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

2. 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

3. 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.

4. 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

5. 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

6. 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

7. 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

8. 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.

9. 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.

10. 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

11. VP of Policy and Innovation
Questions?
Michael McKnight
VP of Policy and Innovation