Homeless service providers and Medicaid agencies share a common goal — to provide services for the most vulnerable individuals in their communities. Many of these homeless individuals are known as super-utilizers because of their frequent use of emergency medical services and their subsequent related costs. Though both Medicaid agencies and homeless service providers frequently serve these same individuals, traditionally there has not been a lot of collaboration between them. Consequently in an effort to help leaders of both sides reach out and work together, the US Department of Health and Human Services Office of Disability, Aging, and Long-Term Care Policy published the following guide, “A Primer on Using Medicaid for People Experiencing Chronic Homelessness and Tenants in Permanent Supportive Housing.” A similar guide by the National Association for Ending Homelessness was also released to state Medicaid agencies entitled, “Using Medicaid to Pay for Services in Permanent Housing: Steps for COC Leads to Get Started.”  The goal of both guides is to encourage the collaboration between homeless service providers and Medicaid agencies.

So why the push? In a nutshell, housing improves health outcomes for individuals, enhances their care experience and saves money for payers; i.e., the Triple Aim of healthcare improvement.

Achieving the Triple AIM

As a consequence of today’s segregated model of healthcare and human service delivery, no one provider is responsible for all three aspects of the triple aim. A large percentage of Medicaid beneficiaries are super utilizers with multiple chronic health conditions. This is costly for all. But when housing/homelessness providers partner with Medicaid agencies to serve chronically homeless individuals, they are able to better coordinate preventative care, thus improving health outcomes and reducing costly emergency room visits and hospitalizations.

Sharing Data Plays a Leading Role in Achieving the Triple Aim

house-with-a-stethoscopeIn order to achieve the Triple Aim, HMIS providers and state Medicaid agencies need to share data to identify high cost Medicaid enrollees who are also experiencing homelessness. By aggregating data to show overlap in care and the costs of services, Care Coordination software enables HMIS and Medicaid providers to share data and identify high-cost individuals who are served by both providers. A great example of this type of collaboration is the state of Connecticut.

In 2011, Connecticut undertook a project to identify the highest cost Medicaid enrollees who were also experiencing homelessness. They used a quarterly data match between state HMIS and Medicaid to identify individuals who were eligible for a super-utilizer program. A collaborative group of regional shelters, outreach workers, and supportive-housing providers were then able to use this list to locate and place individuals into supportive housing. As a result, they identified more than 4,100 Medicaid enrollees who had experienced homelessness in the previous year with the top 10 percent accruing more than $28.5 million in annual Medicaid costs (averaging $68,000 per person). Connecticut used this and other data to secure additional state funding for supportive housing for these individuals.

Getting Started with Data Sharing: What Data Should I Share and how do I Share it?

Making decisions on which data to share can be confusing. Rather than collecting every piece of data available, it is important to think simple. Here are some elements to consider:

  • Identify why you are sharing data. What do you and your partner(s) need to get out of the shared effort?
  • Identify a timeframe. How many years of data you need?
  • Determine which data elements to share. Without sharing too much information, you will want to identify the key elements that you are looking for from each provider, such as services and cost.
  • Identify how to match records. You will have to decide what fields of data will be required to match records. Typically this includes, at a minimum: last name, first name and middle initial; date of birth; and gender. Social Security Numbers (SSN) can be included as well but is not critical and exposes the organization to risk. There are also ways to create anonymous identifiers based on identifying information in order to share across systems.
  • Decide how to share the results. Typically a meeting or series of meetings will be required to review the results and decide if more analysis is necessary.

Conclusion

In order to improve the patient experience and reduce costs for Medicaid agencies and homeless service providers, both providers must work together to identify high-risk individuals experiencing homeless who are also Medicaid enrollees. Although these individuals represent a small percentage of the total Medicaid-eligible population, a large percentage of them are super-utilizers with multiple chronic illnesses and complex care needs. When Medicaid agencies and homeless service providers collaborate to share data, they are able to identify these super utilizers and create care plans that focus on keeping these individuals healthy through primary care, wrap-around social services and supports, and supportive housing.

To learn more

http://www.endhomelessness.org/page/-/files/7-22-2016%20Using%20Medicaid%20in%20PSH%20-%20Guide%20for%20CoCs.pdf

https://aspe.hhs.gov/sites/default/files/pdf/77121/PSHprimer.pdf

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