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Health Service Utilization and Costs at the Outset of a Permanent Supportive Housing Program

Abstract

Research Questions

How do permanent supportive housing (PSH) programs help health systems address the social determinants of health and generate potential cost-savings? What methods do PSH programs use for recruitment? What were the characteristics of the initial cohort of participants with regard to their demographics, service utilization, and health care costs generated in the year before program enrollment?

Overview

Homelessness is a pervasive public health problem in the United States—affecting more than half a million individuals on any given night. Recently, state Medicaid expansion and movement away from fee-for-service payment models have fostered an increased interest in supportive housing programs implemented by health plans, hospitals, and large health systems to address homelessness and high health care service utilization. In this report, the authors assess the baseline implementation of a permanent supportive housing (PSH) program administered by a large not-for-profit Medicaid and Medicare managed care plan in Southern California, describing program operations; participant demographic, clinical, health service utilization characteristics; and medical costs.

Methods

This effort drew from electronic medical records and programmatic data tracking systems. The program enrolled 164 adult health plan beneficiaries with self-reported homelessness and multimorbid medical or behavioral health conditions from April 2018 through October 2019. Program participants were predominantly male, middle-aged, and racially/ethnically diverse, with complex, multimorbid health conditions. The median number of past-year health conditions recorded was 17, generating an average health care expenditure of $70,447 per patient-year (i.e., year of patient enrollment). This compared with an average of three health conditions and an expenditure of $3,898 per patient-year for the typical managed care plan beneficiary. The most commonly reported health conditions among participants included type 2 diabetes, skin and bacterial infections, and septicemia. Baseline findings from this PSH program indicate its success in identifying and enrolling high-need individuals.

Key Findings

The managed care plan was successful in identifying and enrolling a cohort of high-need beneficiaries into its PSH program.

Recommendations

The data in the analysis demonstrate the complex physical and behavioral health needs of the population served by the PSH program, including high utilization of emergency. services and hospitalizations that resulted in significant health expenditures. The data also demonstrate the ability of the health care plan to efficiently identify patients who meet the criteria for significant health and housing needs and enroll them in a PSH program. Future efforts should examine whether and to what extent health care utilization and expenditures evolve in the 12 months subsequent to enrollment, relative to a comparable cohort of individuals who were not enrolled in a PSH program.