April 28, 2017

To cut the cost of 'super users,' one hospital tries fighting homelessness

Daily Briefing

    The University of Illinois Hospital & Health Sciences System (UI Health) has cut annual costs for caring for certain so-called health care "super-users" through a population health initiative to by combat homelessness, AHA News reports.

    Focus on super-users

    Super-users are patients who visit the hospital and ED frequently. They tend to be uninsured or enrolled in Medicare or Medicaid. Super-users account for just 5 percent of the U.S. population, but 50 percent of health care spending.

    UI Health turns attention to homeless population

    Avijit Ghosh, CEO of University of Illinois Hospital and Clinics at UI Health, said super-users' health care costs were between five and 15 times more than average patients' health care costs. Hospital executives, according to AHA News, realized that most of the hospital's super-users were chronically homeless, who would visit the hospital not just for medical treatment but also to get food and shelter.

    "If you do not have housing, you do not have the kind of stability that allows you to achieve better health," Gosh said, adding, "We thought we should do something about it."

    To address the issue, UI Health in 2015 launched a pilot program, called the Better Health Through Housing initiative. Under the initiative, the hospital committed to providing $250,000 to get 27 homeless patients into furnished apartments and enrolled in support services. UI Health through the program pays $1,000 per patient each month to Chicago's Center for Housing & Health, which places patients in temporary units until permanent apartments are arranged. The costs are lower than the nearly $3,000 per day the hospital typically spent on caring for such patients, according to Ghosh.

    And early results suggest the initiative is working, AHA News reports.

    The number of monthly hospital visits among participants in the program has declined by 35 percent, and the annual cost of caring for such patients dropped by more than 40 percent, AHA News reports.

    Hospitals' role in population health management

    Community health advocates say the Better Health Through Housing program shows the important role hospitals and health systems can play in helping to manage population health.

    Barbara Otto, CEO of Health and Disability Advocates, said, "As payers move to value-based models, hospitals like UI-Hospital that take on these social determinants are uniquely positioned to succeed in serving mission and improving their bottom line."

    Peter Toepfer, associate vice president of housing at Chicago's Center for Housing & Health, said hospitals and health systems should view chronic homelessness the same way they do chronic illness, adding, "The best prescription you can write for a homeless patient is permanent supportive housing."

    However, Ghosh said more payment reforms are needed to encourage hospitals and health systems to participate in initiatives like the Better Health Through Housing program. "The payment system still does not incentivize you to do these types of things," he said, adding, "We have been talking about population health and we are slowly moving towards it, but we need more of a transformation in the payment system."

    In addition, Ghosh said he would like to form a collaborative group of community groups, health care providers and insurers, philanthropic groups, and public agencies to work on comprehensive policies aimed at ending homelessness. "It needs to be the next step," he said, adding, "There is only so much any hospital can do on its own" (AHA News, 4/25).

    Create a super-utilizer program

    Create a super-utilizer program

    Every population health manager develops a strategy to manage high-risk, high-cost patients. Many of these super-utilizer programs start small, but as they expand, leaders take the opportunity to re-evaluate program design—from appropriate patient recruitment through graduation.

    This guide offers a blueprint for implementing a super-utilizer program and measuring success across six steps.

    Download the briefing

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