Health Care Study Explores the Impact of Housing on Health Care Use, Costs and Outcomes
A recent study of residents at The Apartments (at Bud Clark Commons indicates a direct relationship between stable housing and both the reduction in health care costs and in improved health care outcomes for Medicaid members. The study, conducted by the Center for Outcomes Research and Education (CORE) at Providence Portland Medical Center on behalf of Health Share of Oregon and Home Forward, found that health care costs, including emergency room visits and hospitalizations, fell by over 50 percent in the first six months after a resident moved into stable housing, and continued to dip in the second and third years after moving in. Concurrently, residents reported significant reductions in unmet needs for physical and mental health care and better health overall.
The study, which was based on resident surveys and health care utilization data, included 99 of the 130 residents at The Apartments at Bud Clark Commons (BCC), a permanent supportive housing building in downtown Portland which serves residents who have been experiencing homelessness and complex health issues. Results showed that in the year before they moved into BCC, residents on Medicaid averaged total health care costs of $2,006 per month, or 4.4 times higher than the average adult Medicaid member. In the year after moving in, average costs were $899 per month, a 55 percent decline.
“The results of this study reinforce what we already know about what impacts an individual’s health outcomes,” noted Janet Meyer, chief executive officer of Health Share of Oregon. “You can’t begin to help someone get their chronic health conditions under control when they’re living in a doorway or under a bridge. Stable housing, along with other social determinants such as adequate food and transportation, is critical in improving outcomes by helping to manage chronic health conditions.”
The study indicates the average resident saw a reduction of over $13,000 in annual claims, which is an amount greater than the estimated $11,600 to house a resident at BCC. Additionally, the reduction in claims was maintained into and beyond the second year of their residency, suggesting that supportive housing has an ongoing impact on health care costs.
“The study certainly adds to evidence supporting a ‘housing first’ model,” said Bill Wright, associate director, Center for Outcomes Research & Education (CORE) at Providence Health & Services and principal investigator for the study. “We found that even when stable housing is not predicated on having already overcome addictions issues; it can produce dramatically better health care outcomes and reduced costs.”
Residents also reported significant declines in unmet health care needs, as well as improvements in their own physical and mental health after moving into BCC.
“The Apartments at Bud Clark Commons pair housing and health care to provide some of the most vulnerable residents in our community with a good place to call home. We’re very pleased that the research results demonstrate the value of this innovative model,” said Steve Rudman, executive director, Home Forward).
“This demonstrates that our investments in affordable housing and ending homelessness are key to reducing health care costs and improving health outcomes in our community. Housing is health care. We’re proud to partner in this work,” said Traci Manning, director, Portland Housing Bureau.
BCC is an innovative partnership among the Portland Housing Bureau, Home Forward, Transition Projects, Inc., and Multnomah County. The center provides vital resources, shelter and housing placement services to individuals and couples experiencing homelessness in Portland.
BCC apartment residents often have numerous health issues and complex psychosocial barriers that make them among the costliest patients to care for in the community. Coordinated care organizations such as Health Share are increasingly looking for new strategies to effectively care for these highly complex and costly patient populations.
“We’re looking forward to continuing our conversations with affordable housing stakeholders in the Tri-County area,” added Meyer. “Addressing the needs of these members, those who often receive the least benefit in terms of health outcomes, but who often use the greatest amount of health care resources, will be critical to the success of health care transformation.”
The Center for Outcomes Research and Education is a grant-funded health services research shop within Providence Portland Medical Center. CORE’s goal is to improve health care and health outcomes for vulnerable populations. To accomplish this, CORE staff field research, conduct program evaluations, and build data systems for health care transformation. They use longitudinal surveys, qualitative interviews, and claims data analysis, and most of their work is conducted with uninsured and Medicaid populations.
About Health Share of Oregon
Serving over 200,000 members in Clackamas, Multnomah and Washington Counties, Health Share of Oregon is Oregon’s largest coordinate care organization. Health Share is a unique community-wide partnership created to ensure quality, cost-effective physical, dental and mental health care for Oregon Health Plan members. With a network of over 18,000 providers, including over 900 dentists, Health Share provides an integrated community delivery system with the objective of achieving better care, better health and lower costs for the Medicaid population and for the region.
Health Share is a collaborative of 11 founding partners: Adventist Health, CareOregon, Central City Concern, Clackamas County, Kaiser Permanente, Legacy Health, Multnomah County, Oregon Health & Science University, Providence Health & Services, Tuality Health Alliance and Washington County.
About Home Forward
As the largest provider of affordable housing in Oregon, Home Forward (formerly known as the Housing Authority of Portland) offers a variety of housing options to low-income individuals and families: more than 6,000 apartments to rent, including approximately 1,980 units of public housing, and approximately 9,390 Section 8 rent assistance vouchers. Housing is available to individuals, families, people with disabilities or special needs and seniors who meet each program's income guidelines. Home Forward is a public corporation serving all of Multnomah County, including the cities of Gresham, Fairview, Portland, and Troutdale, and other East County communities.
About Portland Housing Bureau
Portland Housing Bureau (PHB) focuses community resources on solving the unmet housing needs of the people of Portland by building and preserving affordable housing; supporting programs that help low-income Portlanders find, rent, buy, retain and repair their homes; bringing together and leading our partners as we assess housing needs, choose efficient solutions and identify funding; and reaching out to racially and culturally diverse groups to ensure their participation in the economic opportunities that our housing investments create.