The issue of homelessness is gaining prominence in our national dialogue, with the White House reporting that more than 500,000 people are currently experiencing homelessness in America. Its effects are felt by all—in addition to the devastating impact it has on those directly experiencing it, communities expend significant resources working to combat it.
For instance, when compared to the general population, those who experience homelessness are three times more likely to go to the emergency room at least once a year. The emergency room is typically the only choice many homeless patients have for healthcare. In addition, many will go just to guarantee a bed and a meal, knowing that nearly all emergency rooms receive federal funds and cannot turn patients away.
Emergency room care is vastly more expensive than other care settings. Unwarranted ER visits can cost upwards of $32 billion a year nationally. Considering the cost, is the best course of action to pay for emergency care for the homeless when a root cause for care needs—lack of housing—remains unaddressed? UnitedHealth executive Jeffrey Brenner recognizes that addressing circumstances significantly impacting health status, such as housing, can do wonders in decreasing emergency room usage. He believes insurers have a role to play in addressing this, so he created MyConnections.
MyConnections is UnitedHealth’s program seeking to expand access to social needs for homeless, high-need patients. Unlike many social assistance programs, Brenner follows the “Housing First” methodology. Housing First recognizes that the first step in being able to adhere to a medical plan—such as addiction recovery treatment—is having stable housing. The pilot of the program, located in a low-income neighborhood of Phoenix, provides an average of 60 formerly homeless Medicaid patients with apartments, specifically targeting those with medical expenses exceeding $50,000 a year (with most of that coming from ER and inpatient visits).
The cost of care for patients experiencing homelessness is paid by Medicaid or absorbed by public hospitals, with most states contracting with UnitedHealth and its competitors to help serve vulnerable populations. In this case, Medicaid does not pay UnitedHealth to run the program; UnitedHealth simply recognizes it can save costs by rethinking how it addresses the needs of a population it’s already serving. UnitedHealth spends between $1200-$1800 a month on each MyConnections member for housing and health coaching. United needs to save at least that much to break even on the program; reaching that threshold is what determined the $50,000 a year cost point for enrollees.
And those savings are actually seen. In one example Brenner gave to Bloomberg News, he highlighted one patient who, before joining the program, had medical expenses averaging almost $13,000 a month. In less than a year, his monthly medical expenses were just barely over $2000.
The business of social determinants
The issue of ERs being overutilized by people experiencing homelessness is one example of how our healthcare system is not equipped to address the social needs of patients. More and more resources are funneled into the latest technology, and making hospitals as advanced as possible. Medicare and Medicaid reimburse for medical services, but do not reimburse for most forms of social determinant care. In this equation of improving the clinical side of care, the social determinants of health side—food, shelter, income, and other life conditions playing a role on one’s health status—is forgotten, even though modest social spending can create huge health care cost savings.
With the rising costs of healthcare a constant worry, there is pressure to cut costs at every turn. Instead of curbing costs by restricting care, MyConnections addresses the root cause of increasing costs. Other insurers would be smart to follow suit—allocating more money for social needs such as food, housing, transportation and employment opportunities does vastly more for lowering health costs than restricting care to only the few who can easily afford it. Instead of covering less and less, the program covers what is really needed to help improve patients’ health—and that includes a roof over one’s head.
Brenner’s program is a step in the right direction. When speaking to Bloomberg, Brenner announced that the program will be expanding further, to 30 different markets by 2020. This shows a potential shift in the ideology of US healthcare—larger health organizations are seeing the impact of addressing social determinants, and recognizing that taking tangible steps to address these determinants creates more aggregated savings than cost.