Welcome and Introductions 1000 Homes Update Health Care’s Role in Ending Homelessness Local Health Partners Outlining next steps in your community AGENDA

INTRODUCING FACULTY Catherine Craig Health Integration, Common Ground National Programs Catherine has 13 years of experience in hospital- and community- based social work, mental health research, and systems improvement. Her role with the 100,000 Homes Campaign is to identify successful models that bring together health care, outreach and housing providers; pinpoint sustainable funding streams for services in housing; demonstrate the health impact of housing; and help communities to learn from each other’s successes.

Homelessness & Health SCOPE 405,000+ Americans live on the streets and in shelters each year Roughly 110,000 experience homelessness for >1yr: “chronic” 1 MORTALITY The most vulnerable of these individuals experience multiple chronic illnesses, substance abuse and/or a psychiatric disability HEALTHCARE SYSTEM 3% of Medicaid patients incur 31.7% of costs 2 2/3 of Medicaid patients with frequent admissions are homeless or unstably housed 3 Lack of connection to primary care

Better Care, Lower Cost PERMANENT SUPPORTIVE HOUSING LEADS TO… Reductions in Emergency Department & inpatient ~ 60% Increases in preventive care - CT: 71% decrease in inpatient care with increase in outpatient medical mental health and substance abuse care 5 - ME: 41% decrease in total mental health costs with 35% increase in outpatient mental health services 6 Healthcare savings range from US$1,130 to US$17,625 per member per year

Determinants of Health and Their Contribution to Premature Death Adapted from: McGinnis JM, Williams-Russo P, Knickman JR. (2002). The case for more active policy attention to health promotion. Health Affairs, 21(2): Proportional Contribution to Premature Death

Illness Burden N% Frostbite % HIV/AIDS4136.3% Kidney5738.7% Liver % ER 3X+ in 3 Months % Age 60 or older % Tri-Morbid % ER or Inpatient 3X or more in 1 year % Length of Homelessness Among Total: 4.74 years Among Vulnerable: 5.64 years 15,208 Surveys 6,579 Vulnerable Risk Qualifiers Among Vulnerable

Hospital Provider to patient: “Go home, take care of yourself, get lots of sleep, take your medications, make sure to stay dry GO SEE YOUR DOCTOR and come back and see me in a couple weeks…” Patient to discharge planner: “I don’t have a home, I’d love to take care of myself, but I can’t sleep all night went where I camp, my medications were just stolen, my sleeping bag is soaked and lost I DON’T HAVE A DOCTOR and I don’t have a phone or a way to get back up to the hospital…” Created by Nic Granum, Central City Concern Recuperative Care Program, 2010.

Housing is a Resource for Health & Health Care Permanent Supportive Housing helps to: Reduce health care costs Tenants engage in primary and outpatient care, avoiding high cost of hospital-based and long term care (emergency rooms, inpatient care & nursing homes) Promote healthy behaviors Tenants self-manage: eat better and more regularly, take medication, reduce risky behavior & are better able to keep appointments Support engagement in health care PSH service providers can coordinate with health care providers & assist tenants to understand the treatment plan

The Model & Health Care’s Role

THE HEALTH CARE LANDSCAPE Which local hospital is a natural partner? - Public hospital - Not-for-profit hospital Who are you not yet linked with? What about community health centers? - Health Care for the Homeless Clinics - Federally Qualified Health Centers (FQHCs)

HEALTH CARE REFORM: Health Centers Goal: Double health center volume by million  40 million people Community health centers are key community partners For service collaboration As venues of integrated care, “Health Home” Health Care of the Homeless as a unique resource Invests $11 billion over 5 years $9.5 billion for new locations and services $1.5 billion for capital

WHO WILL YOU TALK WITH NEXT? Who do you already have at the table? How can these messages strengthen their participation in your registry efforts? Who is your liaison at the local hospital? What messages have your State Medicaid office and local health care providers not heard yet about homelessness and housing?

Potential Next Steps Meet with local hospitals to: Inform hospital officials of the 1,000 Homes initiative and ask: - that the Vulnerability Index be administered in the emergency room during Registry Week - them to participate on the leadership team - compare costs to the hospitals of people who are now in permanent supportive housing v those who are not - create a specific housing initiative targeted to housing people identified as frequent users of the emergency room - identify opportunities for funding services through Medicaid

Nonprofit Hospitals Note: New IRS requirements to complete Community Needs Assessments How the 1,000 Homes Initiative can be a partner - Collaborate to complete community needs assessment (VI) - Ask for community benefit funds to pay for services in housing

HOUSING: Health Care Translation Advocacy Talking Points Medicaid helps end homelessness by providing access to primary care and coordinating key services PSH + Medicaid can be cost-effective for communities Housing and health supports can fit together to improve lives and make a stronger safety net

Action Steps Assign a health care “lead” in your organization or network Tell your story, share your vision – concrete, visible, and compelling Know your audience: Mainstream housing (for-profit developers, PHAs) Healthcare partners (local reform coalitions, nonprofit hospitals, clinics) Public agencies (health, housing, social services) Safety net advocates and providers Local and state legislators

LOCAL CAMPAIGN RESOURCES Campaign Endorsers in Healthcare National Association of Public Hospitals and Health Systems National Association of Community Health Centers National Healthcare for the Homeless Council National Alliance on Mental Illness To partner With a public hospital, community health clinic, or mental health resource in your community, contact Catherine Craig Health Integration Call Series – Join us June 21 at 2 ET