Good Climate Policy Starts with Health Community Health & Equity Breakout April 28th, 2019

Healthy Homes Technical Study Overview The HHTS was a GHHI-led partnership investigating the impact of healthy housing across sectors. Cost-Benefit Cost-benefit analysis looking at medical claims, utility bills, as well as school and work attendance. Medical Claims Health outcomes from Medicaid administrative claims Evaluation Matched-comparison group

Intake and Assessment Services start with intake and assessment, where we start to build the relationship. Intake Coordinator Comprehensive intake assessment, Asthma pre-survey, Client consent, and Schedule initial home visit. Environmental Assessor Audit of home-based triggers, and Root cause structural deficiencies. Environmental Health Educator Conduct Asthma Self-Management Education (ASME); Conduct client health surveys and data collection; Distribute HEPA-Vacuum and indoor allergen reduction kit including mattress and pillow covers, Swiffer, et cetera; Referrals and follow-up client services; Review asthma action plan; Medication review and adherence; and Collects information on schools, other caregivers, et cetera.

Healthy Homes Services - Minor “Tier I” services are home-based education, supplies, and related items that do not require more substantial interventions. Home Visiting, Education, and Supplies: 3 home visits from Health Educators supervised by Certified Asthma Educator (education, behavioral reinforcement, follow-up with PCP and care managers); Additional Supplies to reduce asthma triggers; and 3, 6, 9 and 12 month health surveys including CACT/CASI in person t 3 months. Tier I Tier I Healthy Homes Services

Home Rehab – funded through energy efficiency and weatherization funds “Tier II” services are remediation services, ranging from basic mold work to structurally altering a home to address asthma causes and triggers. Generate Scope of work for comprehensive intervention including: Mold remediation: Including root-cause such as plumbing issues. Integrated pest management: Supplies, modification, and behavioral changes (ex. gel baits, glue traps, reducing entry points, cleaning). Venting: Rooms kitchen, bedrooms, bathroom, and dryer. Carpet: Remove, replace, or steam cleaning for allergens. Air filtering: System installed in child’s bedroom or primary residence. Air conditioners and dehumidifiers: Systems installed as needed. Structural repairs: Plumbing, patching, roofing, carpentry, and other. Leveraged funding: Braid other resources for lead-hazard control, weatherization, injury prevention, and more. Quality Assurance / Quality Control Assessment: Multi-party inspections and developing qualified vendor pools. Tier II Tier II Healthy Homes Rehabilitation

GHHI Maryland Asthma Interventions Program Cost Analysis GHHI Maryland Asthma Interventions Group Referrals Contacted Environmental Assessments Interventions Completed Overall 1330 362 270 Tier 1 700 144 Tier 2 630 218 126 Program Cost by Level of Intensity Group Cost/Person Number Served Total Cost Overall $2,718.77 270 $734,067.73 Tier 1 $661.52 144 $95,258.58 Tier 2 $5,088.55 126 $636,069.35

251 cases were matched to potential controls based on: Summary of Methods 251 cases were matched to potential controls based on: Contemporary asthma status per their Medicaid record (i.e., same annual pre-intervention year (baseline) period as cases), Sex (i.e., reported “male” or “female”), Age within 0.25 years, and Geography based on 5-digit resident zip code. Pre-intervention costs Each potential case was ultimately matched to its nearest-neighbor control in relation to baseline (the 12 months before the intervention) total Medicaid expenditures

Mean Difference and Percent Reduction of Key Outcomes GHHI Maryland HHTS Health Survey Results Mean Difference and Percent Reduction of Key Outcomes Results are based on self-report of caregivers in health survey.

Overall Medicaid Costs Group Baseline* Total Cost Follow Up** Total Cost Change (Total Cost) Baseline* Cost (Mean) Follow Up** Cost (Mean) Change (Mean) Baseline* Cost (Median) Follow Up** Cost (Median) Control $1,210,057 $995,435 -$214,622 $5,063 $4,165 -$898 $3,165 $1,927 Treatment (Overall) $1,935,183 $1,538,921 -$396,262 $8,097 $6,439 -$1,658 $3,776 $2,863 Tier 1 $1,001,088 $933,248 -$67,840 $7,821 $7,291 -$530 $3,856 $2,702 Tier 2 $934,065 $605,616 -$328,449 $8,415 $5,456 -$2,959 $3,747 $3,279 *Represents money spent in 12 months prior to intervention. **Represents money spent in 12 months post intervention completion.

Results: The Obianuka Family Pre-Intervention Situation: Homeowner family of five with a daughter who had severe asthma; average of 1 asthma related hospitalizations and 5 ED visits per year Conditions - Lack of kitchen and bathroom venting causing high moisture levels, mouse infestation and dust mites, chipping lead paint hazards; Lack of adequate heat due to needed furnace boiler replacement Costs: $16,035 – Asthma Specific Costs: $4,059 Partners: Baltimore City Community Development Block Grant, the Maryland Energy Administration, and the Weinberg Foundation Results & Outcomes: Allergens and lead and safety hazards remediated; Home weatherized and boiler replaced; Daughter was not hospitalized nor did she go to the emergency room due to asthma episodes in the 12 months post-intervention Asthma symptom free days changed from 0 per month to 29 days per month Annual energy cost savings of $407

VP of Policy and Innovation Questions? Michael McKnight VP of Policy and Innovation mmcknight@ghhi.org