Before the start of the pandemic, nearly 570,000 Americans were homeless. And now, as unemployment rolls mount and moratoriums against evictions and foreclosures expire, an additional 30 to 40 million people could be at risk of homelessness in the coming months (see The COVID-19 Eviction Crisis: an Estimated 30-40 Million People in America Are at Risk). Even before the pandemic, leaders in the health care field had started to acknowledge that housing insecure consumers are consumers who use more health care resources (for our previous coverage of the housing/health care expense link, see The Blending & Braiding Of Housing & Health Care Funding and No Housing, No Health: Why Payers Are Shifting The Paradigm).
But the big question remains—what to do about it? How do health plans approach the issue of caring for housing insecure members? That was the focus of the keynote session, Housing Is Health Care: A Post-Pandemic Look At Integrating Social Determinants Of Health, by Andy McMahon, Vice President, Health & Human Services Policy, UnitedHealthcare Community & State, at The 2020 OPEN MINDS Management Best Practices Institute.
What I was pleased to hear is a concrete plan—described by Mr. McMahon as the “five levers”—to address the issue of housing among their members. The five levers? Data, policy/system reforms, investments, partnerships, and new clinical models. In each of these areas, Mr. McMahon gave an overview of the many UnitedHealthcare initiatives in each area but a few stood out to me:
- Data: Using data to track consumers and intervention outcomes—and integrating data to increase systemwide collaboration.
- Policy/system reforms: Advocating for changes in Medicaid 1115A waivers to pay for tenancy supports and aligning HUD vouchers to connect with health care.
- Investments: Making investments to spur affordable housing development with Stewards for Affordable Housing for the Future, pay-for-success initiatives, and low interest loans for safety net services.
- Partnerships: Participating in multi-system partnerships to increase Medicaid supports for housing-related services and developing value-based purchasing contracts that embrace these concepts.
- New clinical models: Delivering intensive wraparound care onsite through the “housing + health” clinical care model with end care management, patient-centered health coaching and goal planning, addiction recovery support, employment navigation, and non-emergency transportation assistance—transitioning medically stable and financially self-sufficient members to market-rate housing with ongoing support.
So what are the opportunities for provider organizations in this national initiative by one of the largest health insurers?
Funding streams: Provider organizations should check if payers have special funding streams to support new or expanded health care and social service programs. For example, UnitedHealthcare has a “plan-agnostic” $150 million social impact investment fund which provides low-interest “catalytic capital” for housing and health care projects that connect more consumers to holistic services and supports.
Onsite and hybrid care models: Provider organizations that can offer face-to-face and hybrid services will be in demand, even as virtual care gains increasing traction across the board. “Many homeless people with serious mental illness don’t just have an iPad and even if they can access the technology, the remote communication may be troubling for them. You need to have case managers present with these consumers to support them in person, even if they are visiting with their clinical professional virtually,” explained Mr. McMahon. Provider organizations that can provide onsite face-to-face services at housing project sites will also have new contract opportunities.
Medical respite programs: For provider organizations offering residential services, respite care for the homeless population may present a new service line opportunity. The need for respite care has been exacerbated by the pandemic and payers are looking for care and support options for homeless consumers “who are not sick enough to stay in hospital but not well enough to go to back to the streets or a shelter,” said Mr. McMahon.
Holistic health and social services: From tenancy supports to transportation, a spectrum of services is needed to care for the homeless population and Mr. McMahon advised provider organizations to “strive for end-to-end care management.” Payers are seeking provider organizations that are willing to partner across continuums of care and collaborate with other provider organizations (to offer primary care and behavioral health services), public housing authorities, health plans, state housing finance agencies, transportation sources, etc. to build holistic support frameworks for the homeless population. “With value-based payment contracts and alternative payment models, we are looking for other ways to pay for these things provider organizations are doing to help consumers,” said Mr. McMahon.
What is Mr. McMahon’s advice for provider organizations seeking new opportunities in the housing market? “Come knock on the door and ask us how you can partner,” he suggested. Do your research and focus your outreach efforts on specific functions and/or departments of the payer organization such as population heath management, community partnerships, and complex care coordination. He cautioned that provider organizations need to come to the table with data on program efficacy and how they will affect outcomes and expenses. “The worst thing for an MCO to hear is that we spent all this money and nothing happened,” said Mr. McMahon. At the end of the day, payers are looking for partners who will help them understand the “shared population,” build relationships, and work across the continuums of care.
For more building ‘whole person’ partnerships with health plans, check out these resources from The OPEN MINDS Industry Library:
- Think Like A Health Plan
- Building Successful Partnerships With Health Plans: An Insider’s Guide To Payer Relationships
- What Health Plans Are Looking For? Hint: It’s Not A Bigger Provider Network
- Payer, Provider, Partner
- Which Payer/Provider Organization Partnerships Are Working & Why?
- Addressing Social Determinants Of Health Via Medicaid Managed Care Contracts & Section 1115 Demonstrations
- Key To Community-Based Success—‘Partnerships, Partnerships, Partnerships’
- 2019 Trends In Behavioral Health: A Population Health Manager’s Reference Guide On The U.S. Behavioral Health Financing & Delivery System, 2nd Edition
- Five Keys To ‘Partnering’ With Health Plans On Social Determinants
- The Future Of Health Plan/Provider Organization Business Relationships
And for even more, register for the virtual OPEN MINDS Health Plan Partnership Summit: A Guide To Developing & Negotiating Partnership Agreements With Health Plans on October 29, during our Executive Leadership Retreat.