Kaiser Permanente last week revealed the first steps of its $200 million plan to reduce homelessness and increase affordable housing—the largest investment a private health care company has made to address the social determinants of health.
Why Kaiser is targeting homelessness
According to Bechara Couchair, Kaiser Permanente's Chief Community Health Officer, access to affordable housing goes "hand-in-hand" with health outcomes.
"[I]t's not fair to expect people to live healthy lives if they don't have stable housing," she said.
Research shows that chronic homelessness can lower life expectancy by 20 years, while access to stable housing reduces hospital stays by 29% and ED visits by 24%.
The challenge is especially acute in Oakland, home of Kaiser Permanente's headquarters, where homelessness has increased by 25% between 2015 and 2017 and the monthly rent for 1-bedroom apartments eclipses $2,000.
Where Kaiser is putting its money
To begin to tackle the problem, Kaiser Permanente last May announced it would invest $200 million into housing in Oakland. The goal was to improve patient health by addressing the "core issue ... which is the affordability of housing," according to Kaiser Permanente CEO Bernard Tyson.
Now, the first three targets of Kaiser's investments are coming into focus.
On Thursday, Tyson announced that Kaiser, in partnership with East Bay Asian Local Development Corporation, is currently renovating an apartment complex to house more than 500 homeless Oakland residents who are ages 50 and older and have one or more chronic health conditions. The initiative will also provide qualifying residents with social services and other supports, Tyson said.
The two other projects Tyson announced are joint efforts between Kaiser Permanente and Enterprise Community Partners. The organizations are preserving a 41-unit affordable housing complex in Oakland, and they're investing $100 million into a fund that will offer low-interest loans to preserve affordable housing for individuals in the eight states where Kaiser provides services, as well as the District of Columbia.
Kaiser Permanente has long believed in the importance of investing in the "total health" of its communities it serves by working "upstream" of the hospital, Tyson said. Now, the company is "backing [its] talk" with action, according to Tyson.
"Up close you start to see [homelessness] is a complicated problem, but a solvable one," Tyson said. "We believe that the notion or the idea that someone should have to go to bed with the streets of America as their home is unacceptable."
Tyson added that the projects also represent a crucial step toward establishing "an ecosystem" of similar supports throughout the health care system's service areas.
"We're going to learn additional things from this Oakland situation that will be applicable as a toolkit to other parts of the country," Tyson said (Truong, MedCityNews, 1/18; Modern Healthcare, 1/17).
Advisory Board's take
Tomi Ogundimu, Practice Manager, Population Health Advisor
Our research strongly supports Kaiser's emphasis on creating stable housing as a gateway to improving health outcomes, also known as the 'housing first' approach. Inadequate housing contributes to a range of clinical challenges, culminating in a total 26-36 years of reduced life expectancy for those experiencing homelessness compared to the general population.
“Housing instability also has clear economic implications for providers”
Housing instability also has clear economic implications for providers. Patients experiencing homelessness spend an average of four extra days in acute care settings, resulting in an average $2,400 in additional costs. And they also often have decreased access to primary care which often leads to inappropriate ED utilization—80% of ED visits by patients experiencing homelessness could be prevented with primary care treatments.
We've spoken with dozens of providers around the country who have begun to address this critical issue. Despite the many approaches they've taken and different communities that they work with, we found that several key best practices in common have allowed them to be successful. In particular, we found that the most successful programs:
- Start small. Many programs that may aim to make a big dent in the problem may not be equipped to scale appropriately, duplicating service offerings and coordination efforts. To avoid this trap, programs should carefully assess what is already offered in the community and pilot implementation in steps to surface early challenges.
- Select partners with clear goals. Creating successful partnerships in supportive housing requires extensive coordination. Therefore, it is essential to find partners with aligned missions, visions, and levels of investment. Programs can also consider having all partners invest resources in the partnership to promote buy-in and increase start-up capital.
- Be resourceful with services and funds. Programs often fall into the trap of providing services that are necessary but outside of their expertise. This can limit overall efficacy of the program. Therefore, programs must be intentional about what services are best owned or operated by them, and which could be better provided through a partner organization.
- Develop precise enrollment methods. Without a proper way to identify patients experiencing homelessness, these patients can remain 'invisible' to the organization. Therefore, the best programs are intentional about defining their target population (i.e., transitional, episodic, chronic homelessness) and using chart review and/or the EHR to flag patients at risk.
To learn far more about each of these imperatives, and to read case studies of programs that have been able to make a real impact on the issue, make sure to download our research report on How to Close the Housing Gap Through Strategic Partnerships.
Then be sure to join us for a webconference on January 31st at 3 pm ET when we'll be covering the disruptive forces that are reshaping care delivery and how population health leaders can best evolve their strategy to respond.
Learn more: How to close the housing gap through strategic partnerships
A growing trend among progressive provider organizations is connecting at-risk patients with housing and wraparound support. A successful housing program requires strong partnerships with community organizations in order to provide patients with the necessary physical infrastructure, clinical care, and social support.
Learn what roles provider organizations can take to support patients' housing needs, as well as how to operate a successful housing partnership program.