- The University of Illinois Hospital has reinvested $250,000 into their Better Health Through Housing program, which helps address the social determinants of health such as housing security.
The social determinants of health are external factors that significantly impact patient health. Issues such as food security, public safety, and education are common social determinants of health.
University of Illinois at Chicago decided to reinvest in Better Health Through Housing, which initially launched in 2015, because of the considerable impact housing makes on the hospital’s community.
“We are an urban health system engaged in tackling complex social issues that affect health,” said Robert Barish, MD, vice chancellor for health affairs at the University of Illinois at Chicago. “Lack of housing has been shown to have serious health effects. Without a home base, getting and staying healthy is extremely difficult, and this is why we have decided to reinvest in this program.”
The program identifies patients who are homeless who might benefit from housing support from the hospital. Individuals who are homeless tend to be emergency department “super utilizers,” meaning they visit the ED more than eight times per year. The ED is extremely costly to operate, and addressing housing needs may be an effective strategy for reducing ED costs.
Patients who are homeless also suffer from chronic illness at disproportionate rates, according to UI Hospital leaders. These individuals have high rates of asthma, chronic obstructive pulmonary disease (COPD), head and neck cancers, HIV/AIDS, hepatitis, and traumatic brain injury.
The combination of housing insecurity severity and chronic disease comorbidities helps leaders from UI Hospital to determine who should participate in Better Health Through Housing.
“We have a committee that meets regularly and we look over the whole picture, including from a cost-savings point of view, but more importantly, we consider how helpful providing permanent housing would be to a particular patient’s overall health,” said Stephen Brown, director of preventive emergency medicine and director of UI Hospital’s Better Health Through Housing.
“Chronically-ill patients who have multiple diseases that require frequent outpatient visits may be able to benefit most from the program,” Brown added.
The hospital contributes about $1,000 per patient for housing support, a net financial gain of about $2,000 when compared to the amount hospitals usually spend on chronically homeless ED stays.
Average per patient monthly costs have dropped about 18 percent since the program’s inception, from $5,879 to $4,785 each month.
And given subsidies from the US Department of Housing and Urban Development and collaboration with other area hospitals, UI Hospital leaders expect to see the program to have an increasing ripple effect.
“If every hospital in the area agreed to house 10 chronically homeless patients, which would be a relatively modest investment, we could collectively make a huge impact on reducing homelessness, and it would be near cost-neutral to every hospital,” according to Brown.
Hospitals may be incentivized to participate in similar programs and projects that address other social determinants of health by tax exemptions associated with non-profit hospital status.
“A lot of hospitals were concerned about the plummeting rates of uncompensated care they have, and they were nervous that the IRS was going to scrutinize them because of community health needs assessment findings,” Brown said in a separate interview with PatientEngagementHIT.com. “This is a good program for hospitals to feel good about themselves, that they're actually impacting the health of the residents in the community that they serve.”
In addition to the financial gains to be made through a Better Health Through Housing program, Brown contended that addressing the social determinants of health was simply the right thing to do. And from a population health management standpoint, creating better housing supports helps reduce a considerable health issue.
“We have come to view homelessness as a dangerous health condition, not only a social condition, because of the extreme conditions of living on the street,” Brown pointed out.
For example, studies indicate that about 70 percent of the chronically homeless have a neurocognitive disorder, UI Hospital explained.
“If you begin to wear a lens of thinking that it's a dangerous health condition, then it just makes sense that hospitals would want to go beyond what they typically do, beyond delivering excellent medical care, and really move into a population health space,” Brown asserted.
Going forward, UI Hospital wants to refine how it identifies patients who may be homeless. The process is certainly not perfect, Brown reported. At the program’s pilot, UI Hospital believed to be seeing 48 patients it thought were homeless. Through data analysis, Brown and his team found that the hospital was seeing hundreds of patients who are homeless.
UI Health and All Chicago, an organization which maintains a database of homeless of individuals for ED use, have received a grant to better leverage both programs. The two organizations have developed a tool that alerts EDs when a patient who is homeless has been admitted.
“Once we can better identify these patients, and if we can do it sooner rather than later, we may be able to get them the care and services they need earlier so that their health outcomes can be better,” Brown concluded.