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Solving Homelessness to Overcome Population Health Challenges

UI Health's $250,000 investment in permanent housing for homeless patients is a core part of the public hospital's population health strategy.

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Source: Thinkstock

By Sara Heath

- Nearly two years ago, the CEO of the University of Illinois Hospital & Health Sciences System (UI Health) invested $250,000 to help homeless individuals obtain permanent housing. From the onset, the move had no direct financial benefit for UI Health. Instead, the program, called Better House through Housing, shone a light on homelessness, a major population health challenge in the Chicago area.

“Our CEO, Dr. Avijit Gosh, decided to fund this program two years ago, largely because we wanted to draw attention to the housing first model of care that's being done in a lot of other large cities around the country,” recalled UI Health Director of Preventative Emergency Medicine Stephen Brown in an interview with PatientEngagemementHIT.com.

“The idea was more to draw attention to housing first, and to figure out how to identify the homeless, what kind of medical conditions they have, and just how to provide better care for them.”

A 2017 analysis from the Chicago Coalition for the Homeless revealed that housing insecurity is a pressing social determinant of health. About 82,000 individuals are currently homeless in Chicago, with many living in overcrowded or substandard shelters.

The Better Health through Housing project aimed to shine a light on that issue by lending a hand to patients looking to obtain permanent housing.

READ MORE: How to Develop Community Health, Patient Outreach Efforts

The program may sound simple – a patient visits UI Health, a doctor identifies her as homeless, UI Health refers her to social services, and the patient obtains housing – but it is certainly anything but.

Identifying which patients suffer from homelessness presents a significant challenge, and the system had to overcome data challenges during program implementation.

“Data is a big piece of this, too. Just figuring out who's homeless in our patient population,” Brown explained. “It's significantly under-reported and that's one of the things we're advocating for – better reporting of homelessness. It's not coded right now very well.”

Brown, who has a tech background after spending years at Motorola before becoming an emergency department social worker, led a data mining mission.

Through observation and engaging in with the Emergency and Psychiatry Departments, Brown was able to initially identify 48 homeless individuals. Since the housing program’s implementation, that number has increased to about 575 individuals who UI Health knows to be homeless today. That does not include the estimated total number of homeless individuals in Chicago.

READ MORE: How Housing Support Addresses the Social Determinants of Health

This level of data mining and health investigation is UI Health’s contribution to the Better Health through Housing program. Hospital employees work to uncover which patients suffer from social conditions that are negatively affecting their health, in this case homelessness.

Once UI Health has completed its part, it enlists the help of its community partners that are better positioned to arrange social services for homeless patients.

“We partner with an organization called Center for Housing and Health, which is part of the AIDS Foundation of Chicago,” Brown said. “They've always been strong advocates for housing. They do a lot of the quarterbacking after we refer homeless patients to them. They contract with outreach organizations and they have outreach workers.”

These community partners face the challenge of working directly with the homeless patients, Brown explained. Outreach workers will search under bridges and make themselves available 24 hours each day to be able to find these patients to arrange housing assistance.

Advocates also need to find the housing. There are about 150 housing units available right now, and single room options (SROs) in local hotels.

READ MORE: What Providers Should Know to Improve Patient Access to Healthcare

The Better Health Through Housing program is seeing mounting success. To date, UI Health has assisted 27 homeless individuals obtain permanent housing.

As an unintended result, UI Health saw healthcare costs plummet. The first 15 patients the hospital assisted created about 45 percent healthcare cost savings. Today, UI Health has accrued 67 percent cost savings across the 23 patients it has helped who are still living.

When reporting these figures, Brown emphasized that they only include UI Health’s system costs. When individuals are relocated to new and more permanent housing arrangements, they may seek their healthcare at another institution, which also affects UI Health’s total costs.

Even still, these cost savings underscore the promise of community health partnerships in propping up value-based and patient-centered healthcare.

Community health partnership benefits extend beyond the ROI, though. Brown contended that the shift toward value-based population health is the single most motivating factor in the drive for social health.

“So why would hospitals do this?” Brown questioned. “There were no obvious benefits when we started this, but we're beginning to find out that as healthcare organizations transition to population health, this becomes very important.”

Prioritizing the social determinants of health be a difficult transition, Brown conceded. But once a hospital can frame an issue such as homelessness as a health issue, not a social issue, it becomes easier for hospitals to focus on the need.

“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.

“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.

From a population health standpoint, it makes sense for UI Health to invest in housing issues. Housing is health, Brown said, and given the healthcare cost savings and lower overall facility utilization, hospital efforts are paying off.

But beyond that, Brown said there is a significant moral obligation for UI Health to take part in social health programs.

“We like to advocate because we're a public hospital in the state of the Illinois and we take a lot of pride in our health equity mission,” he stated. “It's the right thing to do.”

Going forward, Brown hopes to see more partnerships between UI Health and other community organizations, as well as between UI Health and other area hospitals.

“We've been pitching this with other hospitals in the region,” Brown shared. “There are now three others that have stood up their own programs and we are in discussions with five more. What we hope to be able to do is encourage other hospitals to do this too. Eventually, we could have some collective impact.”

Collective impact refers to the larger results that come from multiple people or institutions pitching in to solve a problem. One hospital helping one patient might not move the needle on homelessness, but everyone in Chicago helping out could.

“If every hospital in the City of Chicago, and there's about 33 of them, were to take on 10 chronically homeless individuals and agree to pay for their housing, we'd reduce the population of the chronically homeless in Chicago by about a third,” Brown reported. “That would be a major impact. It's not that big of a stretch for every hospital to be able to do that.”

There would be very little associated cost, Brown argued. For each hospital to take on the needs of 10 homeless individuals, it would cost approximately $120,000, small potatoes for many hospital systems, especially considering the offsetting tax benefits of such an arrangement.

“When we think about these things, we tend to think of ourselves as standalone islands and hospitals,” Brown said. “There's a tremendous opportunity for collective impact, not only in the City of Chicago, but across the nation.”

Currently in Chicago, these combined efforts are shaping into a common funding pool, Brown explained.

“Here in Chicago, working with several agencies, we are working on something called a flexible housing subsidy pool,” Brown said. “In doing so, every funder of homeless services throws into a common pool. That includes a lot of the city agencies, but we would also then ask hospitals to contribute to that fund too.”

Expanding outreach partners would also enable them to identify more apartments and more neighborhoods where homeless individuals can find home. This could also help fund construction of new properties, as well.

These steps simply make sense in the current healthcare landscape, Brown explained. As the industry continues to embrace value-based care models, community health programs can help hospitals reap the benefits of uncompensated outreach.

“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 concluded. “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.”

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