1. A View From the Ground Better Care at Lower Cost for High Risk Patients

2. LifeLong Medical Care Gray Panther founded FQHC in Berkeley/Oakland/Richmond, California 12 licensed sites, 40,000 patients Emphasis on developing models of care to serve elderly, disabled, homeless and complex patients Supportive Housing Provider Integrated primary care/behavioral health

3. Life Expectancy USA 78 Japan 83 Mongolia 67 Ethiopia 53 USA Homeless 46

4. Health Issues Faced by Homeless Patients Homelessness Serious mental illness Drug and/or alcohol addiction Trauma – adverse childhood events and as homeless adults Advanced chronic disease Poor nutritional status Lack of income – while Affordable Care Act will insure MediCal coverage for most homeless lack of income will still be a significant issue

5. Service Models That Work Data to identify which patients require intensive services and to track outcomes Integrated team approach Intensity of services determined by need High frequency of interaction Strong linkages to community-based services, especially access to housing Low Caseloads Highly individualized/relationship based Close communication with partners (primary care, behavioral health, benefits advocates, ED, discharge planners)

6. So What Does a Health Home for the Homeless Look Like? Care model and payment systems that support intensive services Flexible service models – who provides care (non-licensed staff can be highly effective) – where the care is provided (office, home, streets) – what “care” is (medical and social case management, flexible funds for transportation, basic needs) Marriage of medical and social services models to provide responsive care coordination Fast access to supportive housing and other housing resources Linkages to benefits

7. Change is Possible CA Frequent User 2 Year Results for Medicaid Population *Indicates statistically significant

8. Policy Issues Payments for medical providers to support very intensive medical and psychosocial services and that potentially reward for reducing overall cost to the system Managed care plans must develop appropriate care and reimbursement models, link community based services Case management as a recognized “medical” service Eliminate barriers to qualify for SSI/Medicaid Housing subsidies as cost effective health benefit Discharge policies and funding for medical respite to insure that patients don’t get discharged to homelessness Community Health Centers as key providers for this high risk, high cost population