Health as Housing

Housing as Health Panel

Pam HesterHealth and Housing ManagerCommunity Health Innovation Program

November 16, 2016

CareOregon Serves 230,000 Oregonians in 9

counties

• 80% in Portland metro area

• 53% female

• 41% 19 and younger

• 10% 4 and younger

• 32% do not speak English as their first language

• 45% self-identify as non-Caucasian

CareOregon History Founded in 1993, began as a health plan in 1994

9,500 members in 14 Oregon Counties

1997 - became an independent non-profit

2012 – Oregon moved to Coordinated Care Organizations

2014 – Population Health Partnerships department created

Social Determinants of Health

The social determinants of health (SDH) are the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life. These forces and systems include economic policies and systems, development agendas, social norms, social policies and political systems.

-The World Health Organization

Reallocate Health Care $

$$$

Infographic from bipartisanpolicy.org http://bipartisanpolicy.org/sites/default/files/5023_BPC_NutritionReport_FNL_Web.pdfData from: McGinnis et al 2002. The Case for More Active Policy Attention to Health Promotion. HealthAffairs

Health Care Reform & Homelessness in Multnomah County – City Club or Portland Bulletin, Vol. 97, No. 10, January 6, 2015

The Health Burdens Associated with Homelessness

Before Move-in

After Move-in

% Change

# Primary Care Visits* 2.8 3.4 +20%

# ED Visits* 1.1 0.9 -18%

# In-Patient Non-OB Visits 0.08 0.07 -15%

≥ 1 Primary Care Visit* 0.57 0.67 +18%

≥ 1 ED Visit* 0.40 0.36 -11%

≥ 1 In-Patient Non-OB Visit 0.08 0.07 -11%

Total Cost* $386.3 $338.3 -12 %

KEY FINDINGS: Housing increases primary care visits

Housing decreases ED utilization and total cost

Healthcare supports in affordable housing

N = 1,625 * Findings are significant

More healthcare and housing data

• A 2006 study of CCC’s Chronic Homeless Housing First team: Annual cost for health care and incarceration per client was reduced from an estimated $42,000 per year to $17,199 per year. Once the cost for supported housing was accounted for, the program reduced total annualized costs by 36%.

• A 2006 study of Denver Housing First Collaborative: ER visits reduced by 34%, inpatient costs were reduced by 66%, Detox visits were reduced by 82 %, incarceration days reduced by 76 % and the total average cost saving per person was $31,545.

• A 2002 study by Dennis P. Culhane, et al.: 4,679 homeless people with serious mental illnesses placed in supportive housing in NYC between 1989 and 1997 resulted in reduction in services use of $16,282 per housing unit per year.

Health Plan Alignment

GoalsDecrease measurable medical costIncrease quality metricsIncrease member & provider satisfaction

Data drivenClaims: Individual high risk/high utilizersClaims/HEDIS: Population focusHEDIS/CCO incentives: Targeted individual outreach

Population Health Department• Health Resilience Specialists

– Trauma-informed clinical program– Non-traditional healthcare workers support high-risk, high-

cost patients• Exceptional Needs Care Coordination

– Care coordination to members with complex medical needs• Advanced Illness Care

– Partner with community hospices to provide palliative care• Transitional Care and Outreach

– Coordinated discharge planning, patient education, care coordination

Social Determinants of Health Team

Team functions….Support the PHP department and CareOregon members by:

- Providing direct services to prioritized members

- Ensuring resources and partnerships are in place to support PHP members’ work

- Developing partnerships that align community resources and reduce duplication

Housing service domains…

• Homelessness prevention and transitions of care

• Housing transition service• Tenancy sustaining services

Housing Programs, Partnerships & Investments• Housing with Services

– LLC model involving 9 agencies– Provide health care coordination and services to the 1,400 residents of

11 affordable housing communities– Includes food and social support programming– 644 residents served so far this year– 4,785 services

• Housing case management– Annually place approximately 50 people in permanent housing– Provide eviction prevention to approximately 20 annually– Coordination with medical care team and assistance with housing

transition (housing search, move in assistance, security deposits, etc.– On-going care coordination

Housing Programs, Partnerships & Investments

• Community Service Provider Network– Network of providers that PHP team can deploy to

meet member needs– Food, housing-related services, transportation

• $4 million investment in CCC’s Health is Housing

• Pilot projects, participation in workgroups and community-led councils

Thank You

Pam [email protected]

Neighborhood Partnerships

Panel

November 16, 2016

PacificSource Community Solutions,

Central Oregon CCO

Central Oregon CCO 101• PacificSource is the Coordinated Care Organization (CCO) for

Central Oregon (Crook, Deschutes, Jefferson, and Northern Klamath Counties) and holds the Medicaid contract with the Oregon Health Authority (OHA).

• During the formation of the CCOs, Central Oregon wanted a governance structure that included additional community oversight, involvement, and transparency.

• Senate Bill 204 was created which allows the Central Oregon Health Council (COHC) to be the CCO governing entity in Central Oregon.

• The CCO and the COHC have a Joint Management Agreement which outlines roles/responsibilities, deliverables, and funding streams.

Central Oregon Population

*Approximately 2,000 individuals are homeless in Central Oregon

*There is currently a <1% vacancy rate in the region

Regional Health Improvement Plan (RHIP)• Earlier this year the CCO and the COHC completed the

four-year RHIP which includes housing as a subsection of Social Determinants of Health.

• The housing language was derived from the CCO’s two-year Transformation Plan with the OHA.

• The RHIP workgroup that is focused on the housing subsection is developing a work plan to begin bridging housing solutions with the health system. The upcoming waiver, new rules, and existing restrictions from the Centers for Medicare and Medicaid Services may influence this work.

Community Impact• Under the CCO/COHC Joint Management

Agreement the CCO has a 2% profit cap; any surplus is paid to the COHC for community reinvestments related to the RHIP.

• 34% of the 2016 RHIP funds (>$1M) have been allocated to housing proposals

Community Housing Investments

Pfeifer and Associates Duplexes purchased in Bend and La Pine to house homeless individuals with Substance Use Disorders.

Pacific Crest 50 affordable housing units in a multi-family complex rented to low-income households. Includes resident services that focus on health and access to healthcare.

Bethlehem Inn Existing temporary housing for homeless individuals/families that will be constructing a new building to double the number of family units and add a commercial kitchen and administrative space.

Questions?

Leslie NeugebauerCentral Oregon CCO

[email protected]

541-330-8116

mailto:[email protected]

mailto:[email protected]

Creating Opportunity through Housing: Housing as Health

Josh BallochWednesday, November 16, 2016

05/01/202327

About AllCare Health

05/01/202328


•AllCare Health serves:

•49,000 Medicaid Members

•1,900 Medicare Advantage Members

•2,000 PEBB Members

05/01/202329


•Our company is owned by 85 independent providers in the Rogue Valley

•Our mission, since we were founded in 1994, has been: Working together to provide quality, cost-effective healthcare for our communities.

•And just this year AllCare Health became a Benefit Company or B-Corp- Both our CCO and holding company are B-Corps- We should have B-Lab certification within the next few months- Did this to help protect the board in their investment in the social

determinants and codify our current direction for future boards

05/01/202330

How we see Transformation 2.0

05/01/202331

Housing Investments in 2015-6

Rogue Valley: - Sobering Center

-Hearts with a Mission

-Purchase of a 15-unit transitional housing complex for families and its needed repairs

Curry County: -$100,000 Grant; $20,000 used for crisis housing in Gold Beach

05/01/202332

What the CCOs board goals will be 2017 and beyond

The CCO board has agreed to focus on three areas going forward:

-Housing

-Education

-Community Partner Building

We believe we will need all three to in order to truly improve the health of the communities we serve

Thank you!

Housing + Health Carefor the Whole Person

November 16, 2016

CENTRAL CITY CONCERN’S SCOPE

Housing + Health Care for

the Whole Person

2015

Supportive Housing... Saves lives Reduces emergency room visits Reduces repeat hospitalizations Reduces burden on public safety Stabilizes lives and creates an environment for health and opportunity


the Whole Person


the Whole Person

HOUSING IS HEALTH COLLABORATIVEPortland health care organizations are investing $21,500,000 allowing CCC to build 382 new housing units across three locations and a new health center in Southeast Portland. The health organizations supporting the initiative are: Adventist Health Portland, CareOregon, Kaiser Permanente Northwest, Legacy Health, OHSU, Providence Health & Services – Oregon

CCC HEALTH SERVICES – BY THE NUMBERS

In 2015, CCC served 8,000 patients: 23,000 medical care visits, 54,000 mental health visits, 73,000 substance use disorder visits, 165,000 prescriptions filled at our Old Town pharmacy.

Eastside Integrated Housing and Services will serve 3,000 patients annually through 15,000 medical care visits, 14,000 mental health visits, 36,000 substance use disorder visits, and 49,000 prescriptions. The clinic will include Urgent Care and the housing will include Recuperative Care Program units for hospital step down and palliative care.


the Whole Person

Connecting the dots• CCC operates the Old Town Clinic, a Federally Qualified Health

Center serving the sickest OHA members in the state. OTC is a National Committee for Quality Assurance Tier-3 recognized Patient Centered Medical Home.

• In 2012, OTC was recognized by RWJ as one of the top 30 exemplary primary care practices nationwide.

• We have operated affordable supported housing for 40 years.• Ed Blackburn, the Executive Director is a founding member of HSO

with the CEOs of each of the hospital and health systems that invested in this new project.

• CCC has a proven track record in the Recuperative Care Program hospital partnerships.

• CCC in the nexus of healthcare and housing, recognized nationally by HUD, HRSA, SAMHSA, NAEH, NHCH, NCBH, DOL and the United States Interagency Council on Homelessness.

• This partnership is the result in the confidence in CCC and the quality of services we provide.

Oregon’s Proposal for Coordinated Health Partnerships

Introduction

• The Challenges and Opportunities in Oregon • 1115 Waiver Proposal for Coordinated Health

Partnerships (CHPs)• CHP Advisory Council

The Challenge in Oregon • Unprecedented housing crisis: Oregon’s homeless population

increased by 9 percent in 2015 and on a single night there were 13,176 homeless individuals

• Complex needs among homeless: a large portion of the homeless population suffers from chronic illnesses and one or more physical, mental, or substance use related conditions

• Lack of coordination and gaps in existing services: Federal, state and local programs that target homeless individuals, or those at risk of becoming homeless are often: – Siloed with each program having its own objectives and client

base, – Lacking connections to other federal, state and locally funded

programs serving similar populations.

Opportunity in Oregon• A significant number of Oregon’s chronically homeless and

individuals at-risk of homelessness are now eligible and enrolled in Medicaid

• Leverage Oregon’s health system transformation and our 16 coordinated care organizations (CCOs)

• Oregon’s Legislature and local municipalities have invested millions in expanding affordable housing (2015 and 2016)

• Existing US Department of Justice Agreement with Oregon and the Oregon State Hospital to improve community mental health treatment and programs.

Opportunity in Oregon

Coordinated Health Partnerships (CHPs)

CHPs are five-year pilots to increase supportive housing integration among target populations and develop infrastructure to ensure ongoing collaboration among the participating entities• Form local collaborations to enhance local coordination and

integration of health and housing-related services and transitions of care

• Support and enhance access to flexible services delivered by CCOs and providers serving the target population

• Develop a menu of supportive services that focus on homelessness prevention and care coordination, transitional supports, and tenancy sustainability

Target Populations for CHPs

• High-risk, high needs individualso With repeated incidents of avoidable emergency use or hospital

admissions;o With two or more chronic conditions;o With mental health and/or substance use disorders;o Who are currently experiencing homelessness; and/oro Individuals who are at risk of homelessness, including dual eligibles,

and IHS, Tribal, and Urban Indian program constituents, and those that will experience homelessness upon release from institutions

• CHPs may choose to limit the population served within their pilot application

• OHA will work with CHPs to determine the number and focus of target population

CHP Participating Entities

CHPs will test new models to increase collaboration, coordination, and integration of services among community partners, including:

• CCOs (lead entity)• County agencies• Corrections• Tribes (lead entity)• Health providers• Housing entities• Local hospitals• Other entities serving or advocating for the targeted population

CHP Goals and Objectives

Pilots will seek to address local supportive housing needs and develop solutions that fit local communities in Oregon; pilot objectives include:• Increasing awareness of and access to housing supportive services• Increasing coordination of housing supportive services for a target

at-risk population. – Local CHPs may identify specific sub-populations to include in pilot

program based on community needs• Reducing inappropriate emergency, inpatient and residential

treatment facility utilization• Increasing access to and use of primary care• Improving data collection and sharing among local entities to

support ongoing case management, monitoring, and improvements

Proposed CHP Program Design• CHPs must provide services across three domains:

homelessness prevention/transitions of care, housing transition services, and tenancy sustaining services– At a minimum, CHP pilots will be expected to implement one

program per domain area• Medicaid enrolled can decide to participate in a CHP pilot and

opt in and opt out at any time• Each grantee will be required to develop their own payment

methodology and strategies for financing services (consistent with federal guidelines)

• Initially, payments to grantees will be based on meeting process measure targets and will move towards outcomes based payments

CHP Pilot Domains Example: Potential Types of Services

Homelessness Prevention/ Transitions of Care Support to ensure care coordination among non-medical settings; fund services to support an individual’s ability to move from institutional settings to less costly community-based care settings

Ensuring that CCO members obtain health services necessary to maintain physical, mental, and emotional development and oral health

Ongoing assessment of medical, mental health, substance use disorder or dental needs

Case management and coordinating the access to and provision of services from multiple agencies

Establishing service linkages with community providers

CHP Pilot Domains

CHP Pilot Domains Example: Potential Types of ServicesHousing Transition Services Invest in pre-tenancy services to decrease health care costs and reduce use of high-cost health care services

Tenant screening and assessment Assistance with housing searches and

applications, move-in assistance, short-term expenses such as security deposits, other landlord-required rental or lease costs

Moving costs, basic furnishings, food and grocery supports

Adaptive aids and environmental modifications Housing support crisis plan and intervention

services Care coordination services with medical

homes, behavioral health and SUD providers

CHP Pilot Domains (cont.)

CHP Pilot Domains Example: Potential Types of ServicesTenancy Sustaining Services Invest in services that support the individual in being a successful tenant in his/her housing arrangement

Tenancy rights/responsibilities education; coaching and maintaining relationships with landlords

Eviction prevention (paying rent on time, conflict resolution, lease behavior requirements)

Utilities assistance/management (energy/gas) Landlord relationship/maintenance Crisis interventions and linkages with

community resources to prevent eviction when housing is jeopardized

Linkages to education/job training, employment Care coordination services with medical homes,

behavioral health and SUD providers

CHP Pilot Domains (cont.)

Proposed CHP Timeline

Oregon is proposing a multi-faceted, incremental approach to the state’s integration of health care and supportive housing for the 2017-2022, 1115 Demonstration renewal: • Year 1: Convening and planning initiatives, regionally and

statewide• Years 1-5: Statewide investment in infrastructure development

and creation of CHPs • Years 2-5: Pilot and test new models of housing supportive

programs among CHPs• Years 2-5: Transition to paying for outcomes based on

evidence-based practices• Years 2-5: Dissemination and spread of best practices

Preliminary Evaluation Considerations• Reductions in ED use and psychiatric acute care hospitalizations• Increases in primary care and behavioral health care use, including

medication adherence• Decreased discharges to secure residential treatment facilities • Increase in transitions from recovery to permanent housing settings • Increase in access to care and quality of care after moving into

housing • Retention in housing unit for 12 months or longer • Increase in percentage of adults accessing employment and

benefits services • Increase in the percentage of individuals that transition to affordable

housing (market rate housing/community housing placement)• Increase in self-sufficiency among those served

CHP Advisory Council

• OHA has finalized member selections for the Coordinated Health Partnerships (CHP) Advisory Councilo Jerome Brooks, Oregon Opportunity Networko Ryan Fisher, Northwest Public Affairso Karen Gaffney, Lane County Health and Human Serviceso David Geels, Coos Health & Wellnesso Chris Hoy, Clackamas County Sheriff’s Office o Eric Hunter, CareOregon o Sean Kolmer, Oregon Association of Hospitals and Health Systems o Leslie Neugebauer, Central Oregon CCOo Rachel Post, Central City Concern o Paul Solomon, Sponsors, Inc. o Brandon Tupper, Klamath Tribal Health and Wellness Center o Mellani Calvin, A.S.S.I.S.T Program

CHP Advisory Council (cont.)

• CHP Advisory Council will be initially convened in November 2016

• CHP Advisory Council will provide an opportunity for public input and will be tasked with informing the final design and implementation work plan

• Additional opportunities for involvement: OHA is seeking interested stakeholders willing to provide rapid feedback through online surveys, phone calls, technical advisory groups and other similar activities

Questions

• More information on Oregon’s 1115 Waiver renewal or CHP Advisory Council: – https://

www.oregon.gov/oha/OHPB/Pages/health-reform/cms-waiver.aspx

https://www.oregon.gov/oha/OHPB/Pages/health-reform/cms-waiver.aspx




Health as Housing

Government & Nonprofit

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