile Model in Los Angeles Collaboration hospitals, FQHCs, homeless services Health Homes intensive case management/ care coordination 10thDecile triage tool highest-cost, highest-need 10% of homeless individuals Primary care Permanent Supportive Housing housing navigation and retention Behavioral health Substance abuse Frequent Users Navigator Supportive Housing The Glue: Intensive Case Management i.e., Care Coordination + Housing Navigation

6. 10thDecileHospital Utilization and Cost Avoidance (Actuals): 81% Average Decrease In Total Costs Per Client Per Year • ER utilization down 71% • Hospital readmissions down 85% • Inpatient days down 81% ER costs down 66% Inpatient costs down 83% Total costs decreased 81% Average cost avoidance per person: $59,415 Largest individual cost avoidance: $2.2 million 25% of the cohort avoided costs in excess of $100,000 Source: FUSE/SIF hospital cost data, September 2013

7. AB 361. “Health Homes” Bill (Mitchell) Health Home = Virtual “Home” for Addressing the “Whole Needs” of a Beneficiary Uses an option under Affordable Care Act to create a “Medi-Cal health home benefit”to Medi-Cal beneficiaries who are— FREQUENT HOSPITAL USERS and CHRONICALLY HOMELESS PEOPLE Bill signed by Governor Oct 2013 Frequent Hospital User Beneficiaries Chronically Homeless Beneficiaries

8. Health Home ServicesServices to Address the Needs of the “Whole-Person” OUTREACH & ENGAGEMENT

9. Implementation of AB 361 Define Services: Frequent face-to-face contact (1:20 ratio) • Comprehensive care management: • Outreach/engagement • Motivational interviewing to identify all needs (not just health) & plan to meet all health-impacted needs • Assist beneficiary get into housing • Promote housing stability: help beneficiaries learn to manage finances, pay rent, shop for or gain access to healthy food, maintain eligibility for benefits, communicate with neighbors & management, and participate in community • Care coordination & health promotion: • Include HH staff advocacy with health providers • Referral to social services & supports: • Include partnerships with permanent housing

10. Next Steps on Health Homes Webinar: Oct-Nov Stakeholder Process Draft State Plan Amendment Concept Paper Implement (mid-2016) Ongoing Stakeholder Meetings Advocacy w/DHCS

11. Sharon.Rapport@csh.org(323) 243-7424 (c)(213) 623-4342, x18 (o) \