Housing Is Health Care: New York’s Medicaid Redesign Supportive Housing Initiative C S H E A S T E R N R E G I O N S U P P O R T I V E H O U S I N G C O N F E R E N C E 2 0 1 4

AGENDA Rethinking Care for Medicaid's Highest-Need, Highest-Cost Populations

• Coordinating care for the whole person

• Addressing the Social Determinants of Health

• Using State-only Medicaid dollars to fund supportive housing

• Targeting “high-cost” Medicaid members

• Demonstrating the cost-effectiveness of supportive housing

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MEDICAID EXPENDITURES

Approximately 5 percent of Medicaid beneficiaries drive up to 50 percent of total spending in states across the country.

• 80% of these high-cost beneficiaries have 3 or more chronic conditions.

• Majority of these patients receive fragmented and uncoordinated care often leading to unnecessary and costly hospitalizations and institutionalizations.

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PEOPLE WHO ARE HOMELESS HAVE WORSE HEALTH THAN PEOPLE WHO ARE NOT HOMELESS: • They often have multiple chronic medical problems and difficulty controlling

those medical problems when homeless.

• They have high levels of behavioral health problems including substance abuse and mental illness.

• The net sum of all of these factors is that people who are homeless have mortality rates more than 2 to 3 times higher than people who are not homeless.

• The homeless population is also aging, which is adding to their rates of morbidity and disability.

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“THE AMERICAN HEALTHCARE PARADOX”

• We spend more than any other Industrialized country on health, yet we rank among the lowest in many dimensions of health. • In other words, the reason why the richest country in the world doesn’t have the best health is because it takes more than health care to make a country healthy.

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MRT SUPPORTIVE HOUSING COMPONENTS

Capital

Rent

Support Services

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High-Cost Medicaid Members

Individuals transitioning out of nursing homes

Chronic Homeless with HIV/AIDS, Mental Health

and/or Substance Use Disorders

Chronically Addicted

Homeless or at risk of

homelessness

Developmentally Disabled

Seniors in Shelter or low-income seniors in the

community

Physically Disabled Homeless

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TRACKING AND EVALUATION

• All individuals will be tracked

• Analyze pre and post Medicaid spending

• Partnering with researchers

• Robust tracking and evaluation

• Short Term and Long Term Results

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“Though it's still early in the New York experiment's implementation process and we have yet to generate evidence that it will achieve its intended outcomes, we hope it may serve as a model for other states seeking to provide better, more cost-efficient care for Medicaid recipients who are homeless, unstably housed, or institutionalized.”

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New England Journal of Medicine entitled, "Housing as Health Care: New York's Boundary-Crossing Experiment,” authored by New York State Commissioner of Health Nirav R. Shah, Kelly M. Doran, and Elizabeth J. Misa

• Time and again, taking a narrow view of health care has proven ineffective in producing meaningful change.

• Health care outcomes are far better if people are housed. And it's a good investment because it saves money.

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New England Journal of Medicine entitled, "Housing as Health Care: New York's Boundary-Crossing Experiment,” authored by New York State Commissioner of Health Nirav R. Shah, Kelly M. Doran, and Elizabeth J. Misa

HOUSING IS HEALTH CARE: NEW YORK’S MEDICAID REDESIGN SUPPORTIVE HOUSING INITIATIVE

• To truly reform U.S. health care and lower costs, we suggest that it's time to broaden our thinking and spending to reach outside conventional health care silos.

• Social determinants of health should be central to mainstream discussions and funding decisions about health care.

• New York's plan to use Medicaid for supportive housing represents one such experiment that crosses traditional boundaries to improve care for high-need, high-cost Medicaid recipients.

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New England Journal of Medicine entitled, "Housing as Health Care: New York's Boundary-Crossing Experiment,” authored by New York State Commissioner of Health Nirav R. Shah, Kelly M. Doran, and Elizabeth J. Misa