Health is more than just a set of clinical metrics. Numerous studies highlight that health care and genetics contribute significantly less to one’s health and well-being than do individual behavior and social determinants of health (SDOH).
Social and economic factors are particularly critical to people’s health and well-being, but the current system by which health care and human services are delivered is fragmented and misaligned. By one measure, the United States has the lowest ratio of social service spending to health care among all Organisation for Economic Co-Operation and Development countries, and research shows that countries with lower ratios have worse health outcomes.
Individuals and families on Medicaid face an array of challenges that affect health outcomes and increase healthcare costs, and one of the most significant factors is the availability of stable, safe, and affordable housing. At UnitedHealthcare Community & State, we have developed a multipronged approach to expanding access to affordable housing and the support people need to stay housed.
Our approach entails partnering with existing community-based organizations and investing in them to support the scaling of established, evidence-based interventions. We believe that only through cross-sector partnerships can we connect people to needed social services and align public resources with those in greatest need. Highlighted here are two such efforts.
‘Just in Reach’
Last year, UnitedHealthcare, in collaboration with the Los Angeles County Office of Diversion and Reentry and Department of Health Services, the Conrad N. Hilton Foundation, the U.S. Department of Housing and Urban Development, and the California Board of State and Community Corrections, invested in a project, Just in Reach, that seeks to end chronic homelessness among people experiencing repeat jail stays.
Individuals struggling with homelessness and healthcare issues often find themselves cycling in and out of the criminal justice and emergency healthcare systems. This cycle is costly and leads to poor health outcomes, continued recidivism, and chronic homelessness.
The Just in Reach program is a health-based housing program designed to break the cycle of chronic recidivism. The program provides supportive housing to 300 homeless individuals who are currently in the custody of the Los Angeles County jail. In addition to housing support, participants receive connections to mental health care, substance-use treatment, and physical health services, along with intensive case management.
Using a Pay for Success approach, the county’s payment for services to participating community partners is tied to the achievement of agreed-upon outcomes in terms of housing stability and jail avoidance. The program is has housed more than 100 people since October 2017.
Next Steps to Align Health and Housing
The Corporation for Supportive Housing, the Council of Large Public Housing Authorities (CLPHA), and UnitedHealthcare Community & State, with support from the Robert Wood Johnson Foundation, are developing integrated interventions to effectively address the needs of individuals and families in publicly assisted housing.
Our organizations are developing data-driven population health initiatives that reflect the specific needs and dynamics of each community engaged with the partnership. These initiatives will leverage the capacity, resources, and expertise of CLPHA and its member housing authorities and of UnitedHealthcare’s Medicaid managed care plans.
In five communities—Columbus and Akron, Ohio; Houston and Austin, Texas; and Seattle/King County—efforts are underway to develop interventions to align health and housing resources at the person, program, and system levels. We anticipate that the local strategies developed through this effort will help scale the vision of addressing SDOH in communities nationwide.
Changing the System for the Better
Through these initiatives, we are integrating housing and health care. Indicators such as housing retention/stability, improved health care, and reduced system costs will be measured to show that we are improving people’s health and well-being.
Looking ahead, we are optimistic about the impacts we can have when we partner with housing agencies and other community stakeholders to improve the health outcomes of Medicaid managed care beneficiaries who are homeless, housing-insecure, or live in publicly assisted housing.