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About Street roots. (Portland, OR) 1998-current | View Entire Issue (July 19, 2013)
8 street roots July 19, 2013 Add it up Health Share looks at ways to merge health care and afforable housing BY AM A N D A WALDROUPE S T A F F W R IT E R here’s a lot of money — and lives — resting on Oregon’s grand experiment in restructuring health care through Medicaid. Portland metropolitan area’s largest coordinated care organization, Health Share of Oregon, like others across the state, have a mandate to serve more, serve better, and do so with less. With that on their plate, social-service agencies and advocates are hoping to compel Health Share’s board of directors to include in its programs and health services something that has rarely been part of conversations about health care: affordable housing Ed Blackburn, the executive director of the social-service agency Central City Concern, is spearheading the effort. He and other housing providers and advocates are making the case that a person’s housing status can drastically affect a person’s ability to lead and maintain a healthy life. “It’s not the job of jurisdictions to transform health care. It’s not the job of health care to end homelessness,” Blackburn says. “When there’s an intersection of common goals, they can be more successful by coordinating.” The opportunities go both ways. “I’m hopeful that health care becomes a more prominent element of housing,” says John Miller, executive director of the Oregon Opportunity Network, a coalition of affordable housing advocates, builders and managers. “There’s a lot more efficient ways we could be working together.” Coordinated care organizations, or CCOs, are the backbone of the state’s newly overhauled Medicaid delivery system under the Oregon Health Plan. Created by the Legislature in the 2011 session, CCOs are charged with coordinating and integrating the physical, mental and dental health of Oregon Health Plan patients. The coordinated model of care is meant to create a patient-focused system that efficiently provides more effective and streamlined health care, but also save money and stop Medicaid expenses from rising. Instead of a fee for service structure, CCOs will have to operate with a capped budget that they can control — provided they cut costs. Health Share of Oregon is one of the two CCOs serving the Portland metropolitan area, but it is by far the largest. It comprises a partnership among 11 health organizations — including Legacy, Kaiser and Providence hospitals, Central City Concern, and the health departments of Clackamas, Multnomah and Washington counties. Because of its mandate to cut costs, Health Share has prioritized a group of Medicaid patients known as “high utilizers,” including people who are homeless or impoverished, have chronic diseases such as diabetes that go unmanaged, who suffer from mental health or addictions issues, or have a high-risk pregnancy and pre-natal issues. While such patients represent only about 20 percent of the Medicaid population, they are most likely to delay primary care, not prevent their illnesses or conditions from worsening, use the emergency room as their primary source of medical care and only use it when circumstances are dire. “These populations are very expensive,” T Blackburn says. “If you could \' address their issues more ' ' effectively, you could save some money.” When Blackburn was asked to become a member of Health Share of Oregon’s board of directors, he knew from experience what was at stake. Central City Concern is one of Portland’s largest social-service agencies, and the organization’s reputation is built on the strength of its wraparound services for formerly homeless individuals: substance abuse treatment, peer counseling, case management, and its Old Town Clinic, which provides primary physical and mental health care time of day (or at all), eating regularly and to low-income people. other tasks regarded as routine become In 2005, Central City Concern began difficult. Health problems become partnering with area hospitals and created exacerbated and go untreated. its Recuperative Care Program, which Before CCOs were created, Oregon houses low-income and homeless individuals Health Plan providers were paid by a “fee- after they’ve been discharged from the for-service” billing system. There was little hospital. People in the program also incentive to emphasize preventive or continue receiving medical care and are coordinated care, and like the rest of the connected with services to help them stay health care industry, patient interaction was in housing. strictly medical. On average, the program saves “The way the system is set up is that the approximately $80,000 per year, per patient interaction is someone coming into their in reduced hospitalizations, emergency office,” Miller says. “They see the part of room visits, and medical costs. It’s a someone waiting in their waiting room or startling amount of money, and Blackburn office with a particular [medical] need.” and others say the savings are due to one All CCOs in Oregon were granted a simple reason: ensuring those unhealthy waiver from the federal Medicare and homeless or low-income individuals are Medicaid stably housed. administrators that “For these allow them to use populations, housing their budgets more is critical,” Blackburn H ealth Share of © re f oa nimbly. This includes says. received a three-year^ $17,3 in some cases to pay Blackburn created for services or a workgroup made up » U llo a f rant from the of affordable housing aatloaal ©eater lo r Medicare equipment that improve a person’s providers and Health and M edicaid Imtowatlos health, but are not Share board (CMMI)r which loads projects medically related. members. The Gov. Kitzhaber has workgroup’s purpose d e s lf aed to provide more illustrated the was to show Health effective health care. situation with his oft- Share how integral Mpprorisaately $ 1 0 0 ,0 0 0 Is told air conditioner housing is to a b e la f ased lo r short-term story, that for want of person’s health and a $200 air conditioner create ways that real subsidies aad other a woman suffered Health Share could services that help people congestive heart work with housing rem ala stably boused, providers to create failure, a costly and dangerous condition. programs that help It’s not clear if people become healthy and remain short-term rent assistance would qualify under the waiver. housed. “There is a limit to what Medicaid can pay The workgroup met for nine months and for and what CCOs can do,” Blackburn says. presented information to Health Share’s But New York has received such an board of directors on June 19. In the coming exception. In 2012, the state received a months, the workgroup will develop a list of waiver from federal Medicaid and Medicare recommended programs and services that administrators that allowed the state to Health Share could then begin operating. direct $86 million of its Medicaid budget As Traci Manning, the director of directly toward funding supportive housing Portland’s Housing Bureau puts it, “If you’re programs. The state also applied for another homeless, getting health care is almost waiver that would generate $150 million impossible.” each year that would be used for expanding People with diabetes, for instance, need to refrigerate their insulin. That’s difficult, if the availability of supportive housing. “There is strong and growing evidence in not impossible, for homeless people to New York and around the country that a manage. Because of the stress, mobility and lack of any regularity in their daily lives, lack of stable housing results in unnecessary remembering and getting to medical Medicaid spending,” the state’s Medicaid appointments, taking medication at the right Redesign Team wrote in a report. Closer to home, Health Share of Oregon received a three-year, $17.3 million grant from the national Center for Medicare and Medicaid Innovation (CMMI), which funds projects designed to provide more effective health care. Approximately $100,000 is being used for short-term rent subsidies and other services that help people remain stably housed. Cindy Becker, director of Clackamas County’s Health, Housing and Human Services and a Health Share board member says that the increasing awareness Health Share has of the connections between a person’s housing and ability to be healthy is also an example of how Health Share is moving toward a model of healthcare that is not focused exclusively on medical care and doctor visits. “We’re still in that education period,” she says. “People are beginning to understand that your health is not determined by your visit to a doctor’s office, but also by whether you have a place to live? Do you have healthy behaviors? Are you isolated? Those things contribute more to your health than the time you spend in a doctor’s office.” Blackburn also points out that people with multiple health needs may have been seeing a doctor, but not all of their health problems were being addressed. He gives the example of someone who has anxiety and asthma. An anxiety attack can trigger asthma. If the person is receiving mental health treatment for anxiety, their therapist or doctor may not know they have asthma - a physical health condition — and may not think to ask. As part of the workgroup’s work, Health Share staff conducted a survey at three properties - the Martha Washington, Musolf Manor and the apartments above the Bud Clark Commons. Between January and March, 171 out of 332 tenants were interviewed. The survey identified tenants health conditions and illnesses, identified how many medications they took and what they are for, the last time they had seen a doctor, and how often they use the health care system. The survey also asked how their life generally had changed since moving into housing and specifically if their health had improved. Sandra Clark, a program manager with Health Share who worked directly with the affordable housing workgroup, says the data is still being analyzed. But she says she See HEALTH CARE page 9 M any thanks to all o f our volunteers who contribute their time and energy toward Street Roots! Inquire about volunteeringatwww.streetroots.org/volunteer.
