Maximizing Health Benefits through Home Performance Programs

1. Positive Health Care Outcomes for Home Performance Prescriptions & Potential Business Models for Collaboration

2. Home Performance Coalition J. Joseph Cullen Director of Policy and State Outreach jcullen@homeperformance.org (301) 652-5194 (office)

3. Overview of Presentation • Energy Efficiency as a Resource (From 10,000 Feet) • Non-Energy Benefits of Energy Efficiency Retrofits • Capturing the Value of Non-Energy Benefits (Health Benefits) of Residential Retrofits – Highlights of three models • Project Description – Vermont HEAT Squad • Pilot Project Summary – NYSERDA/Multi-Agency (including Medicaid) • Perspectives of a Pennsylvania EE Provider on Healthy Homes • Discussion – The Intersection of Healthy Homes and Health Care Providers – New Models of Collaboration

4. Energy Efficiency As a Resource JOBS & Economic Development • Energy Efficiency is the lowest cost source of new energy (lower than a new coal plant, gas plant, nuclear plant, wind or solar sources). • Energy Efficiency is an economic engine supporting 2.25 million U.S. jobs in 2017. • Pennsylvania has 62,431 energy efficiency jobs and ranks 41st in per capita employment in the states (US DOE – USEER Report 2017). • Pennsylvania has 15,454 Oil and Petroleum, 8,674 Natural Gas and 6,528 coal extraction jobs; 4,670 Solar, 2,467 wind generation jobs (USEER Report 2017).

5. Energy Efficiency As a Resource Energy Efficiency and Health Benefits in Homes • See results of Vermont Department of Health – December 2018 Report • From Vermont Weatherization Assistance Program Handout

6. Energy Efficiency As a Resource Current PUC/Utility Approaches to Energy Efficiency • In 2016, combined spending on gas and electric Demand Side management programs totaled over $8.8 billion from all sources and $8.5 billion from ratepayers. 2017 Consortium for Energy Efficiency. • State based spending under PUC supervision applies cost effectiveness tests based upon the 1983 California Practice Manual. • Many states do not account for health benefits of energy efficiency retrofits and most undervalue this “non-energy benefit.”

7. Energy Efficiency As a Resource Summary and Introduction • Good News – Bi-partisan agreement in all 50 states that energy efficiency programs benefit ratepayers by lowering costs, creating jobs, providing reliability and resiliency to energy systems and adding environmental and heath benefits. • Bad News – There is a lot of confusion and inconsistency across states on the proper method to assign a value to the health benefits of residential retrofits. • Opportunity – There are several emerging business and community health models – that quantify & capture the health and economic benefits of residential retrofits. • Three Examples: • Vermont HEAT Squad (Hospital/Provider as partner) • NYSERDA Multi-Agency Healthy Homes (Medicaid/Insurance Co. as partner) • CCI – Pittsburgh Healthy Homes (Non-profit foundation as partner)

8. Positive Healthcare Outcomes for Home Performance Melanie Paskevich, Program Director

9. NeighborWorks of Western VT • Nonprofithousing organization • One-stop-shop • Provide all the answers and support homebuyers and owners need – We are All Things Home • Keep customer’s best interest front and center • Realty, Lending, Financial Counseling and Homebuyer Education, Home Repair, HEAT Squad • Part of a national nonprofit network, NeighborWorks America

10. Meet the HEAT Squad • Providing support to improve efficiency, comfort, health & safety of homes, regardless of income since 2010 • Reduced cost audits, same day audit reports, objective advice, help with contractors, in-house financing • Available in 8 VT counties, 9 KY counties • Completed almost 5,000 audits and2,000 projects • Partners: Efficiency VT, Green Mountain Power, WAP, Local Contractors, Energy Committees

11. Healthy Homes Initiative Partnership between Rutland Regional Medical Center and NeighborWorks of Western Vermont: • Beginning: RRMC realized patients homes impacting health, could not address; directors meet at conference, hear needs/services; RRMC realizes: Healthy Home=Healthy Patient=Lower Healthcare Costs • Program: started pilot with no goals; patients with asthma, COPD, accessibility, fall risk, general housing needs referred by RRMC staff; up to 120% Area Median Income

12. Healthy Homes Initiative • Offering: grant up to $6,000 with matching loan, in some cases 100% grant up to $6,000 (can be more if need) • Process: referral form emailed, site visit, estimates, connect with contractors, project management • Tracking: health conditions, housing needs, installed measures, costs/grants, reason for no service, impact on health after work Collect as much data as possible!!!

13. Healthy Homes Initiative Pilot Program Launch: • Energy auditors certified: BPI HHE • Efficiency + Health Training and Falls Training: RRMC staff, contractors, NWWVT staff, agencies • RRMC Presentations: case workers, pulmonology department, emergency department • Engage RRMC staff for energy audits on their homes: BEST ADVOCATES • Establish steering committee; check-in team meetings to gage success, discuss patients, issues

14. Healthy Homes Initiative Referrals: Asthma/COPD Repairs: • Carpet removal • IAQ improvements • Moisture/mold mitigation • Ventilation • Weatherization • Woodstove/pellet removal Accessibility/Fall Risk Repairs: • Grab bars • HC showers, bathroom • Reduce steps, flr transition • Railings • Ramps

15. Healthy Homes Initiative Lessons Learned: • Lengthy program launch • Patients that rent, difficult to help • Hard capturing and joining data • Hand-holding intensive process • Difficult to get attention of medical staff • Language: medical vs. construction • Incorrect info from medical staff to patients • Hard to maintain communication, relay updates

16. HOPD: Health Outcomes Demonstration Project Goal: Evaluating our partnership with medical providers and organizations whereby NWWVT staff take our Home Repair/HEAT Squad services to homes of patients/customers for recommendations to make health, safety, and efficiency upgrades to improve specific health outcomes. Measuring: • Potential medical cost savings • Changes in the health status of customers • Benefits- comfort, security, energy savings; Satisfaction rates RESULTS: To prove and quantify by data based evidence that partnering with housing organizations and investing medical dollars into preventative home improvements saves money for the health care system. Survey: Round 1=109 customers before service, Round 2=42 of 109 customers after service (completed home repair/weatherization) Participants: All incomes, majority low-to-mod income homeowners; Rutland County Project funded by Enterprise Community Partners and NeighborWorks America

17. HOPD: Key Findings from Surveys 1. Highest proportion of survey respondents had weatherization efficiency improvements to their homes since baseline (Fall 2017, Round 2). 2. Home repairs/weatherization have improved the comfort of survey respondents’ homes (Round 1 to Round 2).

18. HOPD: Key Findings from Surveys 3. Survey respondents have a good understanding of the social determinants of health; this remained consistent from Round 1 to Round 2. 4. Respondents from Round 2 reported some money saved on heating, cooling, and electrical costs after their home improvements and listed things they used the savings for: Buy health insurance could not previously afford. Make a doctor’s appointment could not do before. Paying off existing medical expenses. Purchasing healthy foods could not afford before. 25% reported savings $1-$250 25% reported savings $251-$500 25% reported savings $501-$750 18% reported savings $751-$1,000 7% reported savings $1,000+

19. Three Key Takeaways: • Engage health professionals for energy efficiency on their own homes: BEST ADVOCATES FOR THE PROGRAM!! • Never guarantee that weatherization or home repair measures will cure patient condition, we are not healthcare professionals. • Make sure process is Simple and Straight-forward for health professionals and patients- dealing with many issues at the same time and need time to convert. Extra hand-holding.

20. Thank You! Melanie Paskevich 802.797.8610 mpaskevich@nwwvt.org

21. New York State Healthy Homes Value Based Payment (VBP) Pilot Keystone Energy Efficiency Alliance: Healthcare Industry Forum on Energy Efficiency March 6, 2019

22. NYSERDA • NYSERDA offers objective information and analysis, innovative programs, technical expertise, and support to help New Yorkers increase energy efficiency, save money, use renewable energy, and reduce reliance on fossil fuels. • Clean Energy Fund (CEF) • 10-year, $5 billion funding commitment • Supports Governor Andrew M. Cuomo’s Reforming the Energy Vision (REV), a strategy to build a clean, resilient, and affordable energy system for all New Yorkers • Reduces cost of clean energy by accelerating adoption of energy efficiency to reduce load while increasing renewable energy to meet demand

23. NYS Healthy Homes VBP Pilot - Context • Large low and moderate-income and Medicaid population • Old housing stock contributes to poor health outcomes • Energy burdens for lower-income households have disproportionate impacts • Deferral rate for EE/Wx projects of >10% • High Medicaid utilization for asthma and unintentional household injury • Medicaid Redesign Team goal of reducing avoidable hospitalization costs by 25% by 2020, through Delivery System Reform Incentive Payment Program • Fragmented delivery of programs and services across NYS

24. NYS Healthy Homes VBP Pilot • Pilot Objective • Develop a framework that allows managed care organizations (health plans) to fund residential healthy homes interventions (energy efficiency/weatherization plus asthma trigger reduction and household injury prevention) as part of their value based payment arrangements within the Medicaid Healthcare Delivery System. • Scope • Partnership between NYS Department of Health (DOH) and NYSERDA • Implementing 500 healthy homes interventions in Medicaid member homes, intended to reduce Medicaid utilization associated with asthma and unintentional household injury • Pilot funded at approximately $10 million

25. NYS Healthy Homes VBP Pilot • Intervention Components • Residential energy and environmental assessment • Energy measures (e.g. envelope improvements, electric load reduction, heating system repair/replacement, ventilation) • Asthma trigger reduction measures (e.g. mold remediation, carpet removal, integrated pest management, furnace filters) • Household injury prevention measures (e.g. smoke alarms, carbon monoxide detectors, stair/railing repair, bathtub safety bar installation) • Home skilled nursing visits and community health worker support (e.g. In-home education related to asthma medication self-management) • Resident education, connection to local services, and post-remediation follow-up (e.g. In-home education related to dwelling measure optimization) • Market supports

26. Estimated Intervention Costs Estimated Average Cost, by Intervention* Estimated Average Cost for Integrated Treatment* Source: NYSERDA. 2017. New York State Healthy Homes Initiative Interim Feasibility Analysis. * There are regional variations in material and personnel costs, as well as building type. * There are efficiencies in providing multiple interventions as part of a single approach, which are not reflected in this per-unit pricing.

27. Feasibility Analysis – Estimated Savings Source: NYSERDA. 2017. New York State Healthy Homes Initiative Interim Feasibility Analysis.

28. NYS Healthy Homes VBP Pilot • Outcomes • Validation of healthcare cost savings and benefits to residents, including energy and health/safety, through evaluation undertaken in partnership with DOH Office of Public Health • Demonstrated model for managed care organizations to partner with CBO-affiliated energy/housing contractors • Residential market preparedness for incorporation of healthy homes interventions into the Medicaid Healthcare Delivery System standard business practice • Timeline • Pilot design underway • Expected to be in field in Q3 2019

29. Contact Mishel Filisha, NYSERDA mishel.filisha@nyserda.ny.gov 518-862-1090, ext. 3628

31. Jeaneen leads the Pittsburgh, PA- based non-profit, Conservation Consultants Inc., which focuses on residential energy efficiency and home performance. With more than 20 years of professional experience spanning the for-profit, public, and not-for-profit sectors, her background and expertise ranges from strategic planning to partnership and development to program management and product marketing. Jeaneen A. Zappa, Master of Business Administration — Executive Director