One of the biggest drivers in hospital spending is the rising number of “superusers,” patients who visit the emergency room or are admitted to a general acute care hospital several times a year.
But an Illinois hospital noticed that many of its most frequent users were chronically homeless patients, who didn’t always come for medical care. In many cases they just needed a warm place to stay on a cold night.
To better help care for these patients—and cut costs—the University of Illinois Hospital (UI-Hospital) and Health Sciences System launched a housing initiative in 2015 to provide furnished apartments and support services for homeless patients.
Prior to the program, seven of the top 10 users of the organization’s ER were chronically homeless and accessed the system between 30 and 120 times a year. The organization’s $250,000 investment in the program has led to impressive results, reported AHA News. So far, the monthly hospital visits have declined by 35% and the annual cost of care for these patients dropped more than 40%.
In addition to housing, patients are assigned a case manager who coordinates their care and helps them manage money.
“We see funding housing as a way of improving health," Avijit Ghosh, M.D., CEO of the UI Health Hospital & Clinics, said on the hospital website. "Actions like this are important to address the problems facing our community. By helping those who rely on UI Health, we're improving the health of both the individuals and our community overall."
Peter Toepfer, associate vice president of housing for the Center for Housing and Health in Chicago, which partners with the hospital, told AHA News that hospitals and health systems must view patients who are chronically homeless the same way they consider chronic illnesses. The best prescription, he said, is providing a homeless patient with permanent supportive housing.
Suffering significant health problems, the woman was in and out of hospitals constantly. She did not take prescribed medications because they made her groggy — an unsafe condition for a woman living on the streets.
“And, of course, within a week or two her medical condition would deteriorate again,” says Shannon Nazworth, executive director of Ability Housing, a nonprofit organization serving northeast and central Florida. “She was just cycling in and out of the hospital, not because anybody was not giving her good care or did not care about her, but because the system was broken.”
In the two years before the woman was placed in an apartment, three hospitals spent more than $750,000 on her care.
“In the year after she moved in, she went to the hospital once for a couple of days,” Nazworth says. “The other factors that were affecting her health were addressed by just getting her housing. She needed a place to sleep at night, a place to store her medicine and the security of a door to lock.”
Patients like this woman exist throughout health care, but, traditionally, most health systems have not seen a way to address homelessness and other social factors that exacerbate individuals’ health problems. That is changing as health systems pivot to population health management and new payment systems that reward them for proactively improving patients’ health status.
“Whatever has been done in the past has not been working, and we have to really think very differently,” says David Perlstein, M.D., president and CEO of SBH Health System in the New York City borough of the Bronx.
In his case, that means proactively reducing inpatient capacity, selling part of the SBH campus to a developer to build low-income housing and opening an urgent care center and other outpatient facilities in the new development. In other places, provider organizations are donating cash. For example, five hospitals and a nonprofit health plan in Portland, Ore., are donating $21.5 million to help build nearly 400 housing units for homeless and low-income people. Still other health care organizations are building apartments that they own and operate themselves, and some are paying the rent for homeless people to have a place to live.
Solutions such as this stem from innovators who think out of the box, merging hospital care with public health issues and other socially demanding problems.
What would work in your community ?
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