Putting ‘Housing is Health Care’ into Action to Help End Chronic Homelessness

As a primary care physician who has worked with people experiencing homelessness in San Francisco for more than 25 years, I know firsthand how important housing is to health. Without housing, nothing I have in my black bag can substantially improve the health of my patients.

But affordable housing is in short supply across the country, leaving people with the most fragile health unable to properly address their treatment needs even while continuing to seek costly emergency care. To improve outcomes for their patients, the health care system in a growing number of communities is coming to the table to help address housing needs. In order to encourage other communities across the country to think creatively about engaging their health care system around housing, my colleagues and I found nine communities whose innovations we thought were worth sharing. We profile these successes in a recent report Innovative Models in Health and Housing, produced by the Low Income Investment Fund and Mercy Housing, with support from the Kresge Foundation and the California Endowment. 

These nine initiatives—in Portland, OR, Phoenix, AZ, Stygler Village, OH, Hennepin County, MN, and Salinas, San Mateo, San Francisco, Los Angeles, and the State of California—are characterized by strict fiscal controls and highly replicable innovations in the health care delivery system. While each case has unique qualities, the initiatives utilize these three main investment strategies:

  1. Use of shared savings, reserves, or increased financial flexibility within a capitated health care delivery system (either a Managed Care or Accountable Care Organization) in partnership with a local housing authority

  2. Use of a hospital community benefits obligation

  3. Local or state investment built upon resources from an expanding health care sector

In the Twin Cities in Minnesota, for example, coordination across government agencies and the health care system has created efficiencies that improve care. The state approved funding for housing for adults with disabilities experiencing homelessness and expanded a low-interest loan fund to provide equity for developers to build new affordable housing units. The behavioral health system facilitates intensive services on-site for people with mental illness. And Hennepin Health hired housing navigators to help adults experiencing homelessness find the type of housing that is the best fit for their condition. The result has been reduced emergency room visits and improved health outcomes.

Another example comes from Los Angeles, where the Los Angeles County Department of Health Services decided to fund a county-wide housing system that will help build 10,000 new homes with supportive services in the coming years. And up the road in Northern California, the Health Plan of San Mateo, a nonprofit managed care organization, successfully moved 124 people from nursing homes to housing with supportive services, by removing inefficiencies in the health care and housing systems that created barriers to autonomy for low-income Medicare and Medicaid recipients. In the six months following the move, the health care costs of these 124 people were 50% lower--saving the health plan $2 million—while improving their quality of life.

Just a few weeks ago, the FDA approved an exciting new treatment for a rare form of leukemia. As we revel in the new opportunities for treatment that come from our advances in science and technology, let’s not lose track of those who need access to basic needs in order to make progress in their illnesses. These nine communities show us that treating housing as a core element of treatment plans not only works to improve health and the quality of care, but that it can also save money. That seems like something we should all be able to get behind.  

Dr. Bamberger is also Chief Medical Consultant for Mercy Housing. For further information or for re-prints of the Innovations in Health and Housing paper, please contact Dr. Bamberger at joshdbamberger@gmail.com.

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